Vesicovaginal Fistula with Secondary Vaginal Stones

Abstract

To our knowledge, this is the first reported case of a vesicovaginal fistula associated with secondary vaginal stones which was managed totally endoscopically. We believe that this is a feasible and efficacious approach for the management of such cases.

A Large Primary Vaginal Calculus in a Woman With Paraplegia

“…Urinary incontinence and stasis can be related to neuropathic bladder [8], myelodysplasia [10,14], and bladder exstrophy [4,9] or can be caused by mental retardation [15] or cerebral palsy [2]. The vast majority of vaginal stones have been reported in association with gynecological conditions, particularly vesicovaginal or urethrovaginal fistulas with concomitant urinary tract infections [5,11,12,16].…”

“…Secondary calculi are less common than primary stones. Secondary vaginal stones are formed around foreign bodies including iatrogenic, retained, or self-induced objects in the vagina [1,4,12,16]. Foreign bodies can lead to chronic inflammation and/or genital fistulas that result in the formation of a vaginal stone.…”

“…In most of the cases, vaginal stones were solitary [2Y4, 6,9,11,13,15,21], but they can also be multiple [5,8,12,20]. The size of the calculi may vary.…”

“…A huge primary vaginal stone weighing 935 g was reported [23]. The biochemical analyses of the vaginal stone reveal that it is usually composed of triple phosphate (struvite) salts [2, 5Y7, 15, 21]; however, stones with other compositions have been reported, including carbonate apatite [7] or mixed types [12,16,20].…”

“…Some authors have removed the calculus from the vagina through hymenal incision [2] or through an episiotomy incision [6,11]. Moreover, lithotripsy using a nephroscope in combination with an ultrasonic device to visualize the vagina and cervix [8] and intracorporeal shock wave lithotripsy has been described [12]. If the stone is diagnosed preoperatively, estrogen treatment can be useful to strengthen the vaginal epithelium before the removal of large stones because the hymen can better withstand iatrogenic stretching without tearing [8].…”