title: A large primary vaginal calculus in a woman with paraplegia.
abstract: OBJECTIVE
  The study aimed to report a primary vaginal stone, an extremely rare entity, without vesicovaginal fistula in a woman with disability.
  
  
  METHODS
  We describe the case of a large primary vaginal calculus in a 22-year-old woman with paraplegia, which, surprisingly, was not diagnosed until she was examined under general anesthesia during a preparation for laparoscopy for an adnexal mass. The stone had not been identified by physical examination with the patient in a recumbent position or by transabdominal ultrasonography and pelvic tomography during the preoperative preparation. Vaginoscopy was not performed because the vagina was completely filled with the mass. As a result of its size and hard consistency, a right-sided episiotomy was performed and a 136-g stone was removed using ring forceps. A vesicovaginal fistula was excluded. There was no evidence of a foreign body or other nidus on the cut section of the stone, and it was determined to be composed of 100% struvite (ammonium magnesium phosphate). Culture of urine obtained via catheter showed Escherichia coli. After the surgical removal of the calculus without complications, a program of intermittent catheterization was started. The follow-up period was uneventful, and the patient was symptom free at 6 months after the operation.
  
  
  CONCLUSIONS
  We postulate that the calculus formed as a consequence of urinary contamination of the vagina in association with incontinence and prolonged maintenance in a recumbent posture. This report is important because it highlights that, although vaginal stones are very rare, their possibility should be considered in the differential diagnosis of individuals with long-term paraplegia.
authors.affiliation: Department of Gynecology and Obstetrics, Ankara Ataturk Education and Research Hospital, Ankara, Turkey.
authors.forename: Ayse Filiz
authors.initials: AF
authors.lastname: Avsar
authors.forename: Huseyin Levent
authors.initials: HL
authors.lastname: Keskin
authors.forename: Tuba
authors.initials: T
authors.lastname: Catma
authors.forename: Basak
authors.initials: B
authors.lastname: Kaya
authors.forename: Ahmet Akın
authors.initials: AA
authors.lastname: Sivaslioglu
mesh_terms: D002137:Calculi / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D010264:Paraplegia / Q000175:diagnosis*; D010388:Pelvis / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014556:Urine / Q000382:microbiology; D014623:Vaginal Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D055815:Young Adult