1/3. A secondary vaginal stone. A case report.A case is presented of a large calculus that was formed in the vagina of a 44-year-old woman within less than 4 months. Urinary salts from a vesico-vaginal fistula deposited around an inadvertently unremoved medical gauze.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
2/3. Vesical calculi associated with vesicovaginal fistulas: management considerations.Vesical calculi were detected in 5 patients with a vesicovaginal fistula. Of these patients 3 had undergone unsuccessful repair of the fistula previously. The predisposing factors for vesical calculous formation in patients with a vesicovaginal fistula in whom urine leaks continuously into the vagina and urinary stasis does not occur in the bladder, as in patients with neurogenic bladder dysfunction or bladder outlet obstruction, are a foreign body (for example nonabsorbable suture material used during previous surgery), incrustation around an indwelling catheter and infection. The vesical calculus is removed transvaginally after enlarging the fistula by a vertical incision at the 6 o'clock position. The incised edges do not usually bleed because of fibrosis and scar formation, and they need not be approximated at that operation. Indwelling catheter drainage is not necessary after transvaginal cystolithotomy in this situation. This operation is preferable to suprapubic cystolithotomy, which may lead to more morbidity from urine leakage in the retropubic space and subsequent fibrosis, in addition to producing bladder scarring, hindering any future reconstructive surgery requiring the use of vesical flaps. Transvaginal cystolithotomy is contraindicated when the fistula is situated close to the bladder neck (for fear of damaging the bladder neck and the vesical continence mechanism) or when the stone is large. Repair of the fistula is undertaken after an interval of 3 months to allow for resolution of stone-induced edema and friability of the vesical wall.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
3/3. Primary vaginal stones.calculi composed of urinary salts rarely occur outside the urinary tract. In female subjects such calculi occuring in the vagina are uncommon, with only 26 cases reported thus far. These stones may be primary or secondary. Primary stones are formed in the vagina owing to the deposition of urinary salts as a result of continuous urinary leakage into the vagina. They have been described in association with urinary leakage caused by vesicovaginal fistulas, urethrovaginal fistulas, an ectopic vaginal ureter in a 7-year-old child and incontinence owing to a neurogenic bladder. A secondardy vaginal stone is formed around a foreign body in the vagina. Rarely, a vesical calculus may migrate into the vagina because of an ulceration of the vesicovaginal septum and grow in the vagina as a secondary calculus. Most of the reported cases are primary, struvite calculi associated with vesicovaginal fistulas. Because of their rarity we present 2 such cases occurring in patients with vesicovaginal fistulas.- - - - - - - - - - ranking = 2keywords = calculus (Clic here for more details about this article) |