A Large Primary Vaginal Calculus in a Woman With Paraplegia

Abstract

We postulate that the calculus formed as a consequence of urinary contamination of the vagina in association with incontinence and prolonged maintenance in a recumbent posture. This report is important because it highlights that, although vaginal stones are very rare, their possibility should be considered in the differential diagnosis of individuals with long-term paraplegia.

Vaginal stone formation around intrauterine device in an ambulatory woman with morbid obesity

“…The physiologic vagina is not conducive to stone formation. In order for stones to form, there typically must be: (a) significant urine; (b) outlet obstruction; and (c) an alkaline environment [1]. In this patient, vaginal urine was likely secondary to retrograde flow due to incontinence and frequent recumbent position, rather than an anatomical abnormality, which is typically seen in vaginal stones.…”

“…Retrograde urinary flow is classically seen only in non-ambulatory patients [2][3][4]. She likely had outlet obstruction from redundant tissue rather than the usual transverse septum, imperforate hymen [5], or trauma [1]. The patient's frequent urinary tract infections (UTIs), thought to be in part due to her habitus, could produce an alkaline environment.…”

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

“…Primary stones are thought to occur from urinary stasis in the vagina, whereas secondary stones form as urine crystalizes around a foreign body in the vagina [ 2 ]. Reports of primary stones have occurred with urethrovaginal fistulas forming after trauma in association with vaginal stenosis, urinary incontinence secondary to neurologic disorders, ectopic ureters, and urethral diverticula [ 2 , 8 , 9 ]. Secondary stones have been reported primarily in cases of vesicovaginal fistulae with cases involving long-term pessary use [ 10 ], an embedded displaced intrauterine contraceptive device [ 11 ], and retained surgical gauze [ 12 , 13 ].…”

“…The treatment of vaginal stones secondary to mesh exposure is typically achieved via vaginal excision with removal of the stone and exposed mesh. In cases of large vaginal calculi, the use of lithotripsy or partial morcellation with episiotomy has been described [ 9 ].…”

Large Vaginal and Bladder Calculi in a Woman With Previous Operation of Bladder Exstrophy: A Case Report

“…In females such calculi occurring in the vagina are uncommon and the diagnosis is difficult, so they are often mistaken for bladder calculi (7). Urethrovaginal fistula is the main etiology of most vaginal calculi and the other etiologies are extremely rare, so primary, struvite calculi are the most reported cases in the literature and are often associated with vesicovaginal fistulas (2, 6).…”