Scleroderma and Pelvic Organ Prolapse: A Multidisciplinary Approach to Patient Care and Surgical Planning

Abstract

Background: Surgical outcomes in patients with systemic sclerosis, and the effect of concomitant treatment with immunosuppressant agents, are not well-studied in gynecology research. This article presents the case of a patient, with scleroderma and complete pelvic organ prolapse (POP), who desired surgical management. Current literature, clinical course of the patient, and further considerations for immunosuppressed patients with POP are discussed from a multidisciplinary perspective, including urogynecology, dermatology, and rheumatology. Case: A 56-year-old female with a history of five prior deliveries, including one Cesarean section, presented to a urogynecology clinic with complete procidentia and occult stress urinary incontinence. Multiple pessary fittings failed while she awaited medical optimization for surgery. She had diffuse scleroderma and diabetes mellitus, as well as a prior laparoscopic cholecystectomy. Her laboratory tests were positive antinuclear antibody and rheumatoid factor. She underwent robotically assisted supracervical hysterectomy, sacral colpopexy, bilateral salpingectomy, posterior repair, perineorrhaphy, midurethral sling, and cystoscopy. Results: The patient tolerated the surgery well. Seven months postsurgery, she had stage I POP and no recurrence of symptoms or postoperative complications. Conclusions: Patients with scleroderma can undergo reconstructive surgery successfully with careful multidisciplinary management, although further research is needed to clarify the specific risks in this patient population. (J GYNECOL SURG 33:198)