Tricholithobezoar: An Unusual Late Complication of Neourethral Reconstruction in Aphallia
An 18-year-old man born with aphallia had undergone phallic reconstruction in childhood at the age of 13 years, which was followed by total urethral reconstruction with a buccal mucosal graft and groin-based pedicle (Singapore) flap. The patient had 5 years of regular follow-up after his urethral reconstruction. In the present case, he presented with a gradual onset of thinning of his urinary stream for 6 months followed by acute urinary retention. Examination revealed a firm swelling in the perineum over the reconstructed urethra. Urethral catheterization to relieve the acute retention was unsuccessful and hence an emergency suprapubic cystostomy was performed. The results of a voiding cystourethrogram revealed a filling defect in the distal urethra (). On urethroscopy, a solitary, smooth 3 cm×2 cm sized stone was seen in the dilated urethra (). Pneumatic lithotripsy was used initially to fragment the stone, but owing to its resistant nature (because of the presence of hair in the stone interstices) (), the stone could not be fragmented completely. A bulbar urethrotomy was therefore performed to remove the remaining bezoar (). Following removal of the tricholithobezoar, hair from the anterior urethra was mechanically epilated. The urethrotomy was closed primarily. The postoperative period was uneventful and patient could successful void with a peak flow rate of 16 mL/s.