Hourglass appearance in cystocele with an impacted vesical calculus : Indian Journal of Urology

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Hourglass appearance in cystocele with an impacted vesical calculus

Ramalingam, Manickam*; Kallappan, Senthil; Janani, M N

Author Information

Department of Urology, Hindusthan Hospital, Coimbatore, Tamil Nadu, India

*E-mail: [email protected]

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Indian Journal of Urology 39(2):p 163-164, Apr–Jun 2023. | DOI: 10.4103/iju.iju_20_23
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Abstract

A 62-year-old hypertensive female presented with a mass protruding from the vagina for the past 20 years. She complained of dysuria and urinary incontinence for the past 3 months. There was no history of surgical intervention in the past. The examination revealed a tender irreducible total uterine prolapse (procidentia) and cystocele with a decubitus ulcer. Computed tomography urogram showed a total uterine prolapse along with the prolapse of a part of urinary bladder, with a vesical calculus of size 2.8 cm × 2.7 cm in the prolapsed part of the bladder, below the level of the pubic symphysis, with minimal wall thickening. After optimization, vesical lithotripsy and bilateral ureteric stenting were performed, followed by hysterectomy after 2 days.

DISCUSSION

Although, pelvic organ prolapse (POP) is common in the elderly, it usually goes unnoticed. Forty-one percent of the patients with an intact uterus and 38% of those who had a prior hysterectomy develop POP.[1] Uterine prolapse most commonly affects multiparous women, either due to the weakness of the pelvic floor muscles or because of the estrogen deprivation in the postmenopausal status.[2] Cystocele is the descent of urinary bladder into the vagina because of the weakness of muscles and the connective tissue. Only 5% of all the patients with vesical calculi are women.[3]

Computed tomography urogram showed a total uterine prolapse along with the prolapse of a part of urinary bladder [Figure 1], with a vesical calculus of size 2.8 cm × 2.7 cm in the prolapsed part of the bladder, below the level of the pubic symphysis [Figure 2], with minimal wall thickening. After optimization, vesical lithotripsy and bilateral ureteric stenting were performed, followed by hysterectomy after 2 days.

F1
Figure 1:
Vesical calculus in the prolapsed bladder
F2
Figure 2:
Contrast image showing the hourglass shaped bladder

CONCLUSION

Long-standing uterine prolapse with vesical calculi is unusual. The computed tomography (CT) image is unique, mimicking an hourglass appearance, with the plain CT showing a vesical calculus in the prolapsed part.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

REFERENCES

1. aaureau M, Carlson KV. Pelvic organ prolapse:A primer for urologists. Can Urol Assoc J 2017;11:S125-30
2. Saha MR, Saha TK, Wahab MAK, Haque MR. Uterovaginal prolapse with multiple vesical calculi:A rare case report. J Dhaka Med Coll 2016;25:77-9
3. Hiremath AC, Shivakumar KS. Cystolitholapaxy and laparoscopic sacrocolpopexy in a case of multiple urinary bladder calculi and vault prolapse. Eur J Obstet Gynecol Reprod Biol 2019;243:12-5
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