Renal failure secondary to uterine prolapse.

A 73-year-old female was referred to the department of geriatric medicine with malaise, lethargy, and swollen feet secondary to chronic renal failure (creatinine 700 umol/l). She had no bothersome urinary symptoms. However, on pelvic examination, stage III uterine prolapse (procidentia) was noted. She admitted having had it for many years. It was not noted on earlier clinical assessments. Bilateral gross hydroureteronephrosis was seen on ultrasound scan (Figure 1). There was no post-void bladder residual. The prolapsed uterus bearing a decubitus ulcer on the cervix was reduced manually and repositioned back in to her pelvis. It was then supported with the help of a 59 mm ring pessary and she was placed on local oestrogen supplements. Her renal function improved over the next 72 hours. A follow-up ultrasound scan showed near-complete resolution of hydronephrosis on both sides (Figure 2) within a week. At nine months follow-up she remained well.