Removal of Large Primary Vaginal Calculus Using the Nephroscope and Endoscopic Ultrasonic Lithotrite: A Case Report

Abstract

Background: Vaginal calculi are rare and can grow quite large if they remain undetected. Vaginal stones are caused by the pooling of urine in the vagina and can be classified as either primary or secondary, depending on the absence or presence, respectively, of a nidus. Primary stones without any urethrovaginal or vesicovaginal fistula are even more uncommon but appear to be more commonly reported in incontinent women with significant physical disabilities. Case Presentation: We present a case of an ∼11 cm primary vaginal stone in a 61-year-old woman with cerebral palsy. This was removed using a nephroscope and an endoscopic ultrasonic lithotrite through the vaginal introitus with subsequent analysis demonstrating a struvite stone composition. Conclusion: This case is unique not only for the large size of the calculi but also for our less invasive approach, using a nephroscope and endoscopic ultrasonic lithotrite to fragment and remove the stone. We hope that this report will assist other providers in the timely and accurate diagnosis and treatment of future vaginal stone patients.

Keywords: instrumentation; nephroscope; urolithiasis; vaginal stone.

FIG. 1.

Plain kidney, ureter, and bladder radiograph of the abdomen and pelvis showing a large radio-opaque calculus.

FIG. 2.

CT imaging showing calcified mass in coronal, sagittal, and axial views (A–C).

FIG. 3.

MRI showing T1 and T2 sagittal (A, B) and T1 axial views (C) of the vaginal stone.

FIG. 4.

Patient positioning in the operating room.

FIG. 5.

Endoscopic view during fragmentation and stone fragments.