Vaginal stones caused by urethrovaginal fistula: A case report

RATIONALE: Vaginal stone is a rare condition that is often misdiagnosed due to its low incidence. It can be divided into 2 types, primary vaginal and secondary vaginal, based on the etiology of the disease. Vaginal stones involve pathologic calcification. The formation of vaginal stones is mainly due to stasis and urine infection. We describe a procedure for the safe extraction of vaginal stones. PATIENT CONCERNS: We report a case of a 25-year-old female patient with congenital genitourinary malformation and urethrovaginal fistula. A urogenital tract malformation repair operation was performed before she was 21 years old. Frequency of urination occurred before and after menstruation for 9 years, and dyspareunia occurred for 1 year. DIAGNOSES: B ultrasound examination showed a 59 × 55 × 23 mm fusiform region of increased signal intensity in the vagina followed by a sound shadow. We performed a gynecologic examination and found that the long diameter of the vaginal opening was 20 mm. A brown substance observed in her vagina had a hard texture and felt like a stone, and a palpation hand test revealed the size was approximately 60 × 50 mm. A cystoscope was inserted into the urethra and revealed that the broken end of the urethra was connected to the vagina. The proximal broken end of the urethra was 20 mm from the distal end. INTERVENTIONS: The purpose of this operation was to make a definite diagnosis and remove the stones. We performed vaginal stone removal surgery and cystoscopy under anesthesia. OUTCOMES: We removed the stone successfully. The patient was discharged from the hospital after a smooth recovery without any complications. Follow-up was conducted 1 month after the operation and then every 3 months. LESSONS: Although vaginal stones are rare, we must pay attention to this disease, especially in patients with congenital genitourinary malformations and urethrovaginal or vesicovaginal fistulas. Obstruction of urine discharge combined with repeated urinary tract infection is the main cause of vaginal stone formation. For these patients, follow-up every 3 months, including a physical examination, B-mode ultrasonography of the urinary system and cystoscopy if necessary, can avoid the occurrence of the disease.