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CASE REPORT
Year : 2002  |  Volume : 18  |  Issue : 2  |  Page : 176-177
 

Primary vaginal calculus in an operated case of mclndoe vaginoplasty


Department of Urology & General Surgery, LTMGH, Mumbai, India

Correspondence Address:
V D Trivedi
Department of Urology, LTMGH, Sion, Mumbai - 400 022
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Primary Vaginal Calculus; Mclndoe Vaginoplasty.


How to cite this article:
Trivedi V D, Salve S, Rajesh B, Dangle P, Awasthi A. Primary vaginal calculus in an operated case of mclndoe vaginoplasty. Indian J Urol 2002;18:176-7

How to cite this URL:
Trivedi V D, Salve S, Rajesh B, Dangle P, Awasthi A. Primary vaginal calculus in an operated case of mclndoe vaginoplasty. Indian J Urol [serial online] 2002 [cited 2018 Nov 18];18:176-7. Available from: http://www.indianjurol.com/text.asp?2002/18/2/176/37636



   Case Report Top


A 35-year-old female was diagnosed as a case of Mayer Rokitansky Hauser syndrome (Mullerian agenesis) in 1981. On examination she had normal external genitalia, foreshortened urethra and a vaginal dimple. She under­went diagnostic laparoscopy, which revealed an atretic uterus and bilateral small ovaries. Mclndoe vaginoplasty was performed wherein skin grafts were placed over an acrylic mould in the perineal pouch created between the bladder and rectum. The mould was removed on the fif­teenth postoperative day by the patient herself. Two months after the surgery the first episode of coitus was followed by profuse urinary leak through the vagina. The patient had no marital relations thereafter and stayed with her parents. Over two years the leak was replaced by vaginal discharge, dysuria and poor stream of urine. Nineteen years later she presented to our outpatients department with the above complaints. On examination she had profuse vagi­nal discharge, the introitus admitted only one finger and a hard object was felt in the vagina. X-ray KUB demon­strated a radio-opaque dumb-bell-shaped density. The main bulk of the calculus was seen occupying the region of the symphysis pubis and inferior pubic rami [Figure - 1]. Cystoscopy revealed a short urethra and a calculus protruding through the trigonal defect. Vaginal examination revealed the same calculus occupying the upper vagina lined by edematous and excoriated skin graft. Urine culture grew  Escherichia More Details coli and klebsiella significantly. Other biochemical param­eters were within normal limits.

The stone was fragmented by ballistic lithoclast per vaginally, fragments removed by forceps and washes. This revealed a large trigonal vesicovaginal fistula 4 x 5 cm in size, 1.5 cm away from the ureteric orifice and 2 cm be­yond the bladder neck.

Two weeks later we closed the bladder primarily with omentum along with sigmoid vaginoplasty and the patient is well at six months of follow-up.


   Discussion Top


Primary vaginal calculi are due to urinary leak into the vagina through various types of fistulae and are associated with vaginal obstruction and urinary stasis. [1] In the absence of obstruction and stasis of urine in the vagina, infection with urease-splitting bacteria alone, is also sighted as an etiological factor for stone formation. [2]

The etiological factors in this case are, vesicovaginal fistula due to surgery, introital narrowing with pooling of urine in the vagina and superadded infection with urease­splitting organisms. The calculus primarily grew in the vagina and then into the bladder. The patient initially had urinary leakage but later the leakage ceased as the stone grew and occluded the fistula. Ballistic energy can be used to fragment the stone vaginally, thus avoiding the need for open surgery advocated in the past.

In a series of 50 patients who underwent Mclndoe Vagi­noplasty[3] vesicovaginal fistula with vaginal calculus as a complication has not been mentioned.

In conclusion, vesicovaginal fistula and vaginal calcu­lus as a complication of Mclndoe's vaginoplasty, though not described previously, should be kept in mind while offering this surgery to patients. from remote villages with poor follow-up.

 
   References Top

1.Raghaviah NY, Devi AI. Primary vaginal stones. J Urol 1980: 123: 771-772.  Back to cited text no. 1    
2.Mahapatra TP, Rao MS, Sharma SK, Vaidyanathan S. Vesical cal­culi associated with Vesico vaginal fistulas - management consid­erations. J Urol 1986; 136: 94-95.  Back to cited text no. 2    
3.James Buss, Raymond Lee. Mclndoe procedure for vaginal agenesis : results and complications. Mayo Clin Proc 1989: 64: 758.  Back to cited text no. 3    


    Figures

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