The patient was a 66-year-old woman who had a hysterectomy for myoma uteri 20 years before presenting to us, followed by vaginal stump prolapse about 10 years later. At the age of 64 years, she developed dysuria and vaginal stump prolapse and visited the urology clinic. An indwelling urethral catheter was inserted and surgical treatment was recommended. In January 2013, she underwent a complete transvaginal mesh operation for vaginal stump prolapse. Postoperatively, the prolapse was cured but stress urinary incontinence occurred. In June 2013, transobuturator tape was used to treat urinary incontinence. Three months later, transurethral inversion of the bladder became obvious associated with pain, and severe incontinence recurred. In November 2014, urethroplasty and a rectus muscle fascia sling procedure were performed. The transurethral inversion of the bladder was cured and the patient could void without urinary incontinence.

Pelvic organ prolapse (POP) is not regarded as life-threatening, and has been left undiagnosed on occasion. However, in some cases, the condition has resulted in hydronephrosis and renal failure. We have investigated the prevalence of hydronephrosis in patients with POP at the Female Pelvic Floor Medicine Center, and how it may be improved through surgery. Of the 555 patients examined between January 2016 and December 2017, 265 patients were diagnosed with POP. This study involved 192 of these cases diagnosed with POP as subjects. Using preoperative ultrasound scanning, hydronephrosis was classified into four categories depending on severity. At the time of surgery, the conditions of POP were classified into stages I to IV of the POP Quantification (POP-Q) system. Of these 192 patients, 20 (10.4%) had been evaluated as hydronephrosis (slight hydronephrosis 9, mild hydronephrosis 6, and severe hydronephrosis 5). It is known that as the staging of POP progresses, the likelihood of developing hydronephrosis also increases. In 20 cases with POP-Q stage IV, 7 were confirmed to have hydronephrosis; 3 of these were severe hydronephrosis. The 6 cases of mild, and 5 cases of severe hydronephrosis achieved cure after tension-free vaginal mesh TVM surgery. POP may cause hydronephrosis, so examination of the upper urinary tract is necessary. Ultrasound scans are useful in detecting hydronephrosis. There has been a case where it took 6 to 10 months for hydronephrosis to improve, so early diagnosis and management are crucial in order to prevent hydronephrosis. TVM surgery can be used for repair of not only anterior prolapse, but also uterine prolapse, which can be thus treated without hysterectomy, and this has the potential to improve hydronephrosis.