Abstract
Posterior urethral valve (PUV) rarely causes adult lower urinary tract obstruction and is rarely linked to posterior urethral calculi. A 21-year-old male with 5-year history of (LUTS) had a 19 × 22 × 39 mm posterior urethral stone removed via open cystolithotomy (35 mm stone). Persistent poor flow led to RUG/MCUG showing urethral dilatation and cystoscopy confirming PUV, ablated with holmium laser. Post-ablation uroflowmetry improved markedly. Adult PUV with impacted calculus is extremely rare, mimicking isolated stone disease. High suspicion for PUV in young males with posterior calculi and post-removal LUTS is vital; cystoscopy and voiding studies ensure accurate diagnosis and management.