UROLOGICAL IMAGE Year : 2023  |  Volume : 39  |  Issue : 2  |  Page : 163-164  

Hourglass appearance in cystocele with an impacted vesical calculus

Manickam Ramalingam, Senthil Kallappan, MN Janani
Department of Urology, Hindusthan Hospital, Coimbatore, Tamil Nadu, India

Date of Submission14-Jan-2023Date of Decision21-Jan-2023Date of Acceptance03-Mar-2023Date of Web Publication31-Mar-2023

Correspondence Address:
Manickam Ramalingam
Department of Urology, Hindusthan Hospital, Coimbatore, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/iju.iju_20_23

     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.

How to cite this article:
Ramalingam M, Kallappan S, Janani M N. Hourglass appearance in cystocele with an impacted vesical calculus. Indian J Urol 2023;39:163-4
   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.

   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.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

 

   References 
1.aaureau M, Carlson KV. Pelvic organ prolapse: A primer for urologists. Can Urol Assoc J 2017;11:S125-30.  
    2.Saha MR, Saha TK, Wahab MAK, Haque MR. Uterovaginal prolapse with multiple vesical calculi: A rare case report. J Dhaka Med Coll 2016;25:77-9.  
    3.Hiremath AC, Shivakumar KS. Cystolitholapaxy and laparoscopic sacrocolpopexy in a case of multiple urinary bladder calculi and vault prolapse. Eur J Obstet Gynecol Reprod Biol 2019;243:12-5.  
    
  [Figure 1], [Figure 2]