Dr. Maryam Emami. Urologist.  A 71 year old woman with a history of :  recurrent UTI  chronic urinary obstructive symptoms  Incomplete bladder emptying.

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Presentation transcript:

Dr. Maryam Emami. Urologist

 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.

 Past medical history:  Vaginal hysterectomy 5 year ago.  Anterior- posterior repair 2 year ago  Anterior- posterior repair 1 year ago

 Genital examination:  vaginal stenonis  Sever organ prolapse Huge cystocele(G4) Cuff prolapse entrocele

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

 Urodynamic study couldn,t be performed Because bladder was outside of the pelvic UDS data,s were,not reliable.

Abdominal approach or vaginal approach  Abdominal sacral colpopexy (lower rate for recurrent vault prolapse, less dyspareunia)  Vaginal Sacrospinous colpopexy (quicker,cheaper,earlier return to activities Of daily living) ?????????? ??????????????

 Vaginal canal was very Narrow and short.  We could n,t reduce This hernia

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

In 2-year fallow –up,no recurrence was observed.