A stone down below: a urethral stone causing acute urinary retention and renal failure.

Impaction of a kidney stone in the male urethra is a rare sequela of an otherwise common disease process. Case reports of urethral stones in the recent literature are scarce. We report a case of a 48 year old man who presented with an impacted urethral stone as a complication of nephrolithiasis. The pathology was twice missed, even with computed tomography showing the stone in the prostatic urethra, which highlights the challenges of making this diagnosis. We review the existing literature outlining the pathogenesis, clinical features and therapeutic considerations as they relate to urethral stones. We underscore the role of the emergency physician in the diagnosis and initial management of this entity, and draw attention to the need to evaluate not just the upper but also the lower genitourinary tracts when interpreting computed tomographic images obtained for the diagnosis of renal colic.