Obstructive Uropathy from Uterine Prolapse: A Preventable Problem in the Elderly

Jay, Gregory D.; Kinkead, Thomas; Hopkins, Timothy B.; Wollin, Michael

doi:10.1111/j.1532-5415.1992.tb01807.x

Cited by 20 publications

(7 citation statements)

References 16 publications

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“…But, their study fails to explain why hydronephrosis is unilateral as well. 15 Author Kang LM in 2000, explained that the obstruction occurs as the uterus descends; the downward traction of the uterine arteries located over the lower ureters causes the bladder trigone and lower ureters to be dragged outside the pelvis. The caudal displacement of the trigone results in compression of the ureters between the uterus and the medial borders of the genital hiatus.…”

Section: Discussionmentioning

confidence: 99%

Renal Impairment Among Patients With Pelvic Organ Prolapse in a Tertiary Care Center

Dongol

Joshi

2014

Kathmandu Univ. Med. J.

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Background Pelvic organ prolapse is a multidimensional phenomenon. The manifestations of renal involvement following pelvic organ prolapse ranges from acute to chronic renal failure and may also lead to end stage renal failure. Prolonged duration and its severity in pelvic organ prolapse are responsible for renal impairment. Objectives This study will find out the incidence of renal impairment among women with pelvic organ prolapse undergoing surgical management. It will also help to establish the association of renal impairment with degree and duration of pelvic organ prolapse. Methods This prospective study includes cases of pelvic organ prolapse who underwent surgical management from the year 2009-2012 in Dhulikhel hospital. Total 140 cases were assessed with age, duration and different symptoms. Clinical examination was done to find out the degree of prolapse and graded according to Baden Walker classification. Urine routine and microscopic examination, renal function test and abdominopelvic sonography were performed routinely. Renal impairment was assessed using hydronephrosis and creatinine clearance. Creatinine clearance was calculated using patient’s weight and serum creatinine value by Cockcroft and Gault formula. Results Among 140 cases, 8 (5.7%) patients had procedentia, 106 (75.7%) had third degree, 22 (15.7%) had second degree, and four (2.8%) patients had first degree uterine prolapse. The mean duration of prolapse was found to be 11.47 years. Total 5 (3.57%) patients had hydronephrosis. Four had moderate and one had severe hydronephrosis. Total 49 (34.1%) patients had moderate to severe renal failure. Forty six (32%) in stage III moderate reduction in creatinine clearance, 2 (1.4%) with severe reduction and 1(0.7%) in end stage renal failure. Conclusion Renal impairment is a common entity among women with pelvic organ prolapse. Both hydronephrosis and degree renal impairment correlates correspondingly with the duration and severity of prolapse. DOI: http://dx.doi.org/10.3126/kumj.v11i1.11031 Kathmandu University Medical Journal Vol.11(1) 2013: 71-74

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Section: Discussionmentioning

confidence: 99%

Renal Impairment Among Patients With Pelvic Organ Prolapse in a Tertiary Care Center

Dongol

Joshi

2014

Kathmandu Univ. Med. J.

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“…A neglected pessary in the vagina may cause complications including disturbance of micturition with incomplete emptying of urinary bladder, chronic cystitis, vesicovaginal fistula, unilateral or bilateral obstructive uropathy, hydronephrosis, pyelonephritis, bacteremia, and even life-threatening urosepsis. [3][4][5] Severity of UTI should be related to the patient's underlying immunocompromised condition, such as diabetes mellitus and debility. Enterobacteriaceae, such as E. coli, originating from the gastrointestinal tract is the most common pathogen with hematogenous spread or ascending infection in UTI.…”

Section: Discussionmentioning

confidence: 99%

“…Known risk factors for stroke include arrhythmia in the form of atrial fibrillation, 3 diabetes mellitus, 4 and heart valve anomalies. 5 Even with those risk factors, brain images…”

Section: Common But Critical Sensation In Older Adultsmentioning

confidence: 99%

Unilateral Acute Pyelonephritis Associated with a Neglected Pessary

Ho¹,

Cheung

2011

J American Geriatrics Society

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of gynecological conditions including stress urinary incontinence, vaginal vault prolapse, cystocele, enterocele, rectocele, and preoperative preparation for pelvic organ prolapse in older women. 1,2 Acute pyelonephritis and urosepsis caused by neglected pessaries are rare conditions. Herein, is reported a case of unilateral acute pyelonephritis due to a neglected pessary in an older woman. CASE REPORTA 74-year-old woman with a past history of diabetes mellitus treated with regular medication for years was sent to the emergency department with high fever and frequency of urine but no dysuria for 3 days. On physical examination, a physician elicited pain with percussion at the left costophrenic angle. Other findings were within JAGS 59:

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“…As there is an increase in the number of patients using pessaries, an increase in their various clinical complications will be seen in the ED. [28][29][30] These include watery discharge (a benign, physiologic reaction to the foreign body), allergic reactions, vaginitis, pressure ulcers, infection, fistula formation, fecal impaction, and bowel obstruction. 31,32 Bleeding is a common presenting complaint.…”

Section: Pessariesmentioning

confidence: 99%

Review Article: Gynecological Disorders in Geriatric Emergency Medicine

Lewiss

Saul

Teng

2009

Am J Hosp Palliat Care

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Emergency physicians must be competent in caring for elderly women because they constitute the fastest growing segment of the population in the United States. Familiarity with acute geriatric gynecologic issues is crucial to providing satisfactory health care for these patients with complaints relating to incontinence, pelvic floor dysfunction, and other gynecologic conditions. Vigilant suspicion for malignancy should be maintained in facilities that service patients without primary health care or insurance. This article provides a systematic approach to emergency department management of common geriatric gynecological conditions. Anatomical and physiological changes are discussed, as well as the geriatric pelvic examination, malignancy, urinary tract infection, incontinence, pelvic organ prolapse, and vulvovaginitis.

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Obstructive Uropathy from Uterine Prolapse: A Preventable Problem in the Elderly

Cited by 20 publications

References 16 publications

Renal Impairment Among Patients With Pelvic Organ Prolapse in a Tertiary Care Center

Renal Impairment Among Patients With Pelvic Organ Prolapse in a Tertiary Care Center

Unilateral Acute Pyelonephritis Associated with a Neglected Pessary

Review Article: Gynecological Disorders in Geriatric Emergency Medicine

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