| Summary: | We present the case of a patient with pyelonephritis secondary to urinary tract obstruction caused by uterine prolapse. An 80-year-old woman with uterine prolapse (pelvic organ prolapse stage 4) was treated with a pessary at an outside hospital due to her high perioperative risk. However, the pessary prolapsed. The patient developed pyelonephritis with hydronephrosis. A pessary was inserted to resolve the blockage of the urinary tract, antibiotic treatment was initiated, and the patient's condition improved. A total vaginal hysterectomy was ultimately performed. Challenges remain in the treatment of pelvic organ prolapse stage 4 for which a pessary cannot be used.
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