Bladder Stones in Women with Vesico-Vaginal Fistula in Kwara State, Nigeria: Two Case Reports and Review of Literature.

Abstract

Women who have vesico-vaginal fistula can sociodevelop
bladder stones because of inadequate intake of water, stasis of urine, incomplete emptying of urine or infection. Bladder stones can also lead to vesico-vaginal fistula if the stone is large and embedded into the bladder wall. The irritating effect of the bladder stone is distressing, affects the social and mental wellbeing of women and it poses a challenge to repair options and outcome.

This case report featured two cases of women with vesico-vaginal fistula (VVF) co-existing with symptomatic bladder stones. The two cases had history of previous caesarean section following prolonged obstructed labour and macerated stillbirth. They presented with suprapubic pain, offensive urine and psychological distress. They had examination and dye test in theater which showed juxtacervical vvf and bladder sound with metal catheter suggested bladder stones confirmed by ultrasound. One patient had IVU to rule out ureteric injury. They both had transvaginal  removal of the stone and concurrent VVF repair with good outcome. The stones were large and of varied sizes ranging 4cm by 2cm and 3cm by 2cm. Both patients were closed and dry 14 days after repair, confirmed by dye test before discharge.

Bladder stones canlead to urinary symptoms such as suprapubic pain and recurrent urinary tract infection in women with VVF. Stones canco-exist with VVF or could lead to VVF. Successful repair can be achieved when bladder stones are removed concurrently during VVF repair in well selected patients.