A ureterovaginal fistula is a rare complication after vaginal mesh surgery, and finding a vaginal stone as a consequence is even more rare.
In this video we present a two stage procedure, with the removal of the vaginal stone with an endoscopic technique  and as a second stage a robotic ureteral reimplantation with very good functional results for our patient.

An 84-year-old lady who had history of  a mesh hysteropexy with anterior vaginal plastia and perineal body repair surgery performed in 2013. That same year, she also underwent a modified left radical mastectomy due to a  T3 N0 M0 breast cancer with neoadjuvant chemotherapy, radiotherapy and Letrozol treatment.
In 2024 she presented to our outpatient clinic with a year long history of  continuous vaginal leakage, which was later confirmed to be urine, reason for her referral to the Urology Department in 2024. During her evaluation she confirmed long-standing urinary incontinence associated with a calcified formation attached to the uterine cervix and a protruding through the vaginal introitus. She also had various urinary infections during this period of time. 
A cystoscopy was performed, ruling out urethral and intravesical findings. 
A urodynamic study reported continuous urethral incontinence during the filling phase, which could be consistent with a vesicovaginal fistula, it also reported detrusor overactivity. 
A CT cystogram was finally performed, demonstrating postoperative changes secondary to hysteropexy: a large 3.8 cm intravaginal calcification. A linear contrast image was found in the excretory phase, appearing to connect the right distal ureter with the vaginal lumen, consistent with a ureterovaginal fistula. 
We performed combined surgery, using endoscopy to excise the vaginal calcification and robotic surgery to perform a right ureteral reimplantation using the Lich-Gregoir technique. The calcification was located over the mesh exposure in the uterine cervix, which, in constant contact with urine, created a large lithiasis.

The intervention time was 160 minutes. No intra- or post-operative complications were recorded, with the patient being discharged after 48 hours.  After a 2 months follow-up the urine leak was resolved with no further need for a pad

The mesh exposure creating a ureterovaginal fistula it is likely to bethe etiological factor for the stone formation. 
If a large vaginal stone is found, it should be mandatory to further investigate in order to rule out the existence of a possible urinary fistula, especially when there is a previous surgical history.
The video showcases the enhanced benefits of greater visualization, precision, and dexterity offered by the robotic surgery system for repairing the ureterovaginal fistula