PREVALENCE OF HYDRONEPHROSIS IN PATIENTS UNDERGOING SURGERY FOR PELVIC ORGAN PROLAPSE

Objective: To determine the prevalence of hydronephrosis in patients u ndergoing surgery for pelvic organ prolapse and to determine whether h ydronephrosis is associated with the type and severity of prolapse. Me thods: The charts of 375 consecutive patients undergoing surgery for p elvic organ prolapse at the Cleveland Clinic Foundation between Januar y 1, 1990, and December 31, 1993 were reviewed. Preoperative renal ult rasounds and intravenous pyelograms (IVF) were evaluated for hydroneph rosis based on the final diagnosis established by the radiologists. Th e severity of prolapse was determined from the preoperative office exa mination or from the examination under anesthesia at the time of surge ry. Results: Of 375 patients, 323 had either a preoperative renal ultr asound or IVP. The mean age was 66.0 +/- 10.2 years (range 35-93) and median parity was 3.0 (range 0-10). Of the 323 patients, 25 (7.7%, 95% confidence interval 5, 11) had hydronephrosis. Thirteen patients (4.0 %) had mild hydronephrosis, nine (2.8%) had moderate hydronephrosis, a nd three (0.9%) had severe hydronephrosis. The prevalence of hydroneph rosis increased with increasing severity of prolapse. Two patients wit h hydronephrosis had evidence of renal insufficiency (creatinine great er than or equal to 1.6), and both had severe bilateral hydronephrosis and complete procidentia. The prevalence of hydronephrosis was lower in patients with vaginal vault prolapse versus uterine prolapse (3.9% compared with 12.6%, P < .01). Conclusion: The prevalence of hydroneph rosis in patients undergoing surgery primarily for pelvic organ prolap se is low, increases with worsening pelvic organ prolapse, and is lowe r in patients with vaginal vault prolapse than in those with uterine p rolapse. (C) 1997 by The American College of Obstetricians and Gynecol ogists.