Transvaginal Cystolithotomy: A Novel Approach

Area of Science:

• Urology
• Minimally Invasive Surgery
• Female Pelvic Medicine

Background:

• Management of cystolithiasis (bladder stones) can be challenging in female patients with prior abdominal surgeries and no urethral access.
• Neurogenic bladder secondary to spinal cord injury and pelvic fractures often necessitates complex urinary diversion and management strategies.

Observation:

• A novel transvaginal cystolithotomy approach was utilized in a 51-year-old female with a history of neurogenic bladder and previous transabdominal bladder neck closure.
• Preoperative imaging revealed a 3 cm bladder stone with overlying bowel, complicating traditional surgical access.

Findings:

• The transvaginal approach allowed for direct visualization and intact removal of the 3 cm bladder stone with minimal operative time (55 minutes) and blood loss (25 cc).
• The patient experienced a rapid recovery, discharged on postoperative day 0, and resumed self-catheterization without complications within 1 year.

Implications:

• This technique demonstrates the feasibility and safety of transvaginal cystolithotomy as an alternative surgical option for select female patients with complex bladder stone burdens.
• The transvaginal route bypasses the need for urethral access and avoids further abdominal surgery, offering a valuable option for patients with challenging anatomy.