A large primary vaginal calculus in a woman with paraplegia

Vaginal Calculus Formation on Exposed Midurethral Sling Mesh

The presence of a vaginal calculus is a rare clinical entity which may develop in the setting of vaginal urinary stagnation. Numerous factors contribute to stone formation, and management can be complicated by variations in size, location of the stone, and location of adjacent structures. Generally, once diagnosed, vaginal calculi should be removed and surrounding anatomy should be evaluated thoroughly for secondary fistula, erosion, or presence of an instituting foreign body. This report presents a case of vaginal calculus formation on exposed midurethral sling mesh in an elderly patient with hemorrhagic cystitis. This report emphasizes contributing pathophysiology, diagnostic factors, and treatment.

Stone accumulation overlying vaginal mesh exposure: A case report

BACKGROUND

Vaginal stones are rare with current literature limited to case reports. Vaginal stones are classified as primary or secondary stones. Primary stones form in the vagina when there is urinary stasis. Secondary stones form in the presence of a vaginal foreign body that acts as a nidus for the deposition of urinary salts. Foreign bodies, such as surgical mesh, make vaginal stone formation more likely, particularly in patients with urinary incontinence and conditions that predispose them to urinary calculi formation.

CASE SUMMARY

A 71-year-old female with a history of sacrocolpopexy, hyperaldosteronism, and urgency urinary incontinence presented with vaginal stone accumulation overlying two areas of vaginal sacrocolpopexy mesh exposure. The vaginal stones were initially removed to permit examination, but the stones reaccumulated at the site of the exposed mesh, later requiring definitive surgical management.

CONCLUSION

Patients with vaginal mesh exposure and conditions that predispose them to kidney stones are not ideal candidates for expectant management of mesh exposure, particularly if they have coexisting urinary incontinence. These individuals should be counseled about possible vaginal stone accumulation, and surgical management should be considered.

Huge vaginal stone: Case report and review of the literature

Primary vaginal stones have been rarely reported; the reports that do exist are usually case reports. Because of their low incidence, they are often misdiagnosed. This case report and literature review of a primary vaginal stone presents an assessment of symptoms and common risk factors for vaginal stone formation. A 28-year-old woman with spastic quadriplegia who had been bedridden for most of her life presented to the emergency department for abdominal distension and fever. She had chronic constipation, recurrent urinary tract infections (UTIs), and vaginal discharge. Abdominopelvic computed tomography (CT) was performed and a large stone observed. The vaginal stone was completely removed through the vaginal stump after hysterectomy. Differential diagnoses of vesicovaginal fistula, urethrovaginal fistula, genital anomaly, and ectopic ureter were made by performing several tests using indigo-carmine dye. She recovered from surgery without any complications. There was no recurrence of vaginal stones after 3 months. A biochemical analysis reported that the vaginal stone was 100% struvite. Vaginal stones are caused by repeated infections in an environment in which urine collects gradually. Patients with recurrent UTIs who are bedridden should be able to prevent vaginal stones with periodic gynecological examinations for early diagnosis and management.

A case of transvaginal lithotripsy for a giant vaginal calculus

Introduction

Primary vaginal calculi are relatively rare, compared with secondary calculi. Primary calculi are often a result of urogenital sinus abnormalities, neurogenic bladder, or chronic incontinence.

Case presentation

Forty-seven years old female with cerebral palsy since infancy had longstanding urinary incontinence. She visited her doctor for a fever and was referred to us with a urinary tract infection. Imaging revealed a large vaginal calculus. It was not possible to remove the calculus vaginally without crushing it, so we performed rigid cystoscopy with lithotripsy, using a pneumatic lithotripsy device. The calculus was completely removed without complications.

Conclusion

We were able to remove a large primary vaginal calculus using ultrasonic and pneumatic lithotripsy through a rigid cystoscope. Minimally invasive surgery is a good option for patients with large vaginal calculi.

Giant vaginal stone as a complication of long-term urethrovaginal fistula: A case report

Case presentation

A case of a 57 years old woman came with the chief complaint of urinary incontinence since 20 years ago. After labor, she complained of urinary incontinence and left untreated. Physical examination and urethrocystoscopy revealed vaginal stone sized 90 × 70 mm and urethrovaginal fistula. We performed hysterectomy and vaginal stone removal, continued with fistula closure and vaginal repair. Up to 2 months follow up, no sign of urinary leakage and incontinence was found.

Conclusion

Vaginal stone is a rare Case that might be present in a case of long term urethrovaginal fistula with neglected contraceptive device.

Large primary vaginal stone in a woman with multiple sclerosis

Vaginal stones are rare and therefore a delay in accurate diagnosis often occurs. We present a 54-year old woman with multiple sclerosis who was diagnosed with a primary vaginal stone. Initially, she presented with recurring urinary tract infections (UTI) and macroscopic haematuria to the urologist. A cystoscopy showed no abnormalities. Because of persistent bleeding, she was referred to the gynaecologist, and on gynaecological examination, a vaginal stone was revealed. Stone formation was likely to be the result of urinary pooling due to incontinence, which was caused by a neurogenic bladder. Other contributing factors were prolonged recumbency, threads of an intrauterine device and a UTI. The presence of a vesicovaginal fistula was excluded by testing with methylene blue. The stone was surgically removed and composed of 70% struvite and 30% apatite. The patient was treated for decubitus ulcerations of the vaginal wall with estriol (Synapause-E3). Follow-up was uneventful.

Primary Vaginal Calculus in a Woman with Disability: Case Report and Literature Review

Background: Vaginal stones are rare and often unknown entities. Most urologists may never see a case in their careers.

Case Presentation: We present the case of a 34-year-old bedridden Caucasian woman with mental and physical disabilities who presented with a large primary vaginal calculus, which, surprisingly, had remained undiagnosed until the patient suffered a right renal colic caused by a ureteral stone. The vagina was completely filled and a digital examination was not possible. For this reason, the stone was removed using surgical pliers with some maneuvering. A vesicovaginal fistula was excluded, as well as foreign bodies or other nidi of infection. After, urethral lithotripsy was performed as planned. The postoperative course and follow-up were uneventful.

Conclusion: Although vaginal calculi are extremely rare in literature, their differential diagnosis should be considered in women with incontinence and associated disabilities, paraplegia, or prolonged immobilization in recumbent position.

Vaginal Urinary Calculi Formation Secondary to Vaginal Mesh Exposure with Urinary Incontinence

Background

Vaginal stones may form in the setting of mesh exposure with urinary incontinence. This report serves to help understand the presentation, evaluation, and management of vaginal urinary stones.

Case

A 68-year-old female presented with a vaginal calculus. She had a history of anterior and posterior polypropylene mesh placement for prolapse 7 years earlier and urinary incontinence. The stone was identified on a portion of exposed mesh and removed in office. Pathology confirmed urinary etiology. The exposed mesh resolved with topical estrogen. Cystourethroscopy excluded urinary fistula and bladder mesh erosion.

Conclusions

When identified, a vaginal calculus should be removed and evaluated for composition. Cystourethroscopy should be performed to assess potential urinary tract fistulas and mesh erosion. Additional imaging should be considered.

Large vaginal and bladder calculi in a woman with previous operation of bladder exstrophy: a case report

This is to report the case of a huge vaginal stone, and bladder calculi in a 26-year-old woman with previous operation of bladder exstrophy. It seems that the vaginal stone was secondary to the remaining wire used in her previous reconstructive surgery for pelvic closure 20 years ago and now surgery is performed to remove the vaginal and bladder stones.