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.
Although vaginal stones are very rare, their possibility should be considered in the differential diagnosis of individuals in prolonged recumbent posture.
Department of Gynecology and Obstetrics, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
Reprint requests to: H. Levent Keskin, MD, Birlik mah. 499.sok. No: 3/5 Cankaya, 06610 Ankara, Turkey. E-mail: email@example.com
The authors declare they have nothing to disclose.