From the Research
No, a 6.8 x 4.0 mm calculus in the proximal penile urethra should not be managed by cystolithotomy. The preferred approach would be urethroscopy with stone extraction or transurethral lithotripsy. Cystolithotomy is a surgical procedure for removing stones from the bladder, not the urethra. For urethral stones, minimally invasive endoscopic techniques are typically used first. The procedure involves inserting a urethroscope through the urethral opening and either extracting the stone with forceps or fragmenting it using laser or pneumatic lithotripsy. If these approaches fail, open urethrotomy might be considered, but cystolithotomy would be inappropriate as it addresses a different anatomical location. The management choice depends on stone size, location, and available equipment. For this specific stone in the penile urethra, endoscopic management offers the best balance of efficacy and minimal invasiveness, as supported by the principles outlined in studies such as 1, which although focused on bladder calculi, underscores the effectiveness of minimally invasive techniques in managing urinary tract stones. Key considerations include:
- Stone size and location
- Availability of equipment and expertise
- Patient's overall health and potential risks associated with different management options Given the small size of the calculus (6.8 x 4.0 mm), a minimally invasive approach is likely to be successful and should be attempted first, aligning with the trend towards less invasive procedures as seen in 2, 3, and 1.