Perioperative nursing care of a patient with urogenital sinus malformation who underwent vaginal calculus removal and correction: a case report

Cases of urogenital sinus malformation with a huge calculus are complex and rare. Improper nursing care of these cases can lead to a series of problems. We report here a 23-year-old married woman who was admitted to hospital because of primary amenorrhea and failed sexual intercourse for 5 years. Through combined diagnosis and treatment of radiology, ultrasound, urology, gynecology, and other disciplines, the patient was diagnosed with urogenital sinus malformation, a vaginal calculus, and primary amenorrhea. After full preparation, the patient underwent an operation for extraction of the vaginal calculus, urethroplasty, vaginoplasty, and hysteroscopy. The calculus of the patient was removed and the vagina was returned to its normal anatomy. Patients with urogenital sinus malformation and a huge calculus have complex care requirements and experience a particular state of vulnerability during the diagnostic phase. By establishing good communication with patients and providing proper perioperative nursing, physiological and psychological rehabilitation of these patients can be achieved.

Vaginal stones caused by urethrovaginal fistula: A case report

RATIONALE

Vaginal stone is a rare condition that is often misdiagnosed due to its low incidence. It can be divided into 2 types, primary vaginal and secondary vaginal, based on the etiology of the disease. Vaginal stones involve pathologic calcification. The formation of vaginal stones is mainly due to stasis and urine infection. We describe a procedure for the safe extraction of vaginal stones.

PATIENT CONCERNS

We report a case of a 25-year-old female patient with congenital genitourinary malformation and urethrovaginal fistula. A urogenital tract malformation repair operation was performed before she was 21 years old. Frequency of urination occurred before and after menstruation for 9 years, and dyspareunia occurred for 1 year.

DIAGNOSES

B ultrasound examination showed a 59 × 55 × 23 mm fusiform region of increased signal intensity in the vagina followed by a sound shadow. We performed a gynecologic examination and found that the long diameter of the vaginal opening was 20 mm. A brown substance observed in her vagina had a hard texture and felt like a stone, and a palpation hand test revealed the size was approximately 60 × 50 mm. A cystoscope was inserted into the urethra and revealed that the broken end of the urethra was connected to the vagina. The proximal broken end of the urethra was 20 mm from the distal end.

INTERVENTIONS

The purpose of this operation was to make a definite diagnosis and remove the stones. We performed vaginal stone removal surgery and cystoscopy under anesthesia.

OUTCOMES

We removed the stone successfully. The patient was discharged from the hospital after a smooth recovery without any complications. Follow-up was conducted 1 month after the operation and then every 3 months.

LESSONS

Although vaginal stones are rare, we must pay attention to this disease, especially in patients with congenital genitourinary malformations and urethrovaginal or vesicovaginal fistulas. Obstruction of urine discharge combined with repeated urinary tract infection is the main cause of vaginal stone formation. For these patients, follow-up every 3 months, including a physical examination, B-mode ultrasonography of the urinary system and cystoscopy if necessary, can avoid the occurrence of the disease.

Migration of a fractured ring IUD resulting in vesicovaginal fistula and vaginal calculus

CASE

Although many complications have been reported with intrauterine contraceptive devices (IUDs), vesicovaginal fistula with secondary vaginal stones is rare. We report the case of a 46-year-old woman who presented with a vaginal discharge lasting 2 months. Two years previously, she had undergone cystoscopic lithotripsy and surgery to remove an IUD, after pelvic radiography had revealed a fractured Chinese stainless steel ring IUD with secondary vesical stones that had been the cause of her urinary tract symptoms. When she again complained of vaginal discharge, vaginal stones and a vesicovaginal fistula were found on physical examination and CT urography. The patient underwent stone removal and concurrent vesicovaginal fistula repair. IUD fragments were found in the vesicovaginal and rectovaginal spaces. No abnormalities were found at follow-up 6 months after surgery.

CONCLUSION

In any woman undergoing surgery to remove a migrated IUD, complete exposure and removal of the IUD are necessary to avoid fracturing of the IUD, secondary breakage and residue.

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.