Answer these questions based on the Case Study that follows: 1) What is the prog

Question

Answer these questions based on the Case Study that follows:

1) What is the prognosis of Mrs. Meriwether's cystocele? Can you mention other causes of urinary obstructions?

2) According to the history, our patient was very concerned about having a tumor. What are some tumors of the female reproductive system that we should rule out in this case?

3) Mrs. Meriwether had two episodes of renal colic produced by a renal lithiasis. Describe this diagnosis and the prognosis. Is this condition related to a chronic kidney disease? Why or why not?

Personal Information

Name: Mrs. Maggie Meriwether

Age: 56 years old

Gender: Female

Description

Mrs. Meriwether is a 56-year-old woman, who was apparently in good health until six months ago, at which point she started noticing an uncontrollable urge to urinate when she was exercising, lifting weights, sneezing, or coughing. The embarrassing part for her is that, although she has tried to suppress the urge, she has voided in her underwear very often. The problem has become more frequent, and she has to wear a sanitary pad constantly. The patient also shares that she has something protruding through her vagina. She is anxious because she thinks she has a tumor. After conducting a thorough medical interview and physical examination, the doctor diagnoses stress urinary incontinence and cystocele.

Our patient is a mother of four children with vaginal deliveries complicated by shoulder dystocia. During her last pregnancy, she had a whitish and cottage cheese-like vaginal discharge. A year ago, Mrs. Meriwether had an episode of gastroenteritis accompanied by profuse vomiting and diarrhea, which produced moderate dehydration and electrolyte and acid-base imbalances. Our patient also indicates she has had two episodes of right renal colic produced a renal lithiasis. Patient has no history of smoking or alcohol intake.

On physical examination we found:

Remarkable Signs on Physical by Systems

Urinary system: Leakage of urine through the urethra during Valsalva maneuver

Reproductive system: Soft mass protruding through the vagina, mostly when the patient is pushing

Lab Tests

Complete blood count (CBC)

Urinalysis

Pelvic ultrasound

Cystourethrogram

Supporting Material

Mrs. Meriwether exhibits several conditions related to her urinary and reproductive systems. While the conditions may or may not be related, it is important as a medical professional to have a good understanding of these systems and potential disorders that affect them. In this module, you will explore the disorders that Mrs. Meriwether has, as well as other disorders that you will run across in your career.

Explanation / Answer

1. A cystocele is also known as prolapsed or fallen bladder. It occurs when the ligaments that holds the bladder stretches or weakens. As she said that mass is protruding through vagina, she is in grade III. Although it is not a life threatening problem it can affect the women’s quality life, and if left untreated it gets worse and urination may become difficult which results in kidney problems.

For grade III cystocele patients, surgery is required to put the bladder in a normal position which is also called an anterior repair. It is contraindicated in patients having local vaginal problems, vaginitis, and neoplasms. As patient is having 66 years, she may have already attained menopause condition, which suppose to cause oestrogen level imbalance. It may also consider for risk factor, hence hormonal therapy suggested.

Other causes of urinary obstruction:

2. Common reproductive system cancers include leiomyomas and cervical, endometrial, and ovarian carcinomas whereas vulvar, vaginal, fallopian tube cancers, and choriocarcinomas are very rare.

In this case, as pelvic mass has been determined using pelvic ultrasound we can rule out ovarian tumor, fallopian tube cancer and uterine sarcoma. cystourethrogram tests can identify endometrial cancer which consists fibroid masses and cervical cancers.

We can rule out vulvular, vaginal cancers which can assess by physical and symptomatic appearance. leiomyomas most probably occur as complication during pregnacy conditions, so we can rule out leiomyomas. cervical carcinoma can be ruled out as the major risk factor includes viral infection.

3. The major cause of renal colic is kidney stones. Pain starts from kidney region (lower back) and radiates forward to the abdomen and genitalia. Calculi usually forms from substances like calcium, oxalate and uric acid. Presence of higher amounts of one of these substances in urine will leads to formation of crystals of that substance. Cystine stones are very rare, they forms in persons having hereditary disorder which makes kidneys to excrete cystine (cystinuria). Struvite stones are formed in persons having infection. Taking high protein diet and intake of
low amounts of liquids are the main causes of renal calculi. Blood tests may reveal the presence of excess calcium and uricacid levels. Urine tests and imaging techniques are used to diagnose the disease. Small stones usually excretes on their own when we take large amounts of water. Extracorporeal shock wave lithotripsy (ESWL) and procedure called percutaneous nephrolithotomy is used to remove large stones. If it is left untreated it may lead
to urinary tract infection and may also results in Chronic kidney disease.

But the existing condition cannot be considered for chronic kidney disease. As the symptoms include nephritis, increased creatinine levels, decreased volume of urine, burning micturition. In Chronic conditions, dialysis is required. Now for the patient, no such symptoms has been experienced.

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