151 Use of Autologous Dermal Tissue Preserves Sexual Function after Pelvic Organ Prolapse Surgery

Abstract

Established surgical methods for pelvic organ prolapse include use of tension-free vaginal mesh and laparoscopic sacrocopopexy. However, an alert by the US Food and Drug Administration has increased patient anxiety about foreign body insertion. We developed a method of autologous dermal tissue transplantation for treatment of pelvic organ prolapse. This technique improves operative safety and effectiveness and preserves sexual function. Because blood flow is supplied from the uterine and mucosal sides of the bladder, and the engraftment rate is high. To evaluate the safety and effectiveness of using autologous dermal tissue for surgical repair of pelvic organ prolapse. The procedure was performed by adding dermal transplantation to cystocele/uterine prolapse surgery, which does not use conventional mesh, under general anesthesia. First, we resected the epidermis of abdominal skin and defatted the dermis. Next, the mucosa of the vaginal posterior wall was longitudinally dissected, and 2-0 TiCron (nonabsorbable suture) was applied to the left and right sacrospinous ligament (two stitches a side; four stitches in total). A vertical incision was made in the anterior vaginal wall, and 2-0 TiCron was stitched to each side of the arcus tendineus fascia pelvis (two stitches in total). The bladder was sutured with a 3-0 Vicryl three-needle horizontal mattress suture. The dermis was implanted on the bladder and anterior wall of the cervix and was placed on the sacrospinous ligament and the arcus tendineus fascia pelvis. The posterior wall of the uterine cervix was lifted to the sacrospinous ligament. The patient was discharged on the fifth day after surgery and used an external pessary (FemiCushion) for 2 months postoperatively, until the graft was firmly engrafted. This external pessary supports the pelvic floor muscle and can be used before surgery after removing a vaginal pessary, thereby improving patient quality of life. Patients can also use the external pessary if they develop sexual dysfunction while using a vaginal pessary.