Agil Ahmad, Kurniawana Aninditho Dimas
Department of Urology, Hasan Sadikin Academic Medical Center/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Department of Urology, Hasan Sadikin Academic Medical Center/Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
Int J Surg Case Rep. 2022 Jul;96:107311. doi: 10.1016/j.ijscr.2022.107311. Epub 2022 Jun 14.
In developing countries, Vesico-vaginal fistula (VVF) results following obstetric trauma or iatrogenic during hysterectomy. Large calculus associated with VVF is relatively rare, with the risk factor are presence of foreign body, urinary tract infection, and prolonged duration of disease. Most bladder stones can be found among patients who are bedridden, indwelling urethral catheter, bladder outlet obstruction, infection, and other similar characteristic. We report a case of VVF with bladder and vaginal stone in 37 years old woman and reviews the evaluation and treatment and highlights the role of the healthcare team in managing patients with this condition.
A 37-year-old, P2A0, woman with a history of hysterectomy three years ago. Intermittent small amounts of watery vaginal discharge developed 1,5 years after the operation. A physical examination revealed mild tenderness over the suprapubic area and no evidence of uterine prolapse. Cystography computed tomography scan with contrast confirmed a fistula vesicovagina with a connection between posterosuperior wall of vesica urinaria and anterosuperior wall of vagina with vesicolithiasis, size 15 × 26 × 14 mm and two vaginal stone with size of 7 × 12 × 17 mm and 4 × 4 × 5 mm. Cystoscopy revealed a grayish stone identified in supratrigone with size of 30 × 12 mm.
A hanging intravesical stone on the dome of urinary bladder is scarce, possibly caused by any synthetic and non-absorbable suture material inside of the bladder were encrusted forming a bladder stone. Important risk factors known, which is specific in developing countries, are poor socioeconomic status, malnourishment, low literacy rate, early marriage and childbearing, and inadequate obstetrical care.
Although the incidence of VVF accompanied by hanging vaginal stone and a large bladder stone is scarce, reports of any case regarding this study can be beneficial to other studies. Due to its harmful effect, the usage of non-absorbable sutures material during surgery isn't suggested. Hence, the absorbable suture material usage with careful dissection is suggested for any gynecological or pelvic surgery.
在发展中国家，膀胱阴道瘘（VVF）是产科创伤或子宫切除术中医源性损伤的结果。与VVF相关的大结石相对罕见，危险因素包括异物存在、尿路感染和疾病持续时间延长。大多数膀胱结石见于卧床不起、留置尿道导管、膀胱出口梗阻、感染及其他类似情况的患者。我们报告一例37岁女性的VVF合并膀胱及阴道结石病例，并回顾其评估和治疗过程，强调医疗团队在管理此类患者中的作用。
一名37岁、孕2产0的女性，有三年前子宫切除术史。术后1.5年出现间歇性少量水样阴道分泌物。体格检查发现耻骨上区轻度压痛，无子宫脱垂迹象。膀胱造影计算机断层扫描造影证实膀胱阴道瘘，膀胱后上壁与阴道前上壁相连，伴有膀胱结石，大小为15×26×14mm，还有两颗阴道结石，大小分别为7×12×17mm和4×4×5mm。膀胱镜检查发现膀胱三角区上方有一颗灰白色结石，大小为30×12mm。
膀胱顶部悬垂的膀胱内结石很少见，可能是膀胱内任何合成且不可吸收的缝合材料形成结石所致。已知在发展中国家特有的重要危险因素包括社会经济地位差、营养不良、识字率低、早婚早育以及产科护理不足。
尽管VVF伴有悬垂阴道结石和大膀胱结石的发病率很低，但有关本研究的任何病例报告都可能对其他研究有益。由于其有害影响，不建议在手术中使用不可吸收缝合材料。因此，建议在任何妇科或盆腔手术中使用可吸收缝合材料并仔细解剖。
