Severe multicompartment pelvic organ prolapse leading to bilateral upper urinary tract dilatation in a 72-year-old woman with cholestatic jaundice: Successful conservative management with a pessary

Pelvic organ prolapse (POP) is common in elderly women but rarely causes upper urinary tract obstruction. We report the case of a 72-year-old multiparous woman (G5P5) with severe multicompartmental POP—grade IV uterine prolapse, grade III cystocele, and grade III rectocele—complicated by bilateral ureteropyelocaliceal dilatation. The patient also presented with cholestatic jaundice and a suspected hilar mass suggestive of cholangiocarcinoma. Cystoscopy showed ureteral orifices only visible after manual prolapse reduction, and cystography excluded vesicoureteral reflux. In the absence of acute infection or renal failure, and given her general frailty, we opted for conservative treatment with a vaginal pessary. After six weeks, the patient showed clinical improvement and imaging confirmed resolution of hydronephrosis. This case highlights the rare but significant impact of advanced POP on the upper urinary tract and supports pessary placement as a safe option in select frail patients.