Vaginal stone

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Classification according to ICD-10
T19.2 Foreign bodies in the vulva and vagina
ICD-10 online (WHO version 2019)

Vaginal stones , called vaginal calculus ( plural : vaginal calculi ) or vaginolith in the English-language specialist literature , are extremely rare pathological mineral foreign bodies ( concretions or biominerals ) that can arise in the vagina .

etiology

A distinction is made between primary and secondary vaginal stones. Both forms have a different cause ( etiology ). Primary vaginal stones are caused by urine congestion ( urinary stasis ) in the vagina, with or without obstruction of the vaginal outlet . Secondary vaginal stones, on the other hand, are the result of the crystallization of constituents of the urine around a foreign body in the vulva and vagina. Primary vaginal stones are more common than secondary ones.

Obstruction of the vaginal outlet, as well as urinary incontinence , can lead to chronic accumulation of urine within the vagina. There - similar to the urinary stones in the urinary bladder - vaginal stones can form as concretions, which increase in size over time. In addition to obstruction of the vaginal outlet , vesicovaginal fistulas (VVF) can also cause chronic urine buildup in the vagina. A vesicovaginal fistula is an abnormal connection ( fistula ) between the bladder ( Latin: vesica ) and the vagina. A urethrovaginal fistula (UVF, connection between the ureter and the vagina) also leads to a build-up of urine in the vagina, which promotes the formation of vaginal stones. The same applies to a ureter (a Fehlmündung the ureter outside the bladder triangle , the trigone vesical ). The incidence of vaginal stones is also apparently increased with the extreme execution of a circumcision of female genitals , the so-called introcision (scraping of skin and tissue from the vagina).

Secondary vaginal stones form around foreign objects in the vagina. These can be, for example, non- absorbable sutures or gauze that remain in the vagina after the operation of a vesicovaginal fistula. These foreign bodies are then iatrogenic ('created by the doctor') in origin. Other foreign objects that have been introduced into the vagina and remained there can also be the cause of secondary vaginal stones. These include, for example, pessaries , intrauterine devices ('spirals'),

Vaginal stones can sometimes reach considerable sizes due to their progressive growth. Vaginal stones with a diameter of, for example, 8 cm are found in the literature.

Clinical picture

In many cases, vaginal stones are not clinically relevant and are more of an incidental finding. However, they can reach a size at which they obstruct various organs in their function. For example, the ureters can become blocked, which can lead to kidney failure .

diagnosis

Due to the relative rarity of vaginal stones, making a diagnosis is often very difficult and requires a doctor who is aware of the possibility of this diagnosis. For disabled children which is incidence obviously higher.

The formation of vaginal stones is a very slow process that, as long as it is symptom-free, is only an incidental finding. Vaginal stones can be easily identified using imaging methods such as x-rays or computed tomography (CT) of the pelvis. When x-raying, lateral and frontal imaging is recommended for precise localization and organ allocation. Diagnosis is much more difficult with sonography ("ultrasound").

Even after the X-ray, vaginal stones are initially usually misinterpreted as bladder stones . Excretory urography can be used to differentiate between bladder stones and vaginal stones. A reliable diagnosis is usually possible with colposcopy (vaginoscopy, vaginaloscopy).

therapy

Due to their rarity, there are no general guidelines for removing these pathological foreign bodies. The methods of removing the vaginal stones depend on the exact location and size of the concretions. Smaller stones can, for example, be removed minimally invasively using lithotripsy . Often they can also be removed through the vaginal canal with Wrigley obstetric forceps ( Wrigley's Forceps ).

Larger stones may have to be removed from the vagina via a perineal incision (episiotomy). Open surgery can also be indicated.

In addition, in many cases, the elimination of the causes of vaginal stone formation is indicated.

further reading

Individual evidence

  1. NV Raghavaiah, AI Devi: Primary vaginal stones. In: The Journal of urology Volume 123, Number 5, May 1980, pp. 771-772, ISSN  0022-5347 . PMID 7420576 .
  2. H. Ehrlich: Biological Materials of Marine Origin. 2010, Volume 1, Chapter 2 ( Biominerals. ), P. 27, doi : 10.1007 / 978-90-481-9130-7_2
  3. ^ A b c d B. Liu, X. Huang, J. Lu, Z. Zhang, P. Wang, Z. Huang: Vaginal calculi secondary to urethrovaginal fistula with vaginal stenosis in a 14-year-old girl. In: Urological research Volume 36, Number 1, February 2008, pp. 73-75, ISSN  0300-5623 . doi : 10.1007 / s00240-007-0129-x . PMID 18172633 .
  4. JC Plaire, WT Snodgrass, RW Grady, ME Mitchell: Vaginal calculi secondary to partial vaginal outlet obstruction in pediatric patients. In: The Journal of urology Volume 164, Number 1, July 2000, pp. 132-133, ISSN  0022-5347 . PMID 10840445 .
  5. a b N. Malhotra, S. Kumar, KK Roy, R. Agarwal, V. Verma: Vaginal calculus secondary to vaginal outlet obstruction. In: Journal of clinical ultrasound: JCU Volume 32, Number 4, May 2004, pp. 204-206, ISSN  0091-2751 . doi : 10.1002 / jcu.20015 . PMID 15101082 .
  6. J. Faber, H. Heidegger, R. v. Hugo, P. May, A. Wolf: Large vaginal stone in a patient with multiple sclerosis. In: Obstsh Frauenheilk Volume 57, Number 4, 1997, pp. 231-233, doi : 10.1055 / s-2007-1023074
  7. GR Sant, GR Conley, GT Klauber: Vaginal calculus in female with myelodysplasia. In: Urology Volume 22, Number 3, September 1983, pp. 294-296, ISSN  0090-4295 . PMID 6353734 .
  8. P. Oguzkurt, E. Ince, SS Ezer, A. Temiz, S. Demir, A. Hicsonmez: Primary vaginal calculus secondary to urethrovaginal fistula with imperforate hymen in a 6-year-old girl. In: Journal of pediatric surgery Volume 44, Number 7, July 2009, pp. E11-e13, ISSN  1531-5037 . doi : 10.1016 / j.jpedsurg.2009.03.040 . PMID 19573644 .
  9. a b c R. Malik, VK Pandya, G. Agrawal: Giant Vaginoliths. (PDF; 58 kB) In: Indian J Radiol Imaging 16, 2006, pp. 825-826, doi : 10.4103 / 0971-3026.32359
  10. L. Yusuf, S. Negash: Vaginal calculus following severe form of female genital mutilation: a case report. In: Ethiopian medical journal Volume 46, Number 2, April 2008, pp. 185-188, ISSN  0014-1755 . PMID 21309209 .
  11. ^ FH van Oorschot, WM Mallens, PJ van Helsdingen: A secondary vaginal stone. A case report. In: Diagnostic imaging in clinical medicine Volume 55, Number 3, 1986, pp. 157-160, ISSN  0254-881X . PMID 3636199 .
  12. a b c S. Patankar, S. Dobhada, M. Bhansali: Vesicovaginal fistula with secondary vaginal stones. In: Journal of laparoendoscopic & advanced surgical techniques. Part A Volume 16, Number 4, August 2006, pp. 386-389, ISSN  1092-6429 . doi : 10.1089 / lap.2006.16.386 . PMID 16968189 .
  13. ^ TP Mahapatra, MS Rao, K. Rao, SK Sharma, S. Vaidyanathan: Vesical calculi associated with vesicovaginal fistulas: management considerations. In: The Journal of urology Volume 136, Number 1, July 1986, pp. 94-95, ISSN  0022-5347 . PMID 3712627 .
  14. SH Chow, MD LaSalle, GS Rosenberg: Urinary incontinence secondary to a vaginal pessary. In: Urology Volume 49, Number 3, March 1997, pp. 458-459, ISSN  0090-4295 . doi : 10.1016 / S0090-4295 (96) 00453-0 . PMID 9123717 .
  15. ^ S. Dube: Formation of vaginal stone around thread of Copper-T: a case report. In: Journal of obstetrics and gynecology of India Volume 29, Number 3, June 1979, pp. 711-712, ISSN  0971-9202 . PMID 12335927 .
  16. T. Beedham, K. Rao: Giant stone with vaginal contraceptive device embedded.  ( Page no longer available , search in web archivesInfo: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. In: Journal of the Royal Society of Medicine Volume 94, Number 10, October 2001, pp. 522-523, ISSN 0141-0768 . PMID 11581348 . PMC 1282208 (free full text).@1@ 2Template: Dead Link / jrsm.rsmjournals.com   
  17. a b S. Chen, R. Ge u. a .: Giant primary vaginal calculus secondary to vesicovaginal fistula with partial vaginal outlet obstruction in a 12-year-old girl. In: Urology. Volume 78, Number 4, October 2011, pp. 908-910, ISSN  1527-9995 . doi : 10.1016 / j.urology.2011.01.026 . PMID 21420153 .
  18. ^ J. Heintz, J. Chason, A. Kramer: Bilateral ureteral obstruction caused by vaginal foreign body: a case report. In: The Canadian journal of urology Volume 16, Number 5, October 2009, pp. 4870-4872, ISSN  1195-9479 . PMID 19796471 .
  19. a b c S. Cetinkursun, I. Surer, S. Demirbag, H. Oztürk: A primary vaginal stone in a disabled child. In: Obstetrics and gynecology Volume 98, Number 5 Pt 2, November 2001, pp. 978-979, ISSN  0029-7844 . PMID 11704230 .
  20. T. Yoshimura, Y. Nagata, K. Matsuura, H. Okamura: Primary vaginal stone in an 11-year-old recumbent girl. In: Gynecologic and obstetric investigation Volume 50, Number 1, 2000, pp. 64-66, ISSN  0378-7346 . PMID 10895032 .
  21. ^ O. Bar-Moshe, G. Oboy, J. Assi: Vaginal calculi in a young woman. In: European Urology Volume 37, 2000, pp. 505-507. PMID 10765085 .
  22. C. Venet, P. Clapuyt, FX Wese: Vaginal stone in a teenager. In: British Journal of Urology 1997, 79: pp. 804-805. PMID 9158525 .
  23. ^ KR Emge: Vaginal foreign body extraction by forceps: a case report. In: American Journal of Obstetrics and Gynecology Volume 167, Number 2, August 1992, pp. 514-515, ISSN  0002-9378 . PMID 1497062 .