A stone's throw from disaster: A rare case of a spontaneous urethral rupture complicating a prostatic abscess

Urethral injuries can be classified based on location as either anterior or posterior. Anterior urethral injuries are often as a result of blunt or penetrating trauma. On the other hand, posterior urethral injuries are most commonly as a result of pelvic fracture or iatrogenic trauma during pelvic surgeries. Spontaneous nontraumatic urethral rupture is an exceedingly rare and often severe condition, typically resulting from a combination of underlying pathologies such as urinary retention, prostatic abscess, or obstructive uropathies. Unlike traumatic ruptures, which are directly caused by external forces, spontaneous urethral rupture occurs without direct injury and is typically a consequence of increased intraurethral pressure, leading to rupture and urine extravasation into surrounding tissues. Computed tomography, especially with contrast enhancement and delayed-phase imaging, plays a pivotal role in the diagnosis of urethral rupture. It offers superior sensitivity for visualizing urine extravasation, identifying related urological pathologies, and assessing the extent of tissue involvement. Treatment of urethral rupture includes urinary diversion, antibiotics for infection control, and surgical repair. Stone removal is essential if an obstruction is present. Delayed urethral reconstruction follows after the acute phase. This case highlights the rarity and a complex scenario of a nontraumatic urethral rupture, which can occur as a result of a series of obstructive and infectious events. We describe a case of spontaneous nontraumatic urethral rupture in an 85-year-old male, induced by a prostatic abscess secondary to a chronic urinary retention due to a bulbar urethral stone, complicated by a penile urinoma.