Presentation
Spiky like pubic pain radiating to the penis, severe urinary frequency, urgency, hesitancy, and intermittent retention. Background of recurrent urinary tract infections.
Patient Data
![](https://prod-images-static.radiopaedia.org/images/66707793/downloaded_image20240712-969-zdmvp4_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/66707794/3cc67fc1378dd249d268edcdb5fbfdf4dc6f3c274381bb90414c13fb3ed451fc_thumb.jpeg)
![](https://prod-images-static.radiopaedia.org/images/66707793/downloaded_image20240712-969-zdmvp4_big_gallery.jpeg)
Transverse and longitudinal views of the urinary bladder and prostate.
Average size prostate with slightly increased urinary bladder wall thickness, suggestive of cystitis.
Repeat scanning post-void demonstrated minimal change in residual urine volume, and the patient stated micturition difficulty. Close interrogation of the prostatic urethra revealed a focal hyperechoic lesion with posterior acoustic shadows. On color Doppler, the lesion was associated with a twinkling artifact, suggesting urethral stone.
Case Discussion
Typical sonographic features of urinary tract calculi in grayscale are the same with hyperechoic solid objects and posterior acoustic shadows.
The presence of a twinkling artifact in color Doppler is suggestive of urethral calculus.
Also, attention to the patient complaints and insignificant change of post-void residual bladder volume are clues for the diagnosis.
Non-enhanced computed tomography is diagnostic. Cystoscopy is diagnostic and therapeutic.