CHRONIC UTI SECONDARY TO NEUROGENIC BLADDER WITH CALCULI IN PROSTATIC URETHRA, BLADDER, URETER AND KIDNEY

38 year old male, a known case of high anorectal anomaly - undergone emergency colostomy at birth, followed by sacroabdomino perineal pull through surgery done at 5 years has rectal prolapse. He had history of catheterisation for acute urinary retention at 15 years of age because of urethral calculus which he passed spontaneously then. Now he presented to our hospital with obstructive voiding symptoms for 20 days duration. CE revealed midline abdominal laparotomy scar, rectal prolapse and lax sphincter tone. Renal function tests were normal. Xray KUB, USG KUB , CECT KUB revealed multiple right renal calculi, right giant lower ureteric calculus 13 cms in length, vesical calculus and prostatic urethral diverticular calculus. Metabolic work up for stone disease showed minimal increase in serum calcium with evidence of urinary infection and microscopic haematuria. Diagnostic Urethro Cystoscopy revealed soft membranous proximal bulbar stricture treated by OIU and prostatic urethral diverticulum calculus 4cms and vesical calculus of size 1 cm. Treated with right anatrophic nephrolithotomy, right ureter reimplantation after removing giant ureteric calculus, prostatic urethral calculus pushed in to bladder and lithotripsy done along with lithotripsy of prostatic urethral diverticular calculus.