Hydronephrosis due to cystocele : diagnosis and management: about two cases Tlili G, Mallat F, Hmida W , Hidoussi A, Slama A, Jaidane M, Ben Sorba N, Mosbah AF Bouzayen F, Ben Mansour S, Abdelkefi M, Mama N, Tlili K Department of radiology, CHU Sahloul, Sousse Tunisia UR4

Introduction Hydronephrosis consequent to cystocele is even rarer.it can cause compression of ureters and unilateral or bilateral hydronephrosis, predisposing to renal failure. This work emphasizes the rarity of such case and the requirement of surgical approach.

Case one A 59 years old women, was referred to the Urology Service with cystocele and ultrasonography of urinary tract evidencing bilateral hydronephrosis As for her antecedents, she reported having 8 pregnancies in the past, with 6 normal deliveries, 1 cesarean and 1 miscarriage. She did not present urinary incontinence  

Case one On physical examination, was obese and presented a good general state. Gynecologic examination showed a marked cystocele throughout its entire extension with excoriations, hyperemia and fissures on the posterior wall of vagina Laboratory tests showing alteration in urea and creatinine . She presented urinary infection,treated by antibiotherapy

Case one The excretory urography confirmed the presence of bilateral hydronephrosis Patient underwent a siurgical bladdersuspension , with good post-operative results within 23 months of follow-up, and improvement of hydronephrosis grade

Case two A 62 years old women , was referred to the Urology Service with cystocele and ultrasonography of urinary tract evidencing unilateral hydronephrosis,CT showed the compression of the ureter by the cystocele As for her antecedents, she reported having 7 pregnancies in the past, with 7 normal deliveries. She did not present urinary incontinence

Case two On physical examination, wasn’t obese and presented a good general state Gynecologic examination showed a marked cystocele throughout its entire extension with excoriations. Laboratory tests was normal

Case two The excretory urography confirmed the presence of left hydronephrosis Patient underwent a siurgical bladdersuspension Within 6 months of follow-up, any improvement of hydronephrosis grade

a) L’UroTDM, en coupe transversale au temps artériel met en évidence un retard de la néphrographie à droite et une urétéro-hydronéphrose droite. (b) Sur les coupes pelviennes il existe une sténose complète juxta méatique rétrovésicale avec un moignon urétéral de moins d’1cm (flèche), au sein d’une structure tissulaire.

(a) et (b) Sur l’IRM, on retrouve le même obstacle juxtaméatique rétrovésical, avec un moignon urétéral court (flèche).

conclusion Cystocele can cause unilateral or bilateral hydronephrosis Surgical correction either by vaginal approach, intends to resolve the obstructive urinary picture in majority of cases