It is known that if left untreated, women with severe uterovaginal or vault prolapse may have hydronephrosis (1) or renal impairment.The prevalence of hydronephrosis in patients undergoing treatment for pelvic organ prolapse has been reported to be in the range of 7.7% to 17%. (1,3,4) It has been demonstrated that the prevalence of hydronephrosis significantly increases with the severity of prolapse. (4) In this study, we aimed to: (a) evaluate the local incidences of hydronephrosis and renal impairment in the presence of severe uterovaginal or vault prolapse; and (b) determine whether treatment by surgery to correct the prolapse or the use of ring pessary resulted in the resolution of hydronephrosis in these patients.
METHODSThis was a retrospective case study of 121 patients who presented with severe uterovaginal or vault prolapse to the urogynaecology centre at KK Women's and Children's Hospital, Singapore, from All surgeries were performed via the vaginal route by two surgeons who were both consultant urogynaecologists at our centre. Some patients either defaulted follow-up or refused surgery, opting for silicone ring pessary instead.All statistical analyses were performed using the Statistical
INTRODUCTIONWe aimed to evaluate the local incidences of hydronephrosis and renal impairment in the presence of severe uterovaginal or vault prolapse, and determine whether treatment by surgery or ring pessary resulted in the resolution of hydronephrosis in these patients.
METHODSThis was a retrospective case study of 121 patients who presented with severe uterovaginal or vault prolapse. All patients who had fourth degree uterovaginal or vault prolapse, and underwent renal ultrasonography and renal function blood tests were included in the study. Follow-up imaging for hydronephrosis was performed to determine the outcome after patients received treatment.
RESUlTSThe mean age of the study population was 66.1 years. The overall incidence of hydronephrosis was 20.6%.The incidence of hydronephrosis in patients with severe vault prolapse was 7.1%, while that in patients with severe uterovaginal prolapse was 22.4%. Of the 25 patients with hydronephrosis, 16 (64.0%) had complete resolution of hydronephrosis after treatment, 5 (20.0%) had residual but smaller degrees of hydronephrosis, and 4 (16.0%) were lost to follow-up. The incidence of renal impairment was 3.3%.
CONClUSIONThe local incidence of hydronephrosis in patients with severe uterovaginal or vault prolapse was 20.6% in our study. We established that 3.3% of women with severe uterovaginal or vault prolapse had mild renal impairment. Treatment by vaginal surgery for severe uterovaginal or vault prolapse appears to result in either complete resolution or improvement of hydronephrosis in the majority of patients.
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