Dongol A, Joshi K S, K C S
Deparment of Gynaecology / Obstretrics, Dhulikhel Hospital - Kathmandu University Hospital, Dhulikhel, Nepal.
Kathmandu Univ Med J (KUMJ). 2013 Jan-Mar;11(41):71-4. doi: 10.3126/kumj.v11i1.11031.
Pelvic organ prolapse is a multidimensional phenomenon. The manifestations of renal involvement following pelvic organ prolapse ranges from acute to chronic renal failure and may also lead to end stage renal failure. Prolonged duration and its severity in pelvic organ prolapse are responsible for renal impairment.
This study will find out the incidence of renal impairment among women with pelvic organ prolapse undergoing surgical management. It will also help to establish the association of renal impairment with degree and duration of pelvic organ prolapse.
This prospective study includes cases of pelvic organ prolapse who underwent surgical management from the year 2009-2012 in Dhulikhel hospital. Total 140 cases were assessed with age, duration and different symptoms. Clinical examination was done to find out the degree of prolapse and graded according to Baden Walker classification. Urine routine and microscopic examination, renal function test and abdominopelvic sonography were performed routinely. Renal impairment was assessed using hydronephrosis and creatinine clearance. Creatinine clearance was calculated using patient's weight and serum creatinine value by Cockcroft and Gault formula.
Among 140 cases, 8 (5.7%) patients had procedentia, 106 (75.7%) had third degree, 22 (15.7%) had second degree, and four (2.8%) patients had first degree uterine prolapse. The mean duration of prolapse was found to be 11.47 years. Total 5 (3.57%) patients had hydronephrosis. Four had moderate and one had severe hydronephrosis. Total 49 (34.1%) patients had moderate to severe renal failure. Forty six (32%) in stage III moderate reduction in creatinine clearance, 2 (1.4%) with severe reduction and 1(0.7%) in end stage renal failure.
Renal impairment is a common entity among women with pelvic organ prolapse. Both hydronephrosis and degree renal impairment correlates correspondingly with the duration and severity of prolapse.
盆腔器官脱垂是一种多维度现象。盆腔器官脱垂后肾脏受累的表现从急性肾衰竭到慢性肾衰竭不等，还可能导致终末期肾衰竭。盆腔器官脱垂的持续时间及其严重程度是导致肾功能损害的原因。
本研究将找出接受手术治疗的盆腔器官脱垂女性中肾功能损害的发生率。它还将有助于确定肾功能损害与盆腔器官脱垂程度和持续时间之间的关联。
这项前瞻性研究包括2009年至2012年在杜利凯尔医院接受手术治疗的盆腔器官脱垂病例。对总共140例病例进行了年龄、病程和不同症状的评估。进行临床检查以确定脱垂程度，并根据巴登·沃克分类法进行分级。常规进行尿常规和显微镜检查、肾功能测试及腹部盆腔超声检查。使用肾积水和肌酐清除率评估肾功能损害。肌酐清除率通过患者体重和血清肌酐值，采用考克罗夫特和高尔特公式计算。
在140例病例中，8例（5.7%）为子宫脱垂，106例（75.7%）为三度脱垂，22例（15.7%）为二度脱垂，4例（2.8%）为一度子宫脱垂。脱垂的平均持续时间为11.47年。共有5例（3.57%）患者有肾积水。4例为中度肾积水，1例为重度肾积水。共有49例（34.1%）患者有中度至重度肾衰竭。46例（32%）处于III期肌酐清除率中度降低，2例（1.4%）严重降低，1例（0.7%）处于终末期肾衰竭。
肾功能损害在盆腔器官脱垂女性中是一种常见情况。肾积水和肾功能损害程度均与脱垂的持续时间和严重程度相应相关。
