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In The Name of God. 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 .

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Presentation Transcript
slide1

In The Name of God

Dr. MaryamEmami. Urologist

case presentation
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 presentation1
Case presentation
  • Past medical history:
  • Vaginal hysterectomy 5 year ago.
  • Anterior- posterior repair 2 year ago
  • Anterior- posterior repair 1 year ago
case presentation2
Case presentation
  • Genital examination:
  • vaginal stenonis
  • Sever organ prolapse

Huge cystocele(G4)

Cuff prolapse

entrocele

case presentation3
Case presentation
  • Serum creatinine level was high (3) and other

biochemistry results were normal.

  • Sonography revealed bilateral sever hydroureteronephrosis
evaluation
evaluation
  • Urodynamic study couldn,t be performed

Because bladder was outside of the pelvic

UDS data,swere,not reliable.

treatment
treatment

Abdominal approach or vaginal approach

  • Abdominal sacral colpopexy

(lower rate for recurrent vault prolapse,

less dyspareunia)

  • Vaginal Sacrospinouscolpopexy

(quicker,cheaper,earlier return to activities Of daily living)

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vaginal sacrospinous colpopexy
Vaginal Sacrospinouscolpopexy????????
  • Vaginal canal was very

Narrow and short.

  • We could n,t reduce

This hernia

treatment1
treatment
  • Abdominal :

sacral colpopexy with mesh

(correct cuff prolapse)

Moschowitz procedure

(closed cul-de-sac)

Burch colposuspension

(urethral support)

vcug after treatment
VCUG after treatment

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