Yes, kidney stones can become lodged in the penile urethra, though this is uncommon.
While kidney stones typically pass through the urethra during spontaneous passage, they can become impacted at various points along the penile urethra, particularly at anatomical narrowings such as the urethral meatus or in patients with pre-existing urethral strictures or diverticula. This represents a rare but well-documented complication of nephrolithiasis 1, 2, 3, 4.
Clinical Presentation and Risk Factors
Urethral stones are rarely primary formations—they typically originate from the kidney or bladder and migrate distally. When stones become impacted in the penile urethra, patients may present with:
- Acute urinary retention
- Visible or palpable stone at the urethral meatus
- Severe pain
- In rare cases, even penile erection due to obstruction 3
The condition is more likely in men with underlying urethral pathology such as strictures, infection, or anatomical variations 3, 4. One case report described a stone reaching 5 cm in length lodged in the penile urethra, requiring staged surgical intervention 2.
Diagnostic Approach
When a urethral stone is suspected:
- Point-of-care ultrasound of the penile shaft and glans can rapidly characterize the stone, rule out urethral diverticula, and assess whether bedside removal is feasible 1
- CT imaging may miss urethral stones if attention is focused only on the upper tracts—always evaluate the entire genitourinary tract on imaging, including the lower urethra 4
- Physical examination may reveal a palpable or visible stone at the meatus
Management
For stones visible or palpable at the urethral meatus, bedside extraction with intraurethral lidocaine gel and gentle traction is often successful without causing urethral injury 1.
For larger or more proximal urethral stones:
- Cystoscopy-assisted retrieval may be required
- Larger stones (>2 cm) may necessitate urethrolithotomy with staged reconstruction 2
- Initial bladder drainage via catheter or suprapubic tube may be needed for acute retention
Key Clinical Pitfall
The most important pitfall is failing to evaluate the lower urinary tract when interpreting imaging for renal colic. Even when CT demonstrates stones in the kidney or upper ureter, always assess the entire urethra, as missed urethral stones can lead to acute retention and renal failure 4. This is particularly critical in patients with known urethral pathology or those presenting with atypical symptoms.