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GYNAECOLOGY AND OBSTETRICS IMAGING Table of Contents   
Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 825-826
Giant vaginoliths


Department of Radiodiagnosis & Imaging, Gandhi Medical College & Associated Hamidia Hospital, Bhopal, India

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Date of Submission31-Mar-2006
Date of Acceptance10-Aug-2006
 

Keywords: Vaginolith, vesicovaginal fistula, vesicourethral fistula

How to cite this article:
Malik R, Pandya V K, Agrawal G. Giant vaginoliths. Indian J Radiol Imaging 2006;16:825-6

How to cite this URL:
Malik R, Pandya V K, Agrawal G. Giant vaginoliths. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Sep 15];16:825-6. Available from: http://www.ijri.org/text.asp?2006/16/4/825/32359

   Introduction Top


Urinary salt calculi occurring outside the urinary tract are rare and it is even more uncommon to find such stones within the vagina, which form as a result of deposition of urinary salts due to persistent urinary leakage. We report 2 such cases of primary and secondary vaginal stone.


   Case report Top


Case 1

A 15 year female underwent KUB ultrasonography for complaints of mild urinary incontinence with difficulty during micturation.

She had history of pelvic trauma 7 years back when suprapubic cystostomy with urethroplasty was done. Subsequently, she developed mild urinary incontinence and presented with complaints of difficulty and hesitancy during micturation, of one month duration. On interrogation, patient had not attained menarchy.

On physical examination urethral and vaginal orifices were separate from each other and were normal. Evidence of scar mark of previous operation was present.

On ultrasonography, bladder and both kidneys were normal, however a large cystic elongated structure was seen posterior to bladder, in caudal continuity with uterus, which was a fluid filled distended vagina, and it showed a large vaginolith, with dense posterior shadowing. Associated small amount of fluid in uterine cavity was noted Fig. No. 1.

CT pelvis was done which confirmed the above findings with additional information of associated Rt sided hydrosalpinx (Fig. 2, 3).

Vaginoscopy revealed a tight stenosis at the site of earlier vaginal disruption .Surgery revealed urethral sphincter laxity, urethrovaginal fistula, fluid filled vagina with a large vaginolith and rt sided hydrosalpinx. Urethral sphincter plication with vaginolithotomy and vaginalvaginoplasty was done and right sided hydrosalpinx drained.

Case 2

A 35 year female presented with complains of painful coitus and firm to hard swelling in vagina since last 18 months.

Past history of cesarian section 2 years back, for a post dated pregnancy with IUFD where upon, subsequently, she developed vesicovaginal fistula as a complication of surgery.

She was reoperated for repair of vesico-vaginal fistula,which was unsuccessful and she had persistent complaints of dribbling. After 6 months she developed complains of painful coitus and a hard swelling in the vagina .

Pervaginal and perspeculum examination was not possible due to a hard mass encroaching the vaginal canal anteriorly.

On ultrasonography she was found to be 10 weeks pregnant with a dead fetus.A TVS study failed due to a hard vaginal mass not permitting probe insertion.

On CT pelvis a giant sized vaginolith was seen with dense peripheral calcification around a central core of a well circumscribed soft tissue density showing air entrapment, reported as a secondary vaginolith,developing on a ?retained surgical sponge Fig. (4, 5). She was operated and the vaginolith was removed pervaginally .On cut section of vaginolith, inner core of sponge with circumferential calcium deposition was seen.


   Discussion Top


Vaginal 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 caused by vesicovaginal fistula, urethrovaginal fistula and ectopic vaginal ureter.[3]

They have also been described with vaginal outlet obstruction[2] Primary vaginal stones are extremely rare and are often mistaken for bladder calculi on plain radiography however IVP and sonography can help differentiate between the two.[2]

The first case is one such very rare case of primary vaginolith secondary to urethrovaginal fistula and vaginal outlet obstruction where perineal trauma resulted in urethrovaginal fistula and vaginal disruption leading to vaginal stenosis, which was responsible for urinary reflux with secondary urinary stasis and infection in vagina that eventually lead to a distended fluid filled vagina with vaginolith formation.

A secondary vaginal stone is formed around a foreign body in vagina (as in case 2) or from migration of vesical calculus into vagina because of ulceration of vesicovaginal septum.

Most of the reported cases are of primary struvite calculi associated with vesicovaginal fistula.[3]

Calculi in vagina are difficult to detect by ultrasonography ,therefore the procedure should be carried out with particular care.[1] Findings can then be confirmed by CT pelvis in case of doubt, which may also detect additional abnormalities as in case 1, where hydrosalpinx was noted & subsequently drained.

Treatment can vary depending on the cause of stone formation and the consistency of the calculi.[4]

 
   References Top

1.C. venet, Ph. clapuyt, F.x. wese. Vaginal stone in a teenager: Br J urol1997;79,804-805  Back to cited text no. 1    
2.N. Malhotra, S. Kumar, K. K. Roy, R. Agrawal, V. Verma. Vaginal calculus secondary to vaginal outlet obstruction: Journal Of Clinical Ultrasound 2004;32(4),204-206  Back to cited text no. 2    
3.Raghavaiah Nv, Devi Ai. Primary Vaginal Stones: J Urol.1980 ;123(5),771-772  Back to cited text no. 3    
4.Bar-moshe O, Oboy G, Assi J. Vaginal Calculi in a young women. Eur Urol 2000;37,505-507  Back to cited text no. 4    

Top
Correspondence Address:
R Malik
Department of Radiodiagnosis & Imaging, Gandhi Medical College & Associated Hamidia Hospital, Bhopal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32359

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

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    Introduction
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    References
    Article Figures

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