PDF(Pubmed)
Abstract：
Pelvic organ prolapse is rarely associated with severe bilateral ureteral hydronephrosis and renal dysfunction. The etiopathogenetic mechanism has not been fully elucidated. Contemporary imaging methods of the urinary tract play a decisive role in assessing the morphological function of the kidneys. In cases of moderate and severe pelvic organ prolapse, surgery appears to be the main choice of treatment. Our case concerns a post-menopausal patient with three vaginal deliveries in her obstetric history and with a history of bilateral hydronephrosis and impaired renal function who was referred to the outpatient clinic for a gynecological examination due to complete uterine prolapse. Bilateral hydroureteronephrosis due to prolapse was assessed as the main cause of renal dysfunction. A surgical intervention was decided to the pelvic floor and a vaginal hysterectomy was performed with simultaneous correction of the cystocele and rectocele. The postoperative course was uneventful. Three months later, re-examination of the urinary tract showed complete remediation of kidney morphology and function. The present case report emphasizes the significant degree of bilateral hydroureteronephrosis and deterioration of renal function rarely seen in patients with complete uterine prolapse. At the same time, it is pointed out that the exclusion of renal dysfunction related to complete uterine prolapse should be the main concern of the modern gynecologist even for complex cases with coexisting etiological factors for renal disease, in order to avoid permanent renal parenchymal damage and ensure the best health and quality of life of these patients.
摘要：
盆腔器官脱垂很少与严重的双侧输尿管肾积水和肾功能不全有关。病因机制尚未完全阐明。现代尿路成像方法在评估肾脏的形态功能中起着决定性的作用。在中度和重度盆腔器官脱垂的情况下，手术似乎是治疗的主要选择。我们的病例涉及一名绝经后患者，其产科病史中有3次阴道分娩，并有双侧肾积水和肾功能受损的病史，由于子宫脱垂完全而被转诊至门诊进行妇科检查。由于脱垂导致的双侧输尿管肾积水被评估为肾功能不全的主要原因。决定对盆底进行手术干预，并进行阴道子宫切除术，同时矫正膀胱膨出和直肠前突。术后病程顺利。三个月后,重新检查尿路显示肾脏形态和功能完全修复。本病例报告强调了完全子宫脱垂患者很少见的双侧肾积水和肾功能恶化的显着程度。同时,有人指出，排除与完全子宫脱垂相关的肾功能不全应该是现代妇科医生的主要关注点，即使对于患有肾病的复杂病例，以避免永久性肾实质损害，并确保这些患者的最佳健康和生活质量。
