Bilateral Hydronephrosis Secondary to Cystocele

Abstract

A 75-year-old patient applied to the urology clinic with a cystocele and ultrasonography of urinary tract evidencing bilateral grade III hydronephrosis. She didn't complain about any urination problem. Gynecologic examination showed a marked cystocele throughout its entire extension on the anterior wall of vagina. The excretory urography confirmed the presence of bilateral hydronephrosis and 'narrowing distal ureters.' An anterior colporrhaphy and tension-free vaginal tape procedure were performed without any complication. At the third month of the follow-up, regression in hydronephrosis was observed and there was no urinary complaint. In women presenting dilatation of upper urinary tract, pelvic organ prolapses must be kept in mind and a convenient examination is the key point to rule it out. Unnoticed cases can lead to a wrong diagnosis and redundant surgery.

Prevalence of Hydronephrosis in Women With Advanced Pelvic Organ Prolapse

“…[2][3][4][5][6] Although the presence of hydronephrosis is not diagnostic of obstruction, it is commonly associated with obstructed or dysfunctional voiding. In cases of prolapse, the upper urinary tract may be affected, though the exact prevalence is unknown.…”

Original Flow Chart for the Management of Hydroureteronephrosis Caused by Pessary Placement

“…The analysis of full blood tests, serum creatinine and biochemical blood tests should be considered to monitor the clinical evolution of the patient. Nevertheless, a new pessary placement should be considered when critical clinical conditions are resolved (22-24). In this case the appropriate type and size of pessary should be inserted, and the correct positioning should be checked (10).…”

Case Report: Emphysematous Cystitis and Pyelonephritis Induced by Uterine Prolapse in a Subject With Untreated Diabetes Mellitus

“…On the other hand, uterine prolapse can bring out various urination disorders. Especially, severe uterine prolapse leads to the development of obstructive uropathy and end-stage renal disease (3,4).…”