Curriculum VitaeCurriculum Vitae

Name : BUDI IMAN SANTOSO MD Place and Birth : Jakarta, 5 September 1954 Office adress : Departement Obstetric & Gynecology FKUI/RSCM

Jl. Diponegoro 71, Jakarta Pusat Indonesia

Education: 1980 MD 1988 Specialist Obstetric and Gynecology 2003 Urogynecology consultant 2004 Head of urogynecology div depart ObGyn

Curriculum VitaeCurriculum Vitae Organisation :

• Member of Indonesian Medical Association• Vice Chairman of Indonesian Obstetric Gynecology Association• Secretary Continence Society of Indonesian• Secretary Indonesian female pelvic floor dysfunction Association• Chairman Indonesian secure contraception Association • Member of International Continence Society (ICS)• Member of International Uro-Gynecology Association (IUGA)• Member of Asia Pacific Continence Association Board (APCAB)• Member of Australian Association of Vaginal & Incontinence Surgeons (AAVIS)

TRANSVAGINAL REMOVAL OF BLADDER STONES IN GYNECOLOGIC CASES

BUDI IMAN SANTOSO, JUNIZAF

Division of Urogynecology, Department of Obstetric and Gynecology, Faculty of Medicine, University of Indonesia

Human being can alter their live by altering their attitudes of

mind

OUTLINE

INTRODUCTION

CASE REPORT

DISCUSSION

CONCLUSION

INTRODUCTION (1) A common problem Greater in male than female. Rarely found in obstetrics and gynecologic

cases. It may be found in pregnancy and delivery

(0.03 – 0.14%) Obstetric case: found at the time of delivery Gynecologic case: have not been reported

INTRODUCTION (2)

Reporting:

Two gynecologic cases + bladder

stones

Management by TRANSVAGINAL

satisfactory results

CASE REPORT

Two cases:

1. Bladder stone + vesicovaginal fistula

2. Bladder stones + third stage prolapsed

uterine.

CASE 1 Mrs. K, 35 years, P1A0. Referred by a GP diagnosis: vesicovaginal fistula History :

1st child 10 years ago assisted by a traditional birth attendant the baby was delivered dead - prolonged labor after delivery: did not feel urination, vagina discharge never realized had bladder stones referred to Jakarta

CASE 1 Gynecologic examination: irritation on

external genitalia and vaginal discharge normal urethra

Speculum examination: anterior vaginal wall protruded into vagina, a hole in the middle of protrusion, urinary discharge

Vaginal toucher : a bulge on anterior vaginal wall the sounding was held back and tapping test (+) stone

Diagnosis : vesicovaginal fistula with bladder stones

CASE 1 Fistula closure repair and bladder stones -

transvaginal approach Technique:

1. Incision on vaginal mucosa 2. The vaginal wall was separated from its base3. Longitudinal incision fistula hole

measured ± 2 cm x 1 cm4. Through this hole stones destruction

(lithotripsy) stones could be removed into vagina

CASE 1 – Post operation

Permanent catheter for 5 days Prophylactic antibiotics : 4 x 500 mg

amoxycillin. Day 8 : discharged from hospital good

conditions, no complaint, normal spontaneous urination

Follow-up 2 wk – 1 mo : no complaint

CASE 2

Mrs. H, 65 years, P12A0, History: Referred, diagnosis: 3rd stage prolapsed

uterine Since 15 years ago, uterine had descended;

reversible Recently: permanent Discharging stones when urinating about five

years ago Difficult urination

CASE 2 Gynecologic examination: uterine and

anterior vaginal wall had protruded from vaginal opening.

Vaginal palpation: protruding bladder situated in front of the uterine

Several irregular solid matters inside the bladder, sounding :resistance, stone tapping test was (+)

Diagnosis : stage III uterovaginal prolapse + bladder stones.

CASE 2

Radiograph: multiple bladder stones + hydroureter, hydronephrosis

Vaginal hysterectomy, anterior colporaphy and colpoperineoraphy, removal of bladder stones transvaginal approach.

CASE 2 – Post operation

Permanent catheter for 5 days

2 x 200 mg Ciprofloxacin

On day 8 : discharged from hospital

No complaint and urinate spontaneously

DISCUSSION (1) Relative large bladder stones were found 1st case: a stone, 6 cm x 6 cm 2nd case: multiple stones, 0.5 - 4 cm, 16

stones. average diameter 5 x 5 cm Large stone gradually cause protrusion to

posterior bladder wall toward vaginal cavity Posterior bladder tissues will be stretched

in accordance with the stone size.

DISCUSSION (2)

Stretching could occur: Proximally: toward the portio, Distally: toward the urethra Laterally: to the right and left vaginal walls

Distance between urethral orifice and the angle of urethral bladder will be kept far

DISCUSSION (3)

It is possible to perform median incision

without injuring urethral orifice Our experience: large fistula 3 - 4 cm

no trauma or binding had occurred.

DISCUSSION (4) Usual technique : lithotripsy through urethra or

through abdominal bladder operation (sectio alta) Large size bladder stone: easier removed by

transvaginal approach Usual postoperative treatment for gynecologic

cases (other transvaginal operation) No significant complications Discharged from hospital on day 7 or day 8 1 month follow up: no complaint, good healing

DISCUSSION (5)

Relatively large bladder stones stretch the bladder

bladder stones could be removed through transvaginal approach

CONCLUSIONS (1)

Bladder stones + gynecologic cases:

rarely found

We have managed two gynecologic

cases + bladder stones

CONCLUSIONS (2) 1st case: vesicovaginal fistula + single

bladder stone transvaginal lithotripsy and fistula repair

2nd case: stage III prolapsed uterine + multiple bladder stones vaginal hysterectomy and bladder stones removal by transvaginal approach simultaneously

CONCLUSIONS (3)

No complication, day 7 / day 8: discharged Very good outcome Transvaginal method could be applied in the

future as one of the techniques for removing relatively large bladder stones.

REFERENCES 1. Cofe E. Obstructed Labour due to vesical calculas. J Obstet

Gynecol Brit Empire. 1961; 68: 4762. Mc Vann RM. Urinary Calculi associated with pregnancy. Am J

Obstet Gynecol. 1964; 89: 3143. Schmid JP Urinary Calculi in Pregnancy. In: Burchbaum and

Schmadf, eds. Gynecologic and Obstetric Urology. Philadelphia London Toronto: WB Saunders, 1978: 436-46

4. Sjamsuhidayat R. Win De Yong. Buku ajar Ilmu Bedah. Penerbitan Kedoktcran EGC 1997; 1027

5. Stanton SL. Clinical gynecologic urology. Mosby Company 1984; 218