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.