Hidronefrosis bilateral e incontinencia urinaria de esfuerzo secundario a prolapso de órganos pélvicos grado iv: manejo laparoscópico

Abstract

Pelvic organ prolapse is not a life-threatening condition, but it alters the quality of life in women. A woman has an 11% possibility of having pelvic floor dysfunction during her lifetime that will require surgical treatment. The main etiology is complex and multifactorial. We present herein the case of a woman with grade IV pelvic organ prolapse plus stress urinary incontinence. Physical examination revealed bladder prolapse at 6 cm below the vaginal introitus and a positive Marshall test. Computed axial tomography (CAT) identified hydronephrosis of the right kidney, dilated ureters, and a bladder, uterus, and rectum that dropped beyond the vaginal canal. Hysterectomy plus laparoscopic colposacropexy plus anterior and posterior colpoperineoplasty with polypropylene sling placement were performed. Surgery duration was 300 min, blood loss was 95 ml, and hospital stay was 2 days. The Marshall test was negative 60 days after the operation and control CAT scan showed there was no hydronephrosis.

Laparoscopic colposacropexy had become the criterion standard for vaginal prolapse management because it achieves anatomic recovery and lasting urinary, intestinal, sexual, and psychosocial function.