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Prolapse repair after anterior exenteration.

Christopher P Chung1, Eizleayne Edrosa2, Mark T Wakabayashi2

  • 1Divisions of Gynecologic Oncology and Urology, City of Hope Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA. chchung@coh.org.

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Pelvic organ prolapse repair is feasible after anterior exenteration surgery for bladder cancer. This case report details a successful vaginal native tissue reconstruction, offering hope for patients with prior pelvic surgeries.

Keywords:
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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.