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.