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

Abstract

There is no uniform management of women with HUN and a concomitant pessary. For this reason, and based on the literature and our experience, we propose an original management flowchart.

Hydronephrosis associated with pelvic organ prolapse: a review study

“…If the increase in serum creatinine value is detected, possibly ureteral obstruction and renal insufficiency should be considered. If renal insufficiency is suspected, the US can be sufficient, particularly when the finding of bilateral HD is documented 6 . Renal involvement linked to POP ranges from acute to chronic renal failure and may also lead to end-stage renal failure.…”

“…Despite the benefits of pessary use, there are some complications that are usually associated with neglected, oversized, or misplaced pessaries. Major complications may include fistulas, bowel or bladder erosion, and even HD 6 . In cases of pessary presence with a concomitant increase in serum creatinine value, a possible ureteral obstruction is suspected.…”

“…If HD is detected in a patient with no signs of urosepsis, it is recommended a conservative management by the removal of the pessary and catheter placement. When urosepsis is suspected, it is mandatory to administer antibiotic therapy and evaluate the HD drainage by nephrostomy 6 .…”