Bilateral hydronephrosis and megaureters due to grade III cystocele & grade IV total uterine prolapse

Case contributed by Dr Nikos Karapasias


Patient with pain in the right upper quadrant in combination with multiple episodes of vomiting and rigors with fever (39.1 ° C). Patient expresses that "something is protruding" from the vagina. US reports bilateral hydronephrosis and dilatation of ureters. The urinary bladder reported as “empty of urine”.

Patient Data

Age: 65-70
Gender: Female

Grade III cystocele (total type) which causes severe effects in the urinary system (bilateral hydronephrosis & dilated ureters) in combination with a grade IV (total) uterine prolapse (eversion).

Gynecological examination reports a grade IV total uterine prolapse (Baden-Walker halfway system) confirmed with computed tomography.

The findings are confirmed with CT urography.

Findings with virtual reconstruction

Case Discussion

Pelvic organ prolapse (POP) with bulging of one or more of the pelvic organs into the vagina is a type of pelvic floor disorder .

About 1/3 of all women are affected by prolapse or similar conditions over their lifetime. Pelvic organ prolapse can affect the front, top or back of the vagina.

The main types of prolapse are:

1. Anterior prolapse (cystocele): the bladder bulges into the front wall of the vagina

2. Prolapse of the cervix or top of the vagina: the cervix or uterus drops.

 3. Posterior wall prolapse (rectocele or enterocele): part of  the bowel bulges forward into the back wall of the vagina.

It is possible to have more than one of these types of prolapse at the same time.

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Case information

rID: 29233
Case created: 11th May 2014
Last edited: 23rd Oct 2017
Inclusion in quiz mode: Included

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