An Impressive Case of Procidentia with Concomitant Cystocele and Hydronephrosis

Clinical History: A 45 year old African-American nulligravida female presented to the emergency department complaining of 8/10 nonradiating pain deep within her vagina. The patient admitted to having vaginal pain for the past 5 years, however on the day of admission, her pain had markedly increased from baseline. There is also urinary incontinence associated with coughing and laughing. She had a total hip replacement on the right secondary to a motor vehicle accident 25 years ago. Examination of the pelvis was significant for post surgical changes on the right side, asymmetry of the vulva, and protrusion of the entire uterus beyond the introitus.