Renal calyceal rupture and perirenal urinary extravasation from complete procidentia

Genital prolapse is common among ageing women. Urinary obstruction and hydronephrosis have been reported as one of the most severe and fortunately uncommon complications. An 82-year-old multiparous woman with symptomatic pelvic organ prolapse quantification stage 4 genital procidentia fails multiple trials of pessary and abandons the trials due to significant side effects. She chooses to pursue conservative management with estrogen cream and tight underwear. However, she fails to follow up as planned. Two years later, she presents with acute abdomen and renal failure due to renal calyceal rupture and perirenal urinary extravasation from complete procidentia. She is treated promptly with urinary catheter, manual prolapse reduction, and Gellhorn pessary which relieves anuria and stabilizes her condition. She then receives definitive surgical treatment 2 weeks later. Her renal failure and abdominal pain resolve post-operatively.