A Case of Prolapsed Uterus with Stone Bladder Presented by Dr. Narayan M. Patel M.D.,D.G.O. FICS Emeritus Professor Muni. Medical college Postal address-- Mahalaxmi Institute of medical teaching, 3, Shantiniketan park, Naranpura, Nr.Sardar Patel Colony, AHMEDABAD- 380 014 (Gujarat) INDIA T.N.(079) 27682572, Mobile;- 98252 95530 E mail:- narayanpatel1932@yahoo.com

This patient aged about 50 years came with c/o some thing coming out of vagina and burning maturation. She had procedentia as shown in this picture In India, in the state of Gujarat, where I am practicing, some district have vary hard drinking water, with plenty of salts. In these areas, Kidney stones, ureteric stones and bladder stones are vary common. It is our practice to get x-ray done in long standing prolapse cases. We got her x-ray pelvis after reducing the prolapse, and in the next slide you will see 2 stones in urinary bladder.

If we had taken x-ray pelvis without reducing Stone X-ray pelvis shows 2 stones, quite big in size. Stone If we had taken x-ray pelvis without reducing prolapse, then the stones will be seen out of pelvis, This patient was given antibiotics and then was taken up for operation, under spinal anesthesia. At operation, it is always safe to first remove stones and then proceed for hysterectomy

Ant. vaginal wall. Bladder You see in this picture that, anterior vaginal wall is separated from underneath bladder. The bladder bulge is seen. Ellis forceps are holding anterior vaginal wall on either side. Folleys catheter is in the bladder.

Stones Stones Bladder was opened up with knife and we could locate stoned in it. They were carefully removed and a good wash was given to the area, Bladder was sutured in 2 layers by vicryl 2/0 suture. Folleys catheter was kept in for, about 10 days, in post operative period. Recover was uneventful.

After suturing bladder, we proceed doing vaginal hysterectomy in the usual manner. Bladder was emptied more often during The hysterectomy procedure. You see the uterus that was Removed and also the stones by its side. Anterior and posterior repair were done as usual.. Intentional opening of bladder and then care full suturing it, do not give rise to any complications. We have followed this procedure in a number of cases, without any complication.

Thank you