Grade III cystocele and grade IV total uterine prolapse

Case contributed by Nikos Karapasias , 11 May 2014
Diagnosis certain
Changed by Matt A. Morgan, 29 Sep 2015

Updates to Case Attributes

Diagnostic Certainty was set to .
Presentation was changed:
Female 67 years oldPatient with pain in the right upper quadrant in combination with multiple episodes of vomiting and shivering rigors with fever (39.1 ° C). Patient refers known cholelithiasis while constantly complainingexpresses that "something is protruding" from the vagina. US control confirms the refered cholelithiasis and reports bilateral hydronephrosis and dilatation of ureters. The urinary bladder reported as “empty of urine”.
Race changed from Caucasian to .
Age changed from 67 to 65-70.
Body was changed:

Pelvic organ prolapse (POP)with bulging of one or more of the pelvic organs into the vagina is  aa type of pelvic floor disorder .

About 1/3 of all women are affected by prolapse or similar conditions over their lifetime. Pelvic organ prolapse can affect the front, top or back of the vagina.

The main types of prolapse are:

1. Anterior prolapse (cystocele): the bladder bulges into the front wall of the vagina

2. Prolapse of the cervix or top of the vagina: the cervix or uterus drops.

 3. Posterior wall prolapse (rectocele or enterocele): part of  the bowel bulges forward into the back wall of the vagina.

It is possible to have more than one of these types of prolapse at the same time.

  • -</xml><![endif]-->Pelvic organ prolapse (POP)<strong> </strong>with bulging of one or more of the pelvic organs into the vagina is  a type of pelvic floor disorder .</p><p>About 1/3 of all women are affected by prolapse or similar conditions over their lifetime. Pelvic organ prolapse can affect the front, top or back of the vagina.</p><p>The main types of prolapse are:</p><p>1. Anterior prolapse (cystocele): the bladder bulges into the front wall of the vagina</p><p>2. Prolapse of the cervix or top of the vagina: the cervix or uterus drops.</p><p> 3. Posterior wall prolapse (rectocele or enterocele): part of  the bowel bulges forward into the back wall of the vagina.</p><p>It is possible to have more than one of these types of prolapse at the same time.</p><p><!--[if gte mso 9]><xml>
  • +</xml><![endif]--><a title="Pelvic organ prolapse" href="/articles/pelvic-organ-prolapse">Pelvic organ prolapse</a> (POP)<strong> </strong>with bulging of one or more of the pelvic organs into the vagina is a type of pelvic floor disorder .</p><p>About 1/3 of all women are affected by prolapse or similar conditions over their lifetime. Pelvic organ prolapse can affect the front, top or back of the vagina.</p><p>The main types of prolapse are:</p><p>1. Anterior prolapse (cystocele): the bladder bulges into the front wall of the vagina</p><p>2. Prolapse of the cervix or top of the vagina: the cervix or uterus drops.</p><p> 3. Posterior wall prolapse (rectocele or enterocele): part of  the bowel bulges forward into the back wall of the vagina.</p><p>It is possible to have more than one of these types of prolapse at the same time.</p><p><!--[if gte mso 9]><xml>

Tags changed:

  • fluoroscopy
  • ivp
  • uterus
  • ureter
  • kidney
  • ctu

Updates to Study Attributes

Findings was changed:

Grade III cystocele(total type) which causes severe effects in the urinary system (bilateral hydronephrosis&  megauretersdilated ureters) in combination with a grade IV (total) uterine prolapse (eversion).

Images Changes:

Image Fluoroscopy (IVP 25 min) ( update )

Perspective changed from IVP 25min to IVP 25 min.
Description was changed:
EmergingIncreasing calyceal dilatation.

Image Fluoroscopy (IVP 1 hour) ( update )

Perspective changed from IVP 1hour to IVP 1 hour.
Description was changed:
Bilateral hydronephrosis.

Image Fluoroscopy (IVP 2 hours) ( update )

Perspective changed from IVP 2hours to IVP 2 hours.
Description was changed:
Bilateral hydronephrosis and ureteral dilatation.

Image Fluoroscopy (IVP 8 hours) ( update )

Perspective changed from IVP 8hours to IVP 8 hours.
Description was changed:
Bilateral hydronephrosis &and megaureters

Image Fluoroscopy (IVP 8 hours) ( update )

Perspective changed from IVP 8hours to IVP 8 hours.
Description was changed:
Bilateral hydronephrosis, megaureters, and urinary bladder (complete of urine) ~ 10~10 cm below the pubic symphysis. Grade III cystocele(total type) which causes severe effects in the genitourinary.

Updates to Study Attributes

Findings was changed:

Findings that it now appears and under simple clinical observation.

Gynecological examination reports a grade IV total uterine prolapse (Baden-Walker halfway system) confirmed with computed tomography.

Updates to Study Attributes

Findings was changed:

The findings are confirmed computed tomographywith CT urography.

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