Bladder stone as the first clue to a hidden vesicovaginal fistula: diagnostic and surgical insights from a multidisciplinary approach-a case report.

BACKGROUND: Women presenting with urinary tract symptoms such as bladder stones are often presumed to have primary urological disease. However, urogynecologic conditions-including vesicovaginal fistula (VVF) and retained vaginal foreign bodies-can rarely manifest with predominant urological symptoms, leading to diagnostic delay.

CASE DESCRIPTION: A 20-year-old female presented with persistent lower urinary tract discomfort and urinary leakage for 2 years. She denied abdominal pain, distension, or menstrual irregularities. No psychiatric or surgical history was reported, and renal function was within normal limits [serum creatinine 73.9 µmol/L; estimated glomerular filtration rate (eGFR) 100.96 mL/min/1.73 m2]. Contrast-enhanced computed tomography (CT) suggested mildly reduced right renal excretory function, raising concern for possible early functional compromise in the setting of chronic hydronephrosis. Imaging further revealed a bladder stone associated with a retained vaginal foreign body and a 2-cm vesicovaginal fistulous tract, complicated by bilateral upper urinary tract dilatation/giant ureters. The patient underwent a combined transabdominal-transvaginal procedure for complete removal of the stone and foreign body, multilayer fistula repair, and bilateral double-J ureteral stenting. The ureteral stents were removed 1 month postoperatively. CT urography performed 5 months after stent removal demonstrated marked improvement of upper urinary tract dilatation with no evidence of contrast extravasation into the vagina.

CONCLUSIONS: This case underscores that an apparently straightforward urological presentation may conceal complex urogynecologic pathology. Early cross-disciplinary assessment between urology and gynecology, supported by targeted imaging and functional evaluation, is essential for timely diagnosis and comprehensive management.