# A case of pyelonephritis due to ureteral obstruction caused by complete uterine prolapse

## TL;DR

An elderly woman with severe uterine prolapse developed kidney infection due to urinary blockage, which was managed with a pessary and antibiotics before surgery.

## Contribution

Highlights a rare clinical scenario linking uterine prolapse to pyelonephritis and the challenges in managing advanced-stage pelvic organ prolapse.

## Key findings

- Uterine prolapse can cause ureteral obstruction leading to pyelonephritis and hydronephrosis.
- Pessary placement temporarily resolved urinary blockage but required eventual surgical intervention.
- Management of stage 4 pelvic organ prolapse remains challenging when pessaries fail.

## Abstract

We present the case of a patient with pyelonephritis secondary to urinary tract obstruction caused by uterine prolapse. An 80-year-old woman with uterine prolapse (pelvic organ prolapse stage 4) was treated with a pessary at an outside hospital due to her high perioperative risk. However, the pessary prolapsed. The patient developed pyelonephritis with hydronephrosis. A pessary was inserted to resolve the blockage of the urinary tract, antibiotic treatment was initiated, and the patient's condition improved. A total vaginal hysterectomy was ultimately performed. Challenges remain in the treatment of pelvic organ prolapse stage 4 for which a pessary cannot be used.