Bilateral ureteric obstruction of a partially duplicated collecting system improves after surgical correction of procidentia: A case report

BACKGROUND: Although the association between pelvic organ prolapse and upper urinary tract dilation has been documented, the causal relationship between the two has not been established. We report an improvement in severe hydronephrosis and hydroureter of a partially duplicated urinary collecting system after surgical correction of procidentia. CASE: A 52-year-old woman presented with radiologic evidence of a partially duplicated right collecting system with right-sided hydronephrosis and bilateral hydroureter in the setting of stage IV uterovaginal prolapse. A therapeutic trial of pessary placement failed to resolve the upper urinary tract dilation. The patient underwent abdominal hysterectomy, bilateral salpingo-oophorectomy, sacrocolpopexy, midurethral sling placement and posterior colporrhaphy. Repeat intravenous urography 4 weeks after surgery demonstrated interval resolution of the hydronephrosis. CONCLUSION: An improvement in hydronephrosis after surgical correction supports a cause-and-effect relationship between pelvic organ prolapse and obstructive uropathy.