Pictorial Urology

15Urology Journal    Vol 7    No 1    Winter 2010

Tricholithobezoar
An Unusual Long-term Complication of Hypospadias Surgery

A 16-year-old boy presented with gradually increasing painless swelling between the testes. He had 
undergone a 2-stage Denis-Browne repair of congenital proximal hypospadias, second stage performed at 
the age of 8 years. On examination, a hard lump was felt between the testes. Radiography of the pelvis 
showed a faint oval radiopaque shadow in the scrotal region. Cystoscopy revealed a small opening which 
led to a calculus covered with hair inside a urethral diverticulum near the penoscrotal junction. The 
patient underwent open surgical removal of the calculus, excision of the diverticulum, and repair of the 
urethra, all in the same session. Diverticulum with calculus formation is a known late complication after 
hypospadias repair. If the diverticulum develops in a hair-bearing skin, the stone might be “hairy. (1)” 
Open surgical removal of the tricholithobezoar followed by diverticulectomy is the treatment of 
choice.(2) This case report once again underscores the need for proper examination of a patient who has 
undergone hypospadias correction earlier. This particular finding is not unusual where patients with 
hypospadias may present for the first time in late childhood or even adolescence. Consequently, the 
surgical complications of hypospadias repair may manifest up to a later age.

Vishwajeet Singh, Krishna Murari Singh, Rahul Janak Sinha
KK Hospital and Research Center and Department of Urology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

E-mail: vishwajeeturo@sify.com

REFERENCES
1. Hayashi Y, Yasui T, Kojima Y, Maruyama T, Tozawa K, Kohri K. Management of urethral calculi associated with hairballs after 

urethroplasty for severe hypospadias. Int J Urol. 2007;14:161-3.

2. Ozgok Y, Seckin B, Demirci S, Harmankaya C, Erduran D, Sinav A. Surgical treatment of urethral diverticula in men. Scand J 
Urol Nephrol.1994;28:207-10.

Urol J. 2010;7:15. 
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