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Leong KA, Husk KE. Stone accumulation overlying vaginal mesh exposure: A case report. World J Obstet Gynecol 2023; 12:28-32. [DOI: 10.5317/wjog.v12.i3.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023] Open
Abstract
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.
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Affiliation(s)
- Karissa A Leong
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY 12208, United States
| | - Katherine E Husk
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY 12208, United States
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2
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Kerschen A, Aydin S, Marbaix E, Gérin V, Haufroid V, Daudon M, Vanhaebost J. Misdiagnosis of a primary vaginal stone leading to a suspicion of sexual assault in a heavily disabled woman. CANADIAN SOCIETY OF FORENSIC SCIENCE JOURNAL 2022. [DOI: 10.1080/00085030.2022.2051326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anja Kerschen
- Department of Pathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Centre of Forensic Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Selda Aydin
- Department of Pathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Morphology Research Group, Institute for Experimental and Clinical Research, UCLouvain, Brussels, Belgium
| | - Etienne Marbaix
- Department of Pathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Morphology Research Group, Institute for Experimental and Clinical Research, UCLouvain, Brussels, Belgium
| | - Vincent Gérin
- Department of Laboratory Medicine and Pathobiology, Clinique Saint-Pierre, Ottignies, Belgium
| | - Vincent Haufroid
- Morphology Research Group, Institute for Experimental and Clinical Research, UCLouvain, Brussels, Belgium
- Louvain Center for Toxicology and Applied Pharmacology, UCLouvain, Brussels, Belgium
- Department of Clinical Chemistry, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Michel Daudon
- GRC n°20, Department of Multidisciplinary Functional Explorations, Sorbonne University, Paris, France
| | - Jessica Vanhaebost
- Department of Pathology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Centre of Forensic Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Morphology Research Group, Institute for Experimental and Clinical Research, UCLouvain, Brussels, Belgium
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3
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Zhang J, Luo DY, Shen H. Surgical treatment for huge vaginal stone secondary to vaginal mesh exposure with stress urinary incontinence. Int Urol Nephrol 2021; 53:1599-1601. [PMID: 33959848 DOI: 10.1007/s11255-021-02865-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/11/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Jie Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - De-Yi Luo
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Hong Shen
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Abstract
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.
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5
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Ranawaka RS, Goyal A, Shabani A, Hennayake S, Dickson AP, Cervellione RM. Novel approach to vaginal calculus in a girl with urogenital sinus anomaly. J Pediatr Surg 2020; 55:e4-e5. [PMID: 25783409 DOI: 10.1016/j.jpedsurg.2012.07.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/28/2012] [Accepted: 07/08/2012] [Indexed: 10/24/2022]
Abstract
Isolated urogenital sinus can cause distended bladder and/or vagina and may present with an abdominal mass and sepsis during infancy. Older children may present with recurrent urinary tract infections and hematocolpos. We describe a 3-year-old girl with recurrent urinary tract infections thought to be secondary to vesicoureteric reflux. On further investigation, an isolated urogenital sinus anomaly with a calculus inside one of the hemivaginae was noted. She was managed expectantly with a plan to intervene at puberty. At puberty, during removal of the stone, the hemivaginal introitus was found to be stenotic. Gradually increasing sizes of Amplatz type graduated renal dilators were introduced from the introitus of the urogenital sinus into the hemivaginal stone until a size 22F Amplatz sheath could be passed easily. Size 10F cystoscope was passed through this channel, and the stone was fragmented using electrohydraulic lithotripsy. At a later date, she underwent staged anterior sagittal transvulval mobilization of the urogenital sinus.
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Affiliation(s)
- Ravibindu Sujeewa Ranawaka
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Anju Goyal
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Abdusamea Shabani
- Department of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Supul Hennayake
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Alan P Dickson
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom
| | - Raimondo M Cervellione
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester M13 9WL, United Kingdom.
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Vaginal Urinary Calculi Formation Secondary to Vaginal Mesh Exposure with Urinary Incontinence. Case Rep Obstet Gynecol 2017; 2017:8710315. [PMID: 28912989 PMCID: PMC5585649 DOI: 10.1155/2017/8710315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 07/24/2017] [Indexed: 11/21/2022] Open
Abstract
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.
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Tavakkoli M, Ghoreifi A. Large vaginal and bladder calculi in a woman with previous operation of bladder exstrophy: a case report. Nephrourol Mon 2013; 6:e13637. [PMID: 24719809 PMCID: PMC3969001 DOI: 10.5812/numonthly.13637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/23/2013] [Accepted: 09/11/2013] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Mahmoud Tavakkoli
- Department of Urology, Imam Reza Academic Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Alireza Ghoreifi
- Department of Urology, Imam Reza Academic Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Alireza Ghoreifi, Department of Urology, Imam Reza Academic Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118022553, Fax: +98-5118591057, E-mail:
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Khattab SM, Youssef MAFM. Primary anterior vaginal wall pure ammonium acid urate stone. Case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2013. [DOI: 10.1016/j.mefs.2012.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
OBJECTIVE The study aimed to report a primary vaginal stone, an extremely rare entity, without vesicovaginal fistula in a woman with disability. CASE We describe the case of a large primary vaginal calculus in a 22-year-old woman with paraplegia, which, surprisingly, was not diagnosed until she was examined under general anesthesia during a preparation for laparoscopy for an adnexal mass. The stone had not been identified by physical examination with the patient in a recumbent position or by transabdominal ultrasonography and pelvic tomography during the preoperative preparation. Vaginoscopy was not performed because the vagina was completely filled with the mass. As a result of its size and hard consistency, a right-sided episiotomy was performed and a 136-g stone was removed using ring forceps. A vesicovaginal fistula was excluded. There was no evidence of a foreign body or other nidus on the cut section of the stone, and it was determined to be composed of 100% struvite (ammonium magnesium phosphate). Culture of urine obtained via catheter showed Escherichia coli. After the surgical removal of the calculus without complications, a program of intermittent catheterization was started. The follow-up period was uneventful, and the patient was symptom free at 6 months after the operation. CONCLUSIONS 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.
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Oguzkurt P, Ince E, Ezer SS, Temiz A, Demir S, Hicsonmez A. Primary vaginal calculus secondary to urethrovaginal fistula with imperforate hymen in a 6-year-old girl. J Pediatr Surg 2009; 44:e11-3. [PMID: 19573644 DOI: 10.1016/j.jpedsurg.2009.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Revised: 03/26/2009] [Accepted: 03/28/2009] [Indexed: 11/25/2022]
Abstract
Primary vaginal stones are extremely rare in children and may be mistaken for bladder calculi on plain radiography. We present a case of a large vaginal calculus in a 6-year-old girl who had an imperforate hymen and urethrovaginal fistula. Hymenotomy and urethrovaginal fistula repair were performed, and the vaginal stone was extracted. It was postulated that the vaginal calculus originated from stasis of urine through the urethrovaginal fistula in the obstructed vagina. This is a unique case of a vaginal calculus with a congenital urethrovaginal fistula associated with an imperforate hymen.
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Affiliation(s)
- Pelin Oguzkurt
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Ankara, Turkey.
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Goel A, Sankhwar SN, Pandey A. Genitourinary stone in a case of vesicovaginal fistula. Urology 2006; 68:1341-2. [PMID: 17169413 DOI: 10.1016/j.urology.2006.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 06/25/2006] [Accepted: 09/08/2006] [Indexed: 11/29/2022]
Affiliation(s)
- Apul Goel
- Department of Urology, King George Medical University, Lucknow, India.
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Patankar S, Dobhada S, Bhansali M. Vesicovaginal Fistula with Secondary Vaginal Stones. J Laparoendosc Adv Surg Tech A 2006; 16:386-9. [PMID: 16968189 DOI: 10.1089/lap.2006.16.386] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We report a rare case of a vesicovaginal fistula associated with secondary vaginal stones that was managed totally endoscopically. MATERIALS AND METHODS A 52-year-old woman presented with urinary incontinence and perineal pain. On subsequent evaluation, we found a vesicovaginal fistula associated with secondary vaginal stones caused by a retained gauze. Management involved vaginoscopy, intracorporeal shock wave lithotripsy for vaginal stones, and removing retained medical gauze. We performed cystoscopy, laparoscopic cystotomy, transabdominal Foley catheterization of the vesicovaginal fistula for traction, injection of diluted adrenaline-saline solution for better dissection, dissection of the bladder from the vagina, tension-free closure of the bladder and vaginal defects, and closure of the cystotomy. RESULTS Operative time was 155 minutes and blood loss was 60 mL. The patient was discharged on postoperative day 3, and catheterization time was 14 days. At 3-month follow-up, the patient was fully continent. CONCLUSION 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.
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13
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Lin CJ, Chen CP, Wu CH, Chen HY, Hsu HH. Huge Primary Vaginal Stone in a Recumbent Woman. Taiwan J Obstet Gynecol 2005. [DOI: 10.1016/s1028-4559(09)60114-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Dalela D, Goel A, Shakhwar SN, Singh KM. Vesical Calculi With Unrepaired Vesicovaginal Fistula: A Clinical Appraisal of an Uncommon Association. J Urol 2003; 170:2206-8. [PMID: 14634380 DOI: 10.1097/01.ju.0000095503.76155.30] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Primary vesical calculi are uncommon in patients with vesicovaginal fistula (VVF). We retrospectively analyzed 19 such cases and present our experience with the management of this condition. MATERIALS AND METHODS Between January 1989 and December 2002, 19 patients were treated for this association. All patients provided a history and underwent physical examination, metabolic evaluation for stone disease, urine culture test and cystovaginoscopic examination. They were treated with a staged procedure with the fistula repaired 2 to 3 months after stone removal. RESULTS VVF was a result of obstructed labor in all cases. The patients presented a mean of 28.8 months after fistula formation. No metabolic abnormality was detected in any patient. Urine culture was positive for Proteus mirabilis in 6 and Escherichia coli in 5, and it yielded mixed growth in 8. All women had some residual urine in the bladder (mean 11 ml). The fistula was located supratrigonally in 13 cases, while it was high trigonal in the remainder. A total of 17 patients were treated endoscopically by cystolitholapexy or fragmentation of the stone by transurethral cystolithotripsy using a Lithoclast (Microvasive Urology, Natick, Massachusetts). Two patients required open suprapubic cystolithotomy. All patients underwent fistula repair 3 months after stone removal with successful results in 16. CONCLUSIONS Primary vesical calculi in patients with VVF are associated with urinary contamination, a high or supratrigonal fistula location, residual urine in the bladder and a long history of disease. Staged management of the problem showed good results.
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Affiliation(s)
- D Dalela
- Department of Urology, Chhatrapati Shahuji Maharaj Medical University (Upgraded King George's Medical College), Lucknow, India.
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Affiliation(s)
- T Beedham
- Department of Gynaecology, Royal London Hospital, London E1 1BB, UK
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16
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García Ligero J, Tomás Ros M, Navas Pastor J, García García F, Sempere Gutiérrez A, Rico Galiano JL, Fontana Compiano LO. [Primary vaginal lithiasis associated with urethrovaginal fistula. Report of a case and review of the literature]. Actas Urol Esp 2001; 25:582-5. [PMID: 11692802 DOI: 10.1016/s0210-4806(01)72676-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Vaginal stones are rare. We can classify them as primary or secondary, depending on the presence or the absencse of a foreign body nidus. Various cases can led to stone formation. Most of them developed in women with a vesicovaginal or urethrovaginal fistula, as well as in patients with congenital anomalies of the genitourinary tract, previous pelvic radiotherapy, neuropathic bladder and other different causes of vaginal outlet obstruction. Secondary vaginal stones, formed around foreign bodies, are not so frequent. Radiological examination and urethro-vaginoscopy make easy the right diagnosis. Sometimes the stone may be fragmented by lithotripsy before the extraction. The associated etiology should be treated concomitantly in order to prevent recurrence. We report a case of primary vaginal stone associated with an urethrovaginal fistula in a 25 years old women and a review of the related literature.
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Affiliation(s)
- J García Ligero
- Servicio de Urología, Hospital General Universitario, Murcia
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PLAIRE JCHADWICK, SNODGRASS WARRENT, GRADY RICHARDW, MITCHELL MICHAELE. VAGINAL CALCULI SECONDARY TO PARTIAL VAGINAL OUTLET OBSTRUCTION IN PEDIATRIC PATIENTS. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67478-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J. CHADWICK PLAIRE
- From the Division of Pediatric Urology, Children’s Hospital and Regional Medical Center, Seattle, Washington
| | - WARREN T. SNODGRASS
- From the Division of Pediatric Urology, Children’s Hospital and Regional Medical Center, Seattle, Washington
| | - RICHARD W. GRADY
- From the Division of Pediatric Urology, Children’s Hospital and Regional Medical Center, Seattle, Washington
| | - MICHAEL E. MITCHELL
- From the Division of Pediatric Urology, Children’s Hospital and Regional Medical Center, Seattle, Washington
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18
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VAGINAL CALCULI SECONDARY TO PARTIAL VAGINAL OUTLET OBSTRUCTION IN PEDIATRIC PATIENTS. J Urol 2000. [DOI: 10.1097/00005392-200007000-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Drach GW. Secondary and miscellaneous urolithiasis. Medications, urinary diversions, and foreign bodies. Urol Clin North Am 2000; 27:269-73. [PMID: 10778469 DOI: 10.1016/s0094-0143(05)70256-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Secondary stones, those with no "classic" cause, provide unusual diagnostic and treatment challenges to the urologist. Stones related to medications, to urinary diversions or augmentation, or to presence of foreign bodies within the urinary tract occur rarely. Nevertheless, they represent situations that may be corrected fully by appropriate conservative or procedural therapy, and therefore they must be included in the differential diagnosis of many patients who present with symptoms of urolithiasis.
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Affiliation(s)
- G W Drach
- Division of Urology, University of Pennsylvania, Philadelphia, USA
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20
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Lodh U, Kumar S. Haematocolpos, imperforate hymen in an adult presenting with primary vaginal calculi and bladder outlet obstruction. Aust N Z J Obstet Gynaecol 1994; 34:218-9. [PMID: 7980321 DOI: 10.1111/j.1479-828x.1994.tb02698.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- U Lodh
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Abstract
A case report of vaginal calculus formation in a nine-year-old girl with myelodysplasia is presented. Etiologic factors in the formation of such calculi include fistulous communication between the vagina and the bladder, neuropathic urethrovesical dysfunction, anatomic conditions causing vaginal outlet obstruction, and/or vaginal pooling of urine and urease-producing bacterial infection. A correct preoperative diagnosis can be made by using oblique x-ray films and cystoscopy. Surgical treatment is simple and successful.
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