Renal Failure Due to Severe Pelvic Organ Prolapse

抄録

Objective:

Pelvic organ prolapse (POP) is not uncommon in multi-parous or elderly women. One mechanism that may be responsible for renal failure in the presence of POP is chronic retention due to bladder outlet obstruction. We herein presented a case of neglected severe POP in a 60-year-old patient that resulted in renal failure.

Case:

A 60-year-old Japanese woman had a sensation of a vulvar mass since the age of 40. She had general malaise, reduced appetite, and weight loss, but did not exhibit any urinary symptoms or a vulvar mass. Computed tomography (CT) revealed a vulvar mass, and the patient was diagnosed with POP-Q (pelvic organ prolapse quantification) stage 4 following a pelvic examination. A blood examination showed an increased inflammatory response (number of leukocytes 24,600/μl, C-reactive protein 29.10 mg/dl) and renal dysfunction (creatinine 6.40 mg/dl, blood urea nitrogen 83.5 mg/dl). She was initially treated with bladder drainage and antibacterial therapy. Seven months after the initiation of bladder drainage, colpocleisis and urethroplasty were performed following the manual repositioning of POP.

Conclusion:

This patient may have avoided long-term hospital care if she had undergone a gynecological examination earlier. General physicians need to consider POP and learn to perform a basic gynecological examination when examining older women, who are more likely to ignore or conceal symptoms, similar to this case.