Diagnostic challenges and surgical management of a presumed congenital anterior urethral diverticulum complicated by a calculus in a 10-year-old boy: a case report

Background Anterior urethral diverticulum is a rare cause of urinary obstruction in boys, and associated calculus formation is uncommon. Distinguishing congenital from acquired disease can be difficult, particularly when pediatric cystourethroscopy is unavailable. Case presentation A 10-year-old Somali boy presented in June 2025 with acute urinary retention, dysuria, and painful ventral penile swelling during micturition. Plain pelvic radiography showed a 10-mm radiopaque calculus in the bulbar–penoscrotal urethral region. Retrograde urethrography was interpreted as showing a communicating ventral anterior urethral diverticulum containing the calculus. No acquired cause was reported; however, the history did not establish whether symptoms were present from infancy, and prenatal history was unavailable. Congenital origin, therefore, remained presumptive. Cystourethroscopy was unavailable. The patient underwent open diverticulectomy, calculus extraction, and primary urethral reconstruction. The catheter was removed on postoperative day 10, and satisfactory voiding was observed before discharge. During monthly telephone follow-up for 1 year, the parent reported satisfactory urination without recurrent swelling, retention, leakage, or wound symptoms. No objective long-term follow-up assessment was performed. Conclusions Clinical findings and imaging supported a working diagnosis and guided surgical planning in this resource-limited setting. The reported symptomatic improvement does not confirm long-term urethral patency or freedom from recurrence without objective follow-up.