An unusual case of vaginal stones - case study

Vaginal stones formed on the threads of a contraceptive intrauterine device, explains Dr Kowser Kabeer.

Figures 1 and 2: The patient's IUD with stones on both threads
Figures 1 and 2: The patient's IUD with stones on both threads

A 45-year-old woman presented to A&E with abdominal pain and diarrhoea of two days' duration. She was discharged from A&E with a diagnosis of gastroenteritis.

Two days later, the patient had severe lower abdominal cramps and extruded a stony object into the toilet bowl (figures 1 and 2).

She brought it to the surgery to show to her GP. Closer examination of the object by her GP confirmed the patient's own suspicion that it was her IUD, with stone formation around each of the two threads.

An intravaginal speculum examination could not be carried out in the surgery at that time because the patient normally required a hoist for transfer (she was wheelchair bound, with raised BMI).

Learning points
  • Colpolithiasis is rare.
  • It should be considered in patients with a high BMI, relative immobility and urinary incontinence.
  • Periodic self-examination of the IUD threads should be advised.

It is presumed that the weight of the stones slowly pulled the IUD out of the uterus.

This patient was also known to have respiratory muscle weakness requiring non-invasive ventilation during the night.

The IUD had been inserted three years previously, because of heavy menstrual bleeding. The patient had undergone a laparoscopic cholecystectomy in 2009.

All her tests, including serum calcium and parathyroid hormone, were normal. She was referred to a gynaecologist for an internal examination.

Discussion

Colpolithiasis (vaginal stones) is a rare condition. Vaginal stones can be primary or secondary.

Primary colpolithiasis can occur in urethra-vaginal fistula that develops after trauma, surgery, vaginal stenosis, ectopic vaginal ureter, neurogenic bladder, hypospadias, urethral diverticulum or vaginal outlet obstruction.1

Secondary colpolithiasis is usually the result of crystallisation of urinary constituents around a foreign body in the vagina.1

The first case of vaginal stones was reported in 1900.2 Cases reported in the medical literature are usually associated with urinary tract abnormalities, such as urethra-vaginal or vesicovaginal fistulas.

IUDs, even when normally located, tend to form calcareous deposits on their surfaces that differ between devices.3 This patient had a vaginal stone secondary to the IUD.

There were probably multiple contributory factors to stone formation in this patient - it may have resulted from urinary incontinence, high BMI, relative immobility due to her muscular dystrophy, and lack of periodic vaginal examination to check the IUD threads.2-4

  • Dr Kabeer is a GP in Wickford, Essex

References

1. Khattab SM, Youssef MA. Primary anterior vaginal wall pure ammonium acid urate stone - case report. Mid East Fertil Soc J 2013; 18(2): 120-2.

2. Navani S, Tessier PA. A primary vaginal stone. Br J Radiol 1970; 43: 222-3.

3. Beedham T, Rao K. Giant vaginal stone with embedded contraceptive device. J Royal Soc Med 2001; 94: 522-3.

4. Lin C-J, Chen C-P, Wu C-H et al. Huge primary vaginal stone in a recumbent woman. Taiwan J Obstet Gynecol 2005; 44(1): 80-2.

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