Bladder calculi presenting as complete procidentia.

Area of Science:

• Urology
• Gynecology

Background:

• Complete procidentia, particularly when irreducible and associated with urosepsis, poses significant clinical challenges.
• This case highlights the complex interplay between pelvic organ prolapse and urological complications.

Observation:

• A 71-year-old multiparous woman presented with urosepsis and a large, irreducible procidentia.
• Imaging revealed a staghorn calculus and a completely prolapsed, calcified fibroid uterus.
• Examination identified a large bladder mass.

Findings:

• Vaginal hysterectomy and prolapse correction were performed after sepsis resolution.
• Cystotomy revealed multiple bladder calculi, with the largest measuring 8.1 x 6.8 x 4.6 cm.
• A small uterus (67g) was noted alongside the significant bladder calculi.

Implications:

• Cystolithiasis should be a key consideration in patients presenting with large, calcified pelvic organ prolapse.
• This case underscores the importance of thorough urological evaluation in complex gynecological presentations.
• Management requires a multidisciplinary approach addressing both prolapse and stone burden.