Total uterine prolapse causing hydroureteronephrosis.

Six women with advanced uterine prolapse underwent examination by drip infusion urography. A new hypothesis is proposed for the pathogenesis of bilateral hydroureteronephrosis: the ureters are entrapped by the hiatus genitalis, not against the bladder but against the fundus of the fully prolapsed uterus. Drip infusion urography should include an exposure area of about 15 centimeters below the pubis, and at least one exposure should be taken with the patient in the standing position. Thus, the hourglass appearance of the prolapsed bladder will not be overlooked and would be helpful in explaining the cause of the hydroureteronephrosis.