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In The Name of God

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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In The Name of God

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  1. In The Name of God Dr. MaryamEmami. Urologist

  2. 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.

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

  4. Case presentation • Genital examination: • vaginal stenonis • Sever organ prolapse Huge cystocele(G4) Cuff prolapse entrocele

  5. Case presentation • Serum creatinine level was high (3) and other biochemistry results were normal. • Sonography revealed bilateral sever hydroureteronephrosis

  6. MRU

  7. MRU

  8. VCUG before treatment

  9. evaluation • Urodynamic study couldn,t be performed Because bladder was outside of the pelvic UDS data,swere,not reliable.

  10. 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) ?????????? ??????????????

  11. Vaginal Sacrospinouscolpopexy???????? • Vaginal canal was very Narrow and short. • We could n,t reduce This hernia

  12. treatment • Abdominal : sacral colpopexy with mesh (correct cuff prolapse) Moschowitz procedure (closed cul-de-sac) Burch colposuspension (urethral support)

  13. VCUG after treatment In 2-year fallow –up,no recurrence was observed.

  14. The End

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