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CASE PRESENTATION A 71 year old woman with a history
of :
recurrent UTI chronic urinary obstructive symptoms Incomplete bladder emptying Since 2 years ago referred to our
center. She couldn,t void from 1week
ago.
CASE PRESENTATION
Past medical history: Vaginal hysterectomy 5 year ago. Anterior- posterior repair 2 year ago Anterior- posterior repair 1 year ago
CASE PRESENTATION Genital examination:
vaginal stenonis
Sever organ prolapse
Huge cystocele(G4) Cuff prolapse entrocele
CASE PRESENTATION
Serum creatinine level was high (3) and other biochemistry results were normal.
Sonography revealed bilateral sever hydroureteronephrosis
EVALUATION
Urodynamic study couldn,t be performed
Because bladder was outside of the pelvic
UDS data,s were,not reliable.
TREATMENT Abdominal approach or vaginal
approach
Abdominal sacral colpopexy (lower rate for recurrent vault prolapse,
less dyspareunia)
Vaginal Sacrospinous colpopexy (quicker,cheaper,earlier return to activities Of
daily living)
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VAGINAL SACROSPINOUS COLPOPEXY????????
Vaginal canal was very
Narrow and short.
We could n,t reduce This hernia
TREATMENT Abdominal :
sacral colpopexy with mesh (correct cuff prolapse)
Moschowitz procedure (closed cul-de-sac)
Burch colposuspension (urethral support)
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