ABSTRACT
A 62-year-old hypertensive female presented with a mass protruding from the vagina for the past 20 years. She complained of dysuria and urinary incontinence for the past 3 months. There was no history of surgical intervention in the past. The examination revealed a tender irreducible total uterine prolapse (procidentia) and cystocele with a decubitus ulcer. Computed tomography urogram showed a total uterine prolapse along with the prolapse of a part of urinary bladder, with a vesical calculus of size 2.8 cm × 2.7 cm in the prolapsed part of the bladder, below the level of the pubic symphysis, with minimal wall thickening. After optimization, vesical lithotripsy and bilateral ureteric stenting were performed, followed by hysterectomy after 2 days.
DISCUSSION
Although, pelvic organ prolapse (POP) is common in the elderly, it usually goes unnoticed. Forty-one percent of the patients with an intact uterus and 38% of those who had a prior hysterectomy develop POP.[1] Uterine prolapse most commonly affects multiparous women, either due to the weakness of the pelvic floor muscles or because of the estrogen deprivation in the postmenopausal status.[2] Cystocele is the descent of urinary bladder into the vagina because of the weakness of muscles and the connective tissue. Only 5% of all the patients with vesical calculi are women.[3]
Computed tomography urogram showed a total uterine prolapse along with the prolapse of a part of urinary bladder [Figure 1], with a vesical calculus of size 2.8 cm × 2.7 cm in the prolapsed part of the bladder, below the level of the pubic symphysis [Figure 2], with minimal wall thickening. After optimization, vesical lithotripsy and bilateral ureteric stenting were performed, followed by hysterectomy after 2 days.
Figure 1.
Vesical calculus in the prolapsed bladder
Figure 2.
Contrast image showing the hourglass shaped bladder
CONCLUSION
Long-standing uterine prolapse with vesical calculi is unusual. The computed tomography (CT) image is unique, mimicking an hourglass appearance, with the plain CT showing a vesical calculus in the prolapsed part.
Footnotes
Financial support and sponsorship: Nil.
Conflicts of interest: There are no conflicts of interest.
REFERENCES
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