Severe Pelvic Organ Prolapse with Large Vaginal Mucosal Defect Underwent Laparoscopic Shull’s Uterosacral Ligament Colpo-Suspension and TVM Operation by Two Stage Surgery

Yasuyuki Kinjo,Hitomi Nakagawa,Kazuaki Nishimura,Kazuaki Yoshimura,Toru Hachisuga

doi:10.4236/ojog.2017.74041

Abstract

A 75-year-old woman complained of anuria and a sense of discomfort with severe pelvic organ prolapse (POP). We planned tension-free vaginal mesh (TVM) surgery after curing mucosal defects and completing treatment for diabetes mellitus. Anuria and pyelonephritis relapsed repeatedly due to the failure of ring pessary therapy. Surgical treatment was required emergently. We performed a total laparoscopic hysterectomy and uterosacral ligament colpo-suspension (Shull’s method). Although the vaginal apex was supported to a good position, cystocele occurred six months after the initial surgery. A TVM procedure for recurrent cystocele was performed after curing the mucosal defects, and after the improvement of glycemic control. Transvaginal native tissue repair has the advantages of low risk of ureter injury, firm colpo-suspension, and no need for mesh usage. On the other hand, it is not good at treating cystocele. Transvaginal native tissue repair should prove to be a useful surgical option for apical support without mesh.

Highlights

A 75-year-old woman complained of anuria and a sense of discomfort with severe pelvic organ prolapse (POP)
For the POP patients with vaginal mucosal defects, operations should be performed after curing the defects by ring pessary therapy and administration of estrogen/progesterone
The vagina was divided into three parts, i.e., 1) the upper third is suspended from pelvic wall by upper paracolpium and cardinal ligament, 2) the middle third paracolpium attaches vaginal wall laterally to the arcus tendinous and fascia of the levatorani muscles and pelvic wall, and 3) lower third fuses with perineal membrane, levatorani muscle, and perineal body

Summary

Introduction

In the 21st century, transvaginal mesh (tension-free vaginal mesh: TVM) operation, which was a new surgical technique, was developed in France and standardized skills are available in many countries. The US Food and Drug Administration (FDA) announced that surgical mesh devices had complications such as mesh exposure, pain, dyspareunia and infection, stressing the importance of adequate procedure selection [1]. For the POP patients with vaginal mucosal defects, operations should be performed after curing the defects by ring pessary therapy and administration of estrogen/progesterone. In this case, we experienced a severe POP patient who underwent a laparoscopic non-mesh surgery as an initial operation and a TVM operation for the recurrent cystocele

Case Report

Discussion