Two Cases of Obstructive Uropathy in Patients with Advanced Pelvic Organ Prolapse

Jason Cruff, Beaumont Health
Salil Khandwala, Beaumont Health


Background: Pelvic organ prolapse (POP) is a common gynecologic condition. Symptoms include perceiving a vaginal bulge or having difficulty with voiding or defecating. In advanced cases of POP, there is a possibility of damage to the upper urinary tract. Moreover, this problem could be subclinical and go completely unrecognized.

Cases: This article presents 2 cases of women with advanced stage POP who were also found to have hydronephrosis. The first patient was an 86-year-old female who had bilateral hydronephrosis with hydroureters. She had complete vaginal eversion. She opted for pessary management and ultimately underwent colpocleisis and midurethral sling placement. The second case was an 81-year-old female who had worsening left hydronephrosis and stage IV chronic kidney disease. She had stage 4 uterovaginal prolapse. She opted for pessary management.

Results: Both patients were treated with pessary management. Although the pessaries produced improvements, the patient in case 1 wanted more definitive treatment. Colpocleisis and midurethral sling placement were performed and produced complete resolution of this patient's hydronephrosis. In Case 2, although there was no short-term improvement produced by the pessary, 5 months later the improvement was significant and the patient was satisfied with this management.