Urolithiasis and female pelvic organ prolapse (POP) have been reported as linked conditions that significantly impact women’s quality of life. While urolithiasis pertains mineral buildup that forms in the urinary tract, POP refers to descending pelvic organs, in the female, involving the uterus, the vagina We present a case of a 75 year old female with nephrolithiasis bilateral, ureterolithiasis right, who underwent a series of endoscopic stone surgeries over a 6 month period and underwent pessary insertion post-operatively

A 75 year old female consulted at our institution for flank pain, bilateral, no hematuria, no lithuria, no fever or chills. She had undergone cystoscopy, retrograde pyelogram, bilateral, double J stent insertion, bilateral 6 months prior however was lost to follow-up. On repeat consult, patient was noted to have terminal dysuria, generalized weakness, and no fever. Patient underwent cystoscopy, retrograde pyelogram, bilateral double J stent replacement, left, supine percutaneous nephrolithotomy, right, double J stenting, right. The patient was placed on dorsal lithotomy position, on initial cystosurethroscopy, note of pelvic organ prolapse, non-encrusted DJ stent bilateral. On RGP, note of retrograde outflow of contrast to the collecting system. Proceeded with percutaneous renal access. Note of nephrolithiasis at the inferior calix measuring 2.4cm x 2.1 cm x 1.1cm yellowish, hard. Proceeded with pneumathic lithotripsy. Upon stone clearance, DJ stent insertion right, NT insertion, right, then IFC insertion done. Patient tolerated the procedure well. Interim, patient was prepared for second stage operation, management of pelvic organ prolapse was referred to Gynecology service however patient had no consent for intervention at that time. 3 weeks post initial surgical procedure, patient underwent retrograde intrarenal surgery, left, cystoscopy, ureteroscopy, intracorporeal lithotripsy, middle third, right. On RIRS, noted Note of 2cm lithiasis brown hard at the superior pole left. Proceeded with laser lithotripsy with TFL and extraction of stone fragments and suction of dust. On ureteroscopy, noted .5cm lithiasis brown hard at the middle 3rd ureter right, proceeded with intracorporeal lithotripsy, pneumatic lithotripsy, and basket extraction of ureterolithiasis which she tolerated well. On the 6th post-operative day, patient was fitted with a pessary and was discharged.

DJ stent was maintained, patient was sent home with pessary. Patient is due for follow up on April 22, 2025.

When pelvic organ prolapse and urolithiasis are present in one patient, both can be addressed with one being managed conservatively and one being managed more aggresively