Vesical calculi with unrepaired vesicovaginal fistula: a clinical appraisal of an uncommon association.
OBJECTIVE
Primary vesical calculi are uncommon in patients with vesicovaginal fistula (VVF). We retrospectively analyzed 19 such cases and present our experience with the management of this condition.


METHODS
Between January 1989 and December 2002, 19 patients were treated for this association. All patients provided a history and underwent physical examination, metabolic evaluation for stone disease, urine culture test and cystovaginoscopic examination. They were treated with a staged procedure with the fistula repaired 2 to 3 months after stone removal.


RESULTS
VVF was a result of obstructed labor in all cases. The patients presented a mean of 28.8 months after fistula formation. No metabolic abnormality was detected in any patient. Urine culture was positive for Proteus mirabilis in 6 and Escherichia coli in 5, and it yielded mixed growth in 8. All women had some residual urine in the bladder (mean 11 ml). The fistula was located supratrigonally in 13 cases, while it was high trigonal in the remainder. A total of 17 patients were treated endoscopically by cystolitholapexy or fragmentation of the stone by transurethral cystolithotripsy using a Lithoclast (Microvasive Urology, Natick, Massachusetts). Two patients required open suprapubic cystolithotomy. All patients underwent fistula repair 3 months after stone removal with successful results in 16.


CONCLUSIONS
Primary vesical calculi in patients with VVF are associated with urinary contamination, a high or supratrigonal fistula location, residual urine in the bladder and a long history of disease. Staged management of the problem showed good results.
Dalela
D
D
Department of Urology, Chhatrapati Shahuji Maharaj Medical University (Upgraded King George's Medical College), Lucknow, India. drdalela@satyam.net.in
Goel
Apul
A
Shakhwar
S N
SN
Singh
K M
KM
D001437:Bacteriuria; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D001744:Urinary Bladder Calculi / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D014719:Vesicovaginal Fistula / Q000150:complications* / Q000601:surgery