Tension-free vaginal mesh operation for concomitant rectal and uterine prolapse: A case report

Abstract

Rectal prolapse is the protrusion of the mucosal layer or full-thickness layer of rectal tissue through the anal orifice. This anatomical and functional disabling condition has been reported since ancient times, but the cause of rectal prolapse remains unknown. Surgical therapy is most effective for the definitive treatment. Abdominal and perineal methods for surgery to treat rectal prolapse is common, but the most effective operation has not been established. We report herein a patient with pelvic organ prolapse (POP) with concomitant cystocele, uterine prolapse, and rectal prolapse, which was repaired by an anterior and posterior tension-free vaginal mesh (TVM) operation. Case report An 80-year-old Japanese woman who had voiding dysfunction and defecation disorder was referred to our hospital. She had three children through transvaginal delivery, and an unremarkable medical history. Her height, weight, and body mass index were 160 cm, 40 kg, and 15.6 kg/m2, respectively. The gynecological examination revealed cystocele and stage IV uterine prolapse, based on the POP-quantification staging system, and grade V rectal prolapse, based on the Oxford rectal prolapse grading system (Fig. 1). Magnetic resonance imaging (MRI) revealed a cyctocele and uterine prolapse (Fig. 2), and defecography revealed no rectocele (Fig. 3). We chose surgical treatment for patients with POP whose stage, based on the POP-quantification staging system, was stage II with symptoms or higher than stage II. Her rectal prolapse was simultaneously repositioned when her uterine prolapse was pushed back manually; therefore, we believed that an anterior and posterior TVM operation would be useful for correcting the uterine prolapse and the rectal prolapse. Open in a separate window Fig. 1 Operative view. Concomitant stage IV uterine prolapse and grade V rectal prolapse.