A 70-year-old woman with long-standing complete uterine prolapse (procidentia) is found to have bilateral hydroureteronephrosis and a raised serum creatinine. What is the mechanism of renal impairment?
- A Compression of the bladder trigone causing bilateral vesicoureteric reflux
- B Obstruction of both ureters by oedema of the vaginal walls
- C Kinking of the ureters at the level of the pelvic brim by the descending prolapse ✓
- D Chronic retention leading to vesicoureteric junction destruction
Correct answer: C. Kinking of the ureters at the level of the pelvic brim by the descending prolapse
Explanation
In advanced procidentia the ureters are carried downward with the prolapsing uterus and broad ligaments, producing angulation and extrinsic compression at the level of the pelvic brim. This causes bilateral hydroureter and hydronephrosis and can lead to postrenal failure, a classic examination point. Trigonal compression and chronic retention may coexist, but the classical teaching mechanism tested here is ureteric kinking during descent, which reverses after reduction or repair of the prolapse.
Reference: Jeffcoate's Principles of Gynaecology, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.