title: Combination of pessary and periurethral collagen injections for nonsurgical treatment of uterovaginal prolapse and genuine stress urinary incontinence.
abstract: BACKGROUND
  The combination of severe uterovaginal prolapse and stress urinary incontinence in medically compromised patients in whom surgery is contraindicated is a difficult treatment dilemma.
  
  
  METHODS
  A 75-year-old woman with severe cardiac compromise and a history of pulmonary embolus presented with severe uterovaginal prolapse and stress urinary incontinence. The combination of a vaginal pessary and three periurethral collagen injections resulted in successful management of her prolapse and resolution of her stress urinary incontinence.
  
  
  CONCLUSIONS
  Although pessaries are frequently a satisfactory treatment option for women with severe uterovaginal prolapse, the appearance or worsening of urinary incontinence may make the option of pessary use less attractive. The addition of periurethral collagen injections will improve or cure urinary incontinence symptoms.
authors.affiliation: Department of Gynecology and Obstetrics, The Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Walters
authors.forename: L T
authors.initials: LT
authors.lastname: Iannetta
mesh_terms: D000368:Aged; D003094:Collagen / Q000627:therapeutic use*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D010570:Pessaries; D019736:Prostheses and Implants; D014521:Urethra; D014550:Urinary Incontinence, Stress / Q000628:therapy*; D014596:Uterine Prolapse / Q000628:therapy*
chemical_list: D003432:Cross-Linking Reagents; D003094:Collagen