Skip Navigation LinksHome > January 2013 - Volume 17 - Issue 1 > A Large Primary Vaginal Calculus in a Woman With Paraplegia
Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e31824d6f9c
Original Articles

A Large Primary Vaginal Calculus in a Woman With Paraplegia

Avsar, Ayse Filiz MD; Keskin, Huseyin Levent MD; Catma, Tuba MD; Kaya, Basak MD; Sivaslioglu, Ahmet Akn MDı

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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.

©2013The American Society for Colposcopy and Cervical Pathology

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