Year : 2002 | Volume
: 18 | Issue : 2 | Page : 176--177
Primary vaginal calculus in an operated case of mclndoe vaginoplasty
VD Trivedi, Sujata Salve, Bajpai Rajesh, Pankaj Dangle, Anurag Awasthi
Department of Urology & General Surgery, LTMGH, Mumbai, India
V D Trivedi
Department of Urology, LTMGH, Sion, Mumbai - 400 022
|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;18:176-177
|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 2022 May 28 ];18:176-177
Available from: https://www.indianjurol.com/text.asp?2002/18/2/176/37636
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 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.
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.  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. 
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 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.
|1||Raghaviah NY, Devi AI. Primary vaginal stones. J Urol 1980: 123: 771-772.|
|2||Mahapatra TP, Rao MS, Sharma SK, Vaidyanathan S. Vesical calculi associated with Vesico vaginal fistulas - management considerations. J Urol 1986; 136: 94-95.|
|3||James Buss, Raymond Lee. Mclndoe procedure for vaginal agenesis : results and complications. Mayo Clin Proc 1989: 64: 758.|