Transvaginal Repair of Pelvic Organ Prolapse After Cystectomy/Anterior Pelvic Exenteration

Pelvic organ prolapse (POP) in women after cystectomy or anterior pelvic exenteration is a rare yet complicated condition that presents a technical challenge. Limited data exists on the management of this condition. This study aims to review the vaginal approach to management of POP after cystectomy or anterior pelvic exenteration.

Patients undergoing vaginal repair of POP after cystectomy or anterior pelvic exenteration at a single institution from 1/1/2010 to 9/1/2018 were identified and retrospective data was extracted. Only patients with urologic indications for cystectomy or anterior exenteration were included.

Ten patients who underwent vaginal POP were identified. Median time to prolapse diagnosis after cystectomy/anterior exenteration was 5.5 months (0-42). All patients reported bulge symptoms, five (50%) had vaginal discharge, and three (30%) had irritation/pain at presentation. Four patients had sacrospinous ligament repair, three had biologic graft augmented repairs, two had suture-based repairs, and one had a colpocleisis. Complications were reported in three patients (30%)-vaginal bleeding, vaginal pain and biologic extrusion, and enterotomy. At a median follow-up of 12 months (1-58) six (60%) patients did not have recurrent bulge symptoms. Two patients (20%) had or planned for repeat repair.

Transvaginal repair of POP after cystectomy or anterior pelvic exenteration is a feasible and effective treatment option, with 60% reporting durable resolution of bulge symptoms. Eighty percent of patients will not need additional surgery. There is a 30% complication rate due to the complexity of the procedure, and patients should be counseled accordingly.