Dr. Maryam Emami. Urologist

CASE PRESENTATION A 71 year old woman with a history

of :

recurrent UTI chronic urinary obstructive symptoms Incomplete bladder emptying Since 2 years ago referred to our

center. She couldn,t void from 1week

ago.

CASE PRESENTATION

Past medical history: Vaginal hysterectomy 5 year ago. Anterior- posterior repair 2 year ago Anterior- posterior repair 1 year ago

CASE PRESENTATION Genital examination:

vaginal stenonis

Sever organ prolapse

Huge cystocele(G4) Cuff prolapse entrocele

CASE PRESENTATION

Serum creatinine level was high (3) and other biochemistry results were normal.

Sonography revealed bilateral sever hydroureteronephrosis

MRU

MRU

VCUG BEFORE TREATMENT

EVALUATION

Urodynamic study couldn,t be performed

Because bladder was outside of the pelvic

UDS data,s were,not reliable.

TREATMENT Abdominal approach or vaginal

approach

Abdominal sacral colpopexy (lower rate for recurrent vault prolapse,

less dyspareunia)

Vaginal Sacrospinous colpopexy (quicker,cheaper,earlier return to activities Of

daily living)

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VAGINAL SACROSPINOUS COLPOPEXY????????

Vaginal canal was very

Narrow and short.

We could n,t reduce This hernia

TREATMENT Abdominal :

sacral colpopexy with mesh (correct cuff prolapse)

Moschowitz procedure (closed cul-de-sac)

Burch colposuspension (urethral support)

VCUG AFTER TREATMENT

In 2-year fallow –up,no recurrence was observed.