A large vaginal stone on top of ureteric stent migration through a poucho-vaginal fistula after radical cystectomy and ileal neobladder reconstruction - A case report

Introduction and importance: Orthotopic neobladder reconstruction may be associated with complications such as neobladder-vaginal fistula (NVF) and uretero-ileal anastomotic stricture which are often managed using stents, though these can be prone to migration.

Case presentation: We present a 69-year-old lady with a surgical history of radical cystectomy and ileal neobladder that was complicated by a left ureteric stricture and poucho-vaginal fistula for which she underwent a left ureteric stent and bilateral percutaneous nephrostomy (PCN) insertions after which she lost to follow-up. The patient later presented to our center with a right subcostal anterior abdominal wall desmoid tumor for which she underwent wide local excision. During the pre-operative catheterization, a stony hard object was identified within the vaginal cavity. Examination under anesthesia revealed large stones that developed on the migrated stent which was extracted along with five large stones.

Clinical discussion: The most common endoscopically treated neobladder-related late complications are uretero-ileal anastomotic stricture and calculus development. The presented patient developed two of these complications which are left ureteric stricture as well as a poucho-vaginal fistula. Meanwhile, the most difficult complication related to ureteral stents is retained stents and their sequelae including encrustation. About 3.6-10 % of women experience NVF after orthotropic neobladder reconstruction. To the best of our knowledge, this is the first case ever to be presented by such a presentation.

Conclusion: Our presented case underscores the importance of prompt detection and proactive management of complications after ileal neobladder reconstruction which can prevent the development of more complications and save the patients from unexpected scenarios.