A 17 year old female presented to the emergency department with urinary incontinence, lower abdomen pain, foul smelling vaginal discharge and loss of weight of three months duration.

Keywords: Vaginolith, Vaginal foreign body
Authors:

Dr Santi Medhi 
M.S. Obstetrics and Gynaecology, FRCOG (UK), Consultant

Corresponding Author: Dr Rekhda Patidar M.S. Obstetrics and Gynaecology, Registrar

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CASE REPORT

A 17 year old female unmarried school student presented to the accident and emergency department with urinary incontinence of more than five months duration, lower abdomen pain, foul smelling vaginal discharge and loss of weight of three months duration. Her mother noticed she had problems with school attendance and social withdrawal. Her medical and psychiatric history was unremarkable. She denied history of vaginal foreign body. On physical examination, excoriation of skin of vulva and perineum and constant leakage of urine through vagina were observed. On per rectal examination a hard mass was felt in the vagina. She was admitted with provisional diagnosis of vaginal foreign body and associated urovaginal fistula. Pelvic USG (Figure 1) and CT Scan (Figure 2) confirmed the diagnosis of irregular radio opaque foreign body, with tubular component measuring 9x 7x 6 cm seen in upper vagina, extending through the anterior fornix into the urinary bladder. 
Figure 1 


Figure 2


She was examined under anaesthesia; a blue aerosol cap, encased in vaginolith, and a big bladder calculus were removed vaginally (Figure 3). 
Figure 3

The  vaginolith was friable and removed piecemeal, along with the intact cap. On cystoscopic and vaginal assessment, a large fistula of about 5 cm in diameter was identified in the anterior vaginal wall, involving the trigone. Biochemical analysis of the stone revealed lithiasis with predominant phosphate and uric acid structure. Five months later, the patient underwent suprapubic transvesical  repair of vesicovaginal fistula and made an unremarkable recovery.

DISCUSSION
Although females of all age group have experienced vaginal foreign bodies, certain age groups are at greater risk, such as children and elderly. The variety of objects found in the vagina ranges from bottle cap, toys, marble, drinking glasses, ginger roots etc. Vaginal foreign bodies may be as a result of psychiatric disorder or unusual sexual practices or for sexual gratification or as a form of contraception (1). Such a condition is usually recognized after a complication occurs, of which the commonest are infection, abnormal vaginal discharge, bleeding and stenosis . Vaginal foreign body may cause vesicovaginal, rectovaginal, urthrovaginal, ureterovaginal fistula. In the present case, secondary vaginolith formed around the foreign body, which eroded the anterior vaginal wall and resulted in vesicovaginal fistula.Evaluation of unusual urinary symptoms in an adolescent should include pelvic examination and imaging (2). Although vaginal foreign bodies are not uncommon, an undisclosed vaginal foreign body encased in secondary vaginolith contributing to vesicovaginal fistula formation is unusual. 


REFERENCES

1. N.Arikan, K. Turkolmez, S.Aytac and O. Gogus. Vesicovaginal fistula associated with vaginal foreign body. BJU international 2000; 85 (3): 375-376.  
2. Siddiqui NY, Paraiso MF. Vesicovaginal fistula due to an unreported foreign body in an adolescent. J. Pediatr Adolesc Gynecol. 2007; 20 (4): 253-255.


Date added to bjui.org: 25/02/2010 (publication information)
This content is exclusive to bjui.org website.

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CASE REPORTS: A  secondary vaginolith encasing a foreign body, causing unusual urinary symptoms in an adolescent

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