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Robotic surgery for pelvic organ prolapse with complete bladder eversion.

Manabu Ichino1, Hitomi Sasaki1, Masashi Takenaka1

  • 1Department of Urology Fujita Health University School of Medicine Toyoake Japan.

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Pelvic organ prolapse with complete bladder eversion is rare. Surgical management including robotic procedures and colpoclesis can effectively treat this condition, preventing recurrence.

Keywords:
pelvic organ prolapserobotic surgeryurinary bladder eversion

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Area of Science:

  • Urogynecology
  • Minimally Invasive Surgery

Background:

  • Pelvic organ prolapse (POP) is a common condition affecting women.
  • Complete bladder eversion is an extremely rare complication of POP.

Observation:

  • An 82-year-old woman with a history of uterine prolapse presented with vulvar bleeding and a prolapsed uterus.
  • Pelvic examination revealed uterine prolapse and a large ventral mass with urinary outflow, indicative of complete bladder eversion.

Findings:

  • Initial treatment with manual reduction, robotic sacrocolpopexy, and bladder neck reconstruction failed, with recurrence at 10 months.
  • A subsequent multi-stage surgical approach involving robotic Burch colposuspension, cystopexy, bladder neck reconstruction, colpoclesis, and cystostomy achieved no recurrence.

Implications:

  • This case highlights the complexity of managing complete bladder eversion in the context of pelvic organ prolapse.
  • A staged surgical approach combining reconstructive and obliterative techniques may be necessary for refractory cases.
  • Robotic surgery offers a minimally invasive option for complex POP repairs.