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
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