Abstract
Introduction and hypothesis
Pelvic organ prolapse following a radical cystectomy is challenging to treat and recurrence of prolapse after primary repair is common owing to compromised pelvic floor support and tissue quality. Vaginal prolapse repairs are often preferred because of concern for patients’ complex intraabdominal pathological conditions. However, for those with recurrent prolapse following colpocleisis, limited definitive treatment options exist.
Methods
This surgical video presents a 64-year-old G4P4 with a history of radical cystectomy with an Indiana Pouch for invasive urothelial carcinoma who presented with recurrent stage IV vaginal prolapse two years following colpocleisis. Owing to thin vaginal tissue, a sacrocolpopexy with vaginal mesh could not be performed, thus, the patient underwent robotic-assisted vaginal hernia repair with a polypropylene-reinforced ovine tissue matrix attached to Cooper’s ligament and the levator ani muscles.
Results
The surgery was free from complications and her postoperative Pelvic Organ Prolapse Quantification examination revealed a leading vaginal tissue remnant at the level of the hymen. The patient reported overall improved health and quality of life following surgery and recovery on postoperative validated questionnaires.
Conclusions
Vaginal and pelvic floor hernia repair with a polypropylene-reinforced tissue matrix is a feasible definitive surgical treatment for patients with prior radical cystectomy in whom colpocleisis has failed.
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Acknowledgements
Our team would like to acknowledge the patient presented in this video.
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L. Carbone: manuscript writing, video development and recording; V. Webber: video and abstract development; R. Rothenberger: video and manuscript editing, case reviewer; S. Lenger: video and manuscript editing; A. Gupta: video and manuscript editing; J. Messer: consultant surgeon, video production; S. Francis: video production and editing, manuscript editing, senior author, primary surgeon.
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S. Francis acts as a medical expert witness. The other authors report no conflicts of interest. There are no financial disclosures.
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Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
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Carbone, L., Webber, V., Rothenberger, R. et al. Robotic Vaginal Hernia Repair for Recurrent Vaginal Prolapse Status Post-Radical Cystectomy with an Indiana Pouch. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05755-x
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DOI: https://doi.org/10.1007/s00192-024-05755-x