Urologic Complications Associated with Prolapse Uteri

Lee, Dong Hwan; Chang, Kwang Sik; Kim, Jang Heub

Abstract

Changes in the urinary tract associated with prolapse uteri have been known for a long time. However, women who have a prolapse uteri are often free of symptoms. When symptoms are present they are above all, urinary tract infection, difficulties in emptying the bladder, increased frequency of micturition, stress incontinence, and ureteral obstruction. We reviewed 82 patients who had prolapse uteri of grade II and III in order to evaluate the effects of prolapse uteri to the urinary tract. There were 5 patients (6.1%) who had urinary tract infection and urine culture revealed the growth of E. coli in 3 of them. Only 1 patient (1.2%) had high blood urea nitrogen. 51 (62.2%) out of 82 patients showed voiding problems (frequency, voiding difficulty, stress incontinence) and 53 (64.6%) out of 82 patients had cystocele of several degrees, but there was no difference between the degree of prolapse uteri and both voiding problems and cystocele. Vaginal hysterectomy with anterior and posterior colpoperineorraphy was performed in 68 (88. 3%) out of 77 patients who underwent surgical treatment by gynecologists, and in 22 (91.7%) out of 24 patients who showed difficult urination, their symptoms were improved immediately after surgery. Bladder neck suspension was performed simultaneously in 3 patients who showed stress urinary incontinence with prolapse uteri. Intravenous pyelography or abdominal ultrasonography was performed to evaluate accompanied ureteral obstruction in 8 patients who had severe cystocele. In 5 patients, upper tract deteriorations were noted. Bilateral hydroureteronephrosis was found in 3 patient, unilateral lower ureteral dilatation in 1 patient, and severe parenchymal damage in 1 patient. In conclusion, we believe that urologist should participate in managing those patients who have prolapse uteri to improve their voiding problems and prevent upper urinary tract deterioration.