278 THE INDIAN MEDICAL GAZETTE [May, 1933

A CASE OF IMPACTED VESICAL CALCULUS

By W. H. CRICHTON MAJOR, I.M.S.

Agency Surgeon, Kurram and

TEK CHAND WASSON, l.m.p. (Agra) Civil Hospital, Parachinar

H. G., a Muslim, aged 40, was admitted to the Uivil

Hospital, Parachinar, on the afternoon of 14th Decem- ber, 1932, complaining of retention of urine. The history was that for some months previously he

had had some frequency of micturition with pain at the point of the penis on conclusion of the act; that latterly there had been some involuntary dribbling of urine; and that twenty-four hours before admission sudden and complete retention of urine had supervened. On palpation of the abdomen it was found that the

bladder was full and distended to a level three inches below the umbilicus in the middle line. On the presumption that such a sudden onset of

retention of urine in a man of his age was due to urethral

spasm or congestion, the patient was put under an

anaesthetic (A.C.E. mixture) and an effort was made to affect relief bj' means of a soft rubber catheter. But it was found impossible to pass this into the bladder and a metal one was next tried. This however also failed and a definite hard and unyielding obstruction to its

passage was made out high up in the posterior urethra. In view of the history of frequency, and pain at the

end of micturition and the obvious possibility of the retention being due to a stone, the attempt was not

pressed any further. As a measure of temporary relief the bladder was aspirated suprapubically and the patient prepared for operation on the following morning. A suprapubic cystotomy was performed through a

median vertical incision. As soon as the aperture in the bladder was large enough to admit a finger a stone was found which was firmly fixed in the prostatic urethra completely blocking the entrance from the bladder. It required considerable force to dislodge it. On delivery it was found to be a small uric acid

stone roughly pear-shaped in outline, flattened antero- posterior^ and showing a definite constriction or neck broadening out to a head beyond. Looking back on the symptoms displayed one could

now explain the frequency of, and pain on, micturition, as being due to the calculus acting as a foreign body in the bladder; this was followed by incontinence which presumably was due to the stone interfering with the action of the sphincter, after its impaction; and, later still, the sudden retention which was probably determined by a local chill or congestion. There can be little doubt that had this acute complication not supervened the stone would have gone on growing, partly in the bladder and partly in the urethra, and would ultimately have developed into a true

'

hour-glass' calculus. The patient made an uninterrupted recovery and was

discharged from the hospital on the seventh day after operation.