A Case of Recurrent Bilateral Hydronpehrosis and Pyelonephritis Due to Pelvic Organ Prolapse

Abstract

Although bilateral hydronephrosis caused by pelvic organ prolapse (POP) is not rare, it does not usually cause severe pyelonephritis or acute renal failure. Recurrence of POP accompanied with hydronephrosis and pyelonephritis following curative surgery for POP has been rarely reported. We describe a case of recurrent pyelonephritis due to POP. A 79-year-old woman visited our hospital with anorexia. She was diagnosed with right pyelonephritis, acute renal failure with bilateral hydroureteronephrosis, uterine prolapse, and cystocele. She underwent right nephrostomy and received antibiotics, and her condition then improved. Two months later, she revisited us with left pyelonephritis. She underwent left nephrostomy and received antibiotics. As POP seemed to cause bilateral ureteral obstructions, laparoscopic hysterectomy and uterosacral ligament suspension was performed. Although her POP and ureteral obstructions improved temporarily cystocele and ureteral obstructions with left pyelonephritis recurred two months later. Subsequent pessary treatment managed POP and ureteral obstructions during 1-year follow-up. Pyelonephritis in patients with POP is rare. In the review of literature, all of patients undergoing nephrostomy or ureteral stent survived whereas some of patients not undergoing such interventions died. Additionally, most of patients undergoing POP management survived whereas more than half of patients not undergoing POP management died. We encountered a case of recurrent bilateral hydronephrosis and pyelonephritis caused by POP. There was a clear association of POP occurrence with ureteral obstruction and pyelonephritis, suggesting the importance of managing POP and ureteral obstruction appropriately in such case.