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INTRODUCTION Uterovaginal prolapse and vesical calculi are two well-known disorders, but their co- existence is rare. CASE HISTORY A 65-year-old postmenopausal female, presented OPD with something coming out per vaginum for 22 years with irreducibility for 10 years, occasional dribbling of urine since last 2 years On local examination procidentia , decubitus ulcer of around 4 cm, prolapse difficult to reduce, painful to touch, hard anterior cystocele bulge. INVESTIGATIONS USG A+P - Severe urogenital prolapse with significant dilatation of upper urinary tracts, multiple calculi visualized in urinary bladder with gross thickening of urinary bladder. CT KUB (plain + contrast) - Severe urogenital prolapse with cystocele with thickened urinary bladder of small capacity with multiple calculi. Dilatation of both ureter and pelvicalyceal system (left>right) TREATMENT Patient underwent vaginal hysterectomy with colpoperineorrhaphy with open cystolithotomy with ureteric stenting. Intraoperative extensive bladder wall thickening, and fibrosis was noted,33 bladder calculi were removed, Bladder had small capacity of 50 cc. During follow up of 2 months, patient presented with repeated episodes of urinary tract infection with dribbling of urine with foleys in situ. Bladder capacity and the compliance remained poor, with normal kidney function, in consultation with urologist, patient was given an option of urinary diversion surgery but was lost to follow up. DISCUSSION The aetiology for the bladder caliculi in this patient is due to a neglected long standing irreducible genitourinary prolapse causing incomplete emptying of the bladder, with urinary stasis acting as a nidus for stone formation2 Such prolapse with multiple large calculi lead to further irreducibility, with bladder outlet obstruction, along with repeated cystitis resulting in bladder wall thickening and fibrosis. This further lead to a decrease in capacity of the urinary bladder and loss of pliability of the bladder wall causing inflammatory contracted1 (small capacity) bladder, which is a rarity. CONCLUSION Prolonged and neglected prolapse can cause irreducibility which may cause bladder calculi which if neglected can lead to inflammatory contractile or small bladder with its catastrophic effects. Early intervention avoid such rare complications