Management of Bilateral Hydronephrosis with Uterine Prolapse and Stress Incontinence

Initial Assessment and Risk Stratification

Patients with bilateral hydronephrosis and elevated creatinine should be classified as "unknown risk" requiring complete evaluation to assess potential upper urinary tract damage, according to the American Urological Association 1
Multichannel urodynamics are indicated to assess both storage and emptying function in patients with stress incontinence and elevated post-void residual (PVR), as recommended by the American Urological Association 2, 3
Upper tract imaging, such as CT urography or MRU, is essential to evaluate the severity of hydronephrosis and rule out other causes of obstruction, as suggested by the American College of Radiology 4, 5

Stress testing with prolapse reduction should be performed to assess for occult stress incontinence that may be unmasked after prolapse correction, according to the American Urological Association 2, 3
Post-void residual measurements should be monitored regularly in patients with elevated PVR, as they may indicate developing voiding dysfunction, as recommended by the American Urological Association 1
The combination of stress incontinence with elevated PVR suggests possible detrusor underactivity coexisting with outlet dysfunction, according to the American Urological Association 6
Patients with elevated preoperative PVR may be at increased risk for postoperative voiding difficulties following stress incontinence surgery, as suggested by the American Urological Association 2

Surgical options should address both the prolapse and stress incontinence components, according to the American Urological Association 7
For the stress incontinence component, options include mid-urethral synthetic sling, autologous fascia pubovaginal sling, and Burch colposuspension, as recommended by the American Urological Association 7

PVR measurements should be taken to ensure adequate bladder emptying, as recommended by the American Urological Association 1
Voiding diary should be used to track urinary symptoms and continence status, according to the American Urological Association 1, 3

Performing anti-incontinence surgery without addressing voiding dysfunction could worsen retention, as suggested by the American Urological Association 2, 3
Patients should be counseled about the potential need for intermittent catheterization if voiding dysfunction persists postoperatively, according to the American Urological Association 7