What would you recommend to this woman? How would you further evaluate her?

M.B. is a 73-year-old female, G4P4004 with a large bulge outside of the vagina. She complains of urinary frequency, urgency, difficulty with voiding, and pelvic pressure. Her history is significant for hypertension and a cerebral aneurysm, which was clipped in 2000 and has been stable since. Surgeries include the aneurysm clipping and knee and ankle surgeries in 1998 and 1999, respectively. She has had no problems with general anesthesia. Medications include hydrochlorothiazide, potassium, iron, Senokot, and vitamins. She is allergic to aspirin. Exam of the head, chest, heart, abdomen, and extremities are normal. Pelvic exam reveals vulvovaginal atrophy, small uterus, uterine procidentia, enterocele, urethral hypermobility, cystocele, and rectocele. (Note: Procidentia denotes complete failure of all the genital supports with either complete uterine prolapse and/or total eversion of the vagina.) Postvoid residual urine is 220 mL, the urinalysis is normal, and eGFR (estimated glomerular filtration rate) is 55.

1.   What would you recommend to this woman? How would you further evaluate her?

2.   What is your plan?

 

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