Prolapse repair after anterior exenteration

Area of Science:

• Urogynecology
• Surgical Oncology
• Pelvic Reconstructive Surgery

Background:

• Anterior exenteration for invasive bladder cancer involves significant pelvic organ removal.
• Pelvic organ prolapse (POP) can occur or progress after pelvic exenteration, impacting quality of life.
• Previous POP management strategies, such as pessaries, may be insufficient in these complex cases.

Purpose of the Study:

• To present a case of successful pelvic organ prolapse repair in a patient with a history of anterior exenteration.
• To evaluate the feasibility and outcomes of vaginal native tissue reconstruction following extensive pelvic surgery.
• To demonstrate a potential surgical solution for managing refractory POP in cancer survivors.

Main Methods:

• The study details a single-patient case involving robotically assisted laparoscopic anterior exenteration for bladder cancer.
• The patient subsequently underwent vaginal native tissue pelvic reconstruction, including uterosacral ligament suspension, posterior repair, and anterior compartment reconstruction.
• Post-operative follow-up was conducted for 16 months to assess for prolapse recurrence.

Main Results:

• The patient achieved successful pelvic reconstructive surgery with no evidence of recurrent prolapse at 16 months follow-up.
• Vaginal native tissue reconstruction was technically feasible despite the patient's prior extensive pelvic surgery.
• The procedure effectively addressed the patient's symptomatic pelvic organ prolapse.

Conclusions:

• Vaginal native tissue pelvic reconstruction is a viable option for treating pelvic organ prolapse in patients with a history of pelvic exenteration.
• This approach can restore pelvic support and improve quality of life for cancer survivors.
• Further research may explore the long-term efficacy and broader applicability of this technique.