The patient was then brought to the operating room and placed in the dorsal lithotomy position. She was prepped and draped under the usual sterile technique. A 22-French cystoscope was used to evaluate the patient. The anterior urethra was normal in appearance without any evidence of stricture. Upon entering the bladder both ureteral orifices were identified, appeared to be in orthotopic position, with clear efflux urine. Systematic
evaluation of bladder with a 30 and 70-degree angle lens demonstrated no gross intravesical pathology specifically no gross inflammation, tumor, or calculi.
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A 5-French end-hole catheter was placed in the right ureteral orifice. A right retrograde pyelogram under real-time fluoroscopy demonstrated no gross static filling defect or obstructive uropathy. Subsequently, a left retrograde pyelogram was performed. This demonstrated no gross static filling defect or obstructive uropathy. At this point, then the bladder was filled to capacity. The cystoscope was withdrawn. On pelvic examination, she was noted to have urethral hypermobility, POP-Q stage I, anteroposterior compartment prolapse. There appeared to be she has had previous hysterectomy, good support of the vaginal wall.
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