1. VAGINAL URINARY CALCULI IN A PARAPLEGIC WOMAN SW Tham, A Kartina, K Mukudan Obstetrics & Gynaecology Department Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia Abstract Vaginal calculi secondary to urinary incontinence is an infrequent occurrence. We report the case of a 34 year old paraplegic lady, with complaint of mass per vagina. She has urinary incontinence for 10 years due to an MVA. She is a divorcee and not sexually active. On examination, a big, hard rough surfaced mass was noted in the vagina. Trans-abdominal ultrasound revealed a solid calcified mass in the vagina. The removed stone weighed 200grams and measures 8x4x4cm. History Mrs.ZA, is a 34 year old lady, Para 0+1. She presented to us with the complaint of a hard mass in her vagina, which was noted by her care taker. She gave history of an MVA which rendered her paraplegic with urinary incontinence for the past 10 years. She is also bedridden since the MVA. She had no other co-morbid. Mrs.ZA is separated from her husband and has been staying with her care taker since the MVA. Physical Findings General examination was normal except for the paraplegic lower limbs. Abdominal examination was also unremarkable. Vaginal examination revealed urinary incontinence. Inspection showed a calcareous mass just within the vaginal outlet. Digital examination confirmed the presence of a stony hard mass in the vagina measuring 8cm X 4cm X 4cm. Ultrasonography Poor bladder window due to continuous leakage of urine made this difficult. However, a normal sized anteverted uterus with a solid oblong mass measuring 8x4x4cm in the vagina can still be visualized. Treatment The stone was removed vaginally with the help of 2 Sim’s speculums and a Sponge holding forceps. The removed vaginal stone weighed 200gm. Clinical Findings Picture 1 – Mrs.ZA, a paraplegic with urinary incontinence. Picture 2 – The 200gm vaginal stone compared to an ink pen. Picture 3 – Close up of the vaginal stone Discussion Many cases of stone formation in the vagina have been reported in the literature. Presence or absence of foreign body classifies them into primary or secondary stones. To the best of our knowledge, this is the only reported case of primary vaginal stone secondary to paraplegia with urinary incontinence in Malaysia The combination of urinary incontinence and bedridden would have led to stasis of urine in the vagina and formation of the calculi. Primary vaginal stones are extremely rare and are formed due to deposition of urinary salts as a result of continuous leakage and stasis of urine into the vagina. They have been described in association with urinary leakage caused by anatomical abnormalities, incontinence due to a neurogenic bladder, vaginal outlet obstruction and bladder exstrophy. Secondary vaginal stones have been reported in cases of inadvertently unremoved medical gauze in patient with vesico-vaginal fistula and calculus formation around IUD threads. References 1. Kolte SP et al Primary vaginoliths. Ind J Radiol Imag 2002 12;4:511- 512 2. Bar-Moshe O et al. Vaginal calculi in a young women.European Urology 200;37:505-507. 3. Stoller ML et al Urinary stone disease.In: Tanagho EA, McAniach JW. Smith’s general urology. 14 th Edition. Prentice Hall International, 291-316 4. Garcia Ligero et al. Actas Urol Esp. 2001 Sep;25(8):582-5.