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

Abstract

<h4>Purpose</h4>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.<h4>Materials and methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.