A rare vesicovaginal stone case series managed with endoscopic laser lithotripsy and subsequent staged repair of vesicovaginal fistula

Abstract

Vesicovaginal fistula (VVF) due to various obstetric or gynecological causes is not uncommon but vesicovaginal stone in association with VVF is extremely rare presentation. The symptoms of vesicovaginal stone may be variable from recurrent urinary tract infections to perineal swelling with urinary incontinence. To diagnose stone associated with VVF only pervaginal examination is sufficient without need of any invasive investigations but still it is missed or diagnosed lately. To increase knowledge of this unusual condition we present case series of four such rare cases to outline safety and efficacy of endoscopic laser lithotripsy approach to manage vesicovaginal stone. We have used endoscopic laser lithotripsy method to clear the vesicovaginal stone which is minimally invasive way to provide early recovery by avoiding open surgical approach. Subsequently fistula can be repaired successfully after 6 weeks once bladder and vaginal wall infection and inflammation related to stone subside. To minimize morbidity in our cases we have specially used holmium laser energy to break the stone.