Uterine Prolapse and Acute Renal Failure in a Chinese Patient

EDITORIAL COMMENT: A large prolapse of the uterus and vagina (often called a procidentia, although strictly speaking this term refers to any prolapse) may be associated with urgency, frequency, difficulty in passing urine, no urinary symptoms at all, or as in this patient with anuria and acute obstructive renal failure. Women with longstanding prolapses that have not been reduced and which rarely are irreducible, often have hydronephrosis and chronic renal failure. However it is exceedingly uncommon for a prolapse to be associated with anuria as occurred in this patient. The Editor has experience of an elderly patient admitted to the Austin Hospital, Melbourne, 32 years ago who was thought to be demented and who died shortly after admission. At autopsy she was found to have a large uterovaginal prolapse and hydronephrosis, the cause of death apparently being renal failure. A similar case was also reported in a letter in the BMJ approximately 30 years ago. These cases are rare but make the point that a patient who has a uterovaginal prolapse should have the mass replaced and her renal function assessed prior to the anticipated surgery. Usually it is possible to operate on such a patient within 4 or 5 days even when there has been gross ulceration of the cervix and posterior vagina which normally heals rapidly when the uterus and prolapsed vaginal walls (cystocele, enterocele ± rectocele) are reduced and the vagina packed with gauze soaked in oestrogen cream. When a prolapse is large, the bladder can be outside the body with kinking of the ureters, and passage of ureteric catheters may be impossible because of this. Reduction of the prolapse will relieve this obstruction of the ureters, and so lead to improvement in renal function. (See Illustrated Textbook of Gynaecology. Eric VMackay et al. Figures 23.10 and 23.11, pages 344 and 345).