1. Dr. Maryam Emami. Urologist

2.  A 71 year old woman with a history of :  recurrent UTI  chronic urinary obstructive symptoms  Incomplete bladder emptying  Since 2 years ago referred to our center. She couldn,t void from 1week ago.

3.  Past medical history:  Vaginal hysterectomy 5 year ago.  Anterior- posterior repair 2 year ago  Anterior- posterior repair 1 year ago

4.  Genital examination:  vaginal stenonis  Sever organ prolapse Huge cystocele(G4) Cuff prolapse entrocele

5.  Serum creatinine level was high (3) and other biochemistry results were normal.  Sonography revealed bilateral sever hydroureteronephrosis

9.  Urodynamic study couldn,t be performed Because bladder was outside of the pelvic UDS data,s were,not reliable.

10. Abdominal approach or vaginal approach  Abdominal sacral colpopexy (lower rate for recurrent vault prolapse, less dyspareunia)  Vaginal Sacrospinous colpopexy (quicker,cheaper,earlier return to activities Of daily living) ?????????? ??????????????

11.  Vaginal canal was very Narrow and short.  We could n,t reduce This hernia

12.  Abdominal : sacral colpopexy with mesh (correct cuff prolapse) Moschowitz procedure (closed cul-de-sac) Burch colposuspension (urethral support)

13. In 2-year fallow –up,no recurrence was observed.