Background:Gigantic calculus associated with VVF is extremely rare, most common causes usually are presence of foreign body, urinary tract infection, and prolonged duration of disease. Stone can be identified radiologically in 7 % of VVF using excretory urogram. In developing countries, Vesico-vaginal fistula (VVF) results following obstetric trauma or iatrogenic during hysterectomy. 
Objective:
To describe a case of Gigantic calculus associated with an Vesico-Vaginal fistula, review its etiology, contributing factors and discuss surgical management strategies.
Case presentation: We report a case of vesico vaginal stone with vesico vaginal fistula in 60 years old woman presented with total incontinence,patient  plain xray was showed radio opaque shadow fully covered the pelvic area,in which we performed an open cystolithotomy removed stone of about 1220gm along with VVF repair,bladder size and capacity was also markedly reduced after separation from vagina we, also took biopsy from both vagina and bladder.Postoperative patient remained stable, but repair got failed, biopsy suggested malignancy(squamous cell carcinoma). According to guidelines she needs cystectomy and urinary diversion, which was suggested, but she refused and went lama for some spiritual treatment by her Murshid/ Pir.

Study Design:
Case report and comprehensive literature review.
Setting and Duration:
Department of Urology, Jinnah Postgraduate Medical Center, Karachi, Pakistan; January 2022 to January 2023.
Methods:
A detailed literature review was conducted to compile data on the etiology and surgical approaches for managing Gigantic vesical calculus associated with Vesico-Vaginal fistula.

Results:
We performed open cystolithotomy along with VVF repair. The surgical outcome was not satisfactory as repair got failed and biopsy suggested squamous cell carcinoma. Patient denied for further management and got LAMA.

Interpretation of result:
This unique case was studied and necessary investigations were carried out, and surgical intervention was done. The patient wad followed for outcome but satisfactory outcome couldn’t be achieved and further treatment was denied by the patient.

Conclusion:Vesicovaginal stone associated with vesicovaginal fistula is extremely rare. Having foreign body or stone in bladder for long time can cause  metaplasia and squamous ca.Such kind of cases are unfortunately seen only in 3rd world countries where health services are either not available or not reachable to common public, and if available it may not be according to standards. All these factors ultimately responsible for such neglected cases. Doing procedure in this patient was not a big deal , but suffering for such a long time to stone reached  to that extent is definitely worrisome, we as health care workers and offcourse healthcare system should ensure readily availability of healthcare services to prevent such incidences. Purpose of our case report is to highlight the worrisome health care situation for the people of 3rd world countries and to reported the first ever case of gigantic stone of about 1220gm which is associated with VVF and malignancy.