LAUSR

A 15yearold boy, a member of a dance troupe, presented to the outpatient clinic with a 4month history of dull scrotal pain and stress incontinence. He had complete bladder exstrophy epispadias complex identified at birth and underwent bladder reconstruction (modified Kelly procedure) at 6 months of age. At 17 months of age, neourethral reconstruction had been undertaken using flaps from pubic skin and he achieved urinary continence. Physical examination revealed multiple hard, gritty, mobile masses in the scrotal sac beside the right testis and an ultrasound examination showed multiple calcified masses in scrotum (scrotoliths) with indistinct localisation. Subsequent MRI scan showed calculi in the dilated bulbar part of neourethra (figure 1). On surgical exploration, pearly white calculi (0.5–2 cm) were removed from the urethra (urethroliths) and he regained continence. All calculi were covered and entangled by hair (figure 2). Calculi on analysis showed calcium oxalate, calcium phosphate and traces of uric acid and magnesium ammonium phosphate (struvite). Scrotal pearls and urethroliths are rarely reported in children and the aetiology is uncertain. 2 In our child, pubertal hair growth from the pubic skin flap used for urethral reconstruction might have acted as a nidus for stone formation. Urethroliths have not previously been reported in childhood and could have occurred here as an unexpected longterm consequence following urological surgery in a young child, potentially complicated by recurrent microtrauma during dance practice, inflaming the soft tissues and accelerating the deposition of minerals into the hair from the pubic skin flap.