








































This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2023 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Pelvic organ prolapse (POP), bladder calculi, 
cystolitholapaxy, sacrocolpopexy

None declared.

Patient consent: Obtained.

Received on July 12, 2022 
Accepted on, July 27, 2022

Soc Int Urol J. 2023;4(1):69–70

DOI: 10.48083/QJEP9763

References

1. Hiremath AC, Shivakumar KS. Cystolitholapaxy and laparoscopic 
sacrocolpopexy in a case of multiple urinary bladder calculi & vault 
prolapse. Eur J Obstet Gynecol Reprod Biol.2019 Dec;243:12-15. doi: 
10.1016/j.ejogrb.2019.10.002. Epub 2019 Oct 11.

2. Thompson CD, Henderson BE, Stanley R. Bladder calculi causing 
irreducible urogenit al prolapse. BMJ Case Rep. 2 018 Sep 
12;2018:bcr2018225695. doi: 10.1136/bcr-2018-225695.

3. Wai CY, Margulis V, Baugh BR, Schaf fer JI. Multiple vesical 
calculi and complete vaginal vault prolapse. Am J Obstet 
Gynecol.2003;189(3):884-885. doi: 10.1067/s0002-9378(03)00131-5.

4. Mahran M. Vesical calculi complicating uterovaginal prolapse. J Obstet 
Gynaecol Br Commonw. 1972;79(12):1145-1146. doi: 10.1111/j.1471-
0528.1972.tb11902.x

5. Naidu A, Nusee Z, Tayib S. Uterine inversion with massive 
uterovaginal prolapse and multiple bladder stones. J Obstet Gynaecol 
Res.2011;37(6):633-635. doi: 10.1111/j.1447-0756.2010.01401.x. Epub 
2011 Feb 23.

Chronic Pelvic Organ Prolapse and Bladder Calculi  
in an Adolescent

Reyhane Ebrahimi,1 Alireza Soltani Khaboushan,1,2 Abdol-Mohammad Kajbafzadeh1,3

1 Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, children’s Medical Center, Tehran University of Medical 
Science, Tehran, Iran 2 Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran 3 Pediatric Urology and Regenerative Medicine 
Research Center, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran

Vesical calculi complicating pelvic organ prolapse (POP) is very rare and usually be seen in older women. There are 
limited reports of POP associated with vesical calculi; the first was in 1950[1,2]. The pathophysiology of concomitant 
occurrence of POP and vesical calculi is still unknown. It has been mentioned that urinary stasis, along with the 
superimposed infection due to elevated residual urine volume, are among contributory factors and possible etiologies 
of bladder calculi in long-lasting POP cases[2,3]. 

A 17-year-old virgin female presented to our center with massive POP since birth, which had gradually increased 
in size. She had a history of recurrent non-febrile urinary tract infection episodes with urinary stone passing and 
difficulty in voiding. No symptoms of urinary or bowel incontinence were present. Prior to admission, she had to 
push back the bulge protruding out of the vagina and perform the Credé maneuver along with crossing her legs 
in  order  to empty  the  bladder satisfactorily. The patient did not meet the criteria for Ehlers-Danlos syndrome. 
Prolapsed ureters and bladder and the stones within the bladder are shown in Figures 1A and 1B, respectively.  
Figure 1C shows the prolapsed bowel. Biopsies from the interlabial mass revealed no dysplasia or malignancy. Follow-
ing transurethral cystolitholapaxy for removal of bladder stones, the patient underwent abdominal sacrocolpopexy 
to repair POP. The operation and postoperative period were uneventful, and the patient was discharged with a stable 
general condition. In short-term and long-term follow-up, she did not have a recurrence of symptoms, and she had  
2 full-term pregnancies with successful vaginal delivery, 7 and 8 years after her surgery. 

All previous cases with POP and vesical calculi were reported in multiparous women aged over 40 years [1–5].  
To the best of our knowledge, this is the first case of simultaneous POP and vesical calculi occurring in a virgin 
adolescent. Transurethral cystolitholapaxy followed by abdominal sacrocolpopexy is a safe therapeutic approach with 
little associated morbidity. Despite greater prevalence of POP in older women, it should also be considered in younger 
females to prevent the progression into more severe POP with serious complications.

69SIUJ.ORG SIUJ  •  Volume 4, Number 1  •  January 2023

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FIGURE 1

A. Intravenous pyelogram demonstrated prolapse of ureters (asterisks) and bladder (arrow) that are pushed down  
near the knee; B. The prolapsed bladder with six stones (arrow); C. Barium enema showed a significant portion of  
the prolapsed bowel (arrow) 

A B C

70 SIUJ  •  Volume 4, Number 1  •  January 2023 SIUJ.ORG

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