53 Y F has 3rd degree uterine prolapse associated with bladder prolapse (Will under hysterectomy) but there are some urological problems that arose on examination. Initially Right grade 2 Hydronephrosis on US scan (Abdomen and Pelvic), thus she did CT scan to know the cause as directed by the Urologist and the findings are presented as follow (Image attached - CT image). So my Q is how would you manage the renal stones, Kinks, angiomyolipoma, Hydronephrosis? Will you just observe/wait and see the results after hysterectomy or you will try the ureter stent?
Medical History:
Atrial Fibrillation (Bisoprolol 2.5 mg once daily)
Chronic venous insufficiency (Daflon 500 mg one tablet daily)
Allergic Rhinitis (Cetirizine 10 mg once daily)
Non-Alcoholic Fatty liver disease
Why are you doing hysterectomy?
Why dont you put in a pessary and repeat scan? It may relieve the hydronephrosis
I recommend you at the same time hysterectomy + sacrocolpopexy + and RIRS opr. for renal pelvis stone.
The patient is young. Pessary is not clean. I would go for a Hysterectomy + sacrocolpopexy. This will also treat the hydronephrosis. ESWL for the 9mm stone in the renal pelvis.
You can place a d-j stent during hysterectomy for stone side. It will be helpfull for eswl later
I thought of inserting a double J stent while the patient is under anesthesia but after all the stone is only 9mm and you still have a hydroureter.
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