Giant dumb-bell calculus complicating vesico-vaginal fistula - a case report

A 34 year old, para 1(+0) woman was seen in February 2009. Her only confinement was 4 years earlier and was complicated by vesicovaginal fistula (VVF) due to prolonged obstructed labour. She had had 2 failed repairs of the VVF before presentation. About a month before the presentation, she started experiencing increasing perineal and suprapubic pain and the sensation of bearing down. A calculus was readily felt per vaginam and further evaluation revealed its extension into the urinary bladder incorporating nylon suture and vaginal tissues. The calculus was successfully excised by a combination of suprapubic and vaginal approaches. Public enlightenment should emphasize that the first attempt at VVF repair by an experienced surgeon in a proper surgical setting is the best chance for a successful outcome.