Cystocele Research Articles

Evaluating the post-foaling mare with colic. Part 2: the genitourinary and reproductive tracts

Post-foaling colic is a common presenting complaint for equine practitioners that requires careful evaluation. Colic signs can be attributed to conditions of the gastrointestinal, reproductive and genitourinary tracts. Diagnostic workup is similar to that of most other cases of colic, with additional attention paid to the udder, vulva and vaginal vault; transabdominal ultrasound examination is often key in establishing a diagnosis. Conditions of the genitourinary and reproductive tracts include periparturient haemorrhage, which may be intra-abdominal, intrauterine, intramural, vaginal and/or into the broad ligament, uterine tear with or without intestinal evisceration, bladder rupture, septic metritis and/or retained foetal membranes, invagination of a uterine horn, uterine prolapse and bladder prolapse. Prompt diagnosis is vital as aggressive therapy is generally required for the majority of these conditions and prognosis is variable depending on the condition and severity.

Clinical value of transperineal ultrasound in evaluating the effects of different delivery methods on the primipara pelvic floor structure and function

To evaluate the effects of different delivery methods on the pelvic floor structure and function among primiparas by transperineal ultrasound, with a view to providing guidance for early postpartum intervention. Primiparas who underwent postpartum examination with transperineal ultrasound were recruited. Subjects were divided according to mode of delivery (vaginal and cesarean delivery). General information (including age, pre-pregnancy BMI and neonatal weight) were collected, and transperineal ultrasound was performed to measure such indicators as the levator hiatus areas in resting, constrictive anal and maximum Valsalva states, the posterior vesicourethral angles and distances between vesical neck and posterior inferior margin of pubic symphysis in resting and maximum Valsalva states, as well as the vesical neck mobility and urethral rotation angle in maximum Valsalva state. The inter-group differences in ultrasound indicators between the resting and Valsalva states were compared to analyze the postpartum incidences of pelvic floor dysfunctions like stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse in primiparas. The levator hiatus areas in resting, constrictive anal and maximum Valsalva states were all larger in the vaginal delivery group than in the cesarean delivery group (P < 0.05). Compared to the cesarean delivery group, the vaginal delivery group exhibited larger posterior vesicourethral angles in resting and maximum Valsalva states (P < 0.05). The distances between vesical neck and posterior inferior margin of pubic symphysis were greater in the cesarean delivery group than in the vaginal delivery group at both resting and maximum Valsalva, with that at maximum Valsalva showing significant inter-group difference (P < 0.05). The vaginal delivery group exhibited greater vesical neck mobility and urethral rotation angle at maximum Valsalva compared to the cesarean delivery group (P < 0.05). The incidences of stress urinary incontinence, urethral funnel formation, bladder prolapse and uterine prolapse were all higher in the vaginal delivery group than in the cesarean delivery group, with the stress urinary incontinence and bladder prolapse incidences showing significant inter-group differences (P < 0.05). With transperineal ultrasound, various pelvic floor indicators of primiparas can be clearly measured and, through these ultrasound indicators, the effects of different delivery methods on the pelvic floor function can be evaluated, which is conducive to early clinical detection and intervention of postpartum pelvic floor dysfunctions, thus facilitating the early postpartum treatment.

Cloacal Exstrophy Closure Without Osteotomy and Immobilization: A Recipe for Failure

BackgroundCloacal exstrophy (CE) remains one of the most severe birth defects compatible with life with a constellation of anomalies involving the bladder, genitalia, hindgut, and spinal cord. Pelvic osteotomy and immobilization have been utilized to facilitate bladder closure, yet their role as adjuncts remains a topic of debate. The authors sought to evaluate the outcomes of CE closure without the use of osteotomy or lower extremity (LE)/pelvic immobilization. MethodsAn institutional database of 173 CE patients was reviewed for patients closed without osteotomy and/or limb immobilization. Patient records were reviewed for continence procedures, reclosure operations, and continence outcomes. ResultsA total of 59 closure surgeries that met inclusion criteria were identified in 56 unique patients. Thirty-seven closure procedures developed eventual failure (63%) with secondary closure events also resulting in failure. Most closures did not use an osteotomy, 93.2%. LE immobilization-only was used in most closures (43/59), of which only 37% were successful. Failures were attributed to dehiscence (14/37), bladder prolapse (19/37), or both dehiscence and prolapse (4/37). The median age at closure was 3 days old (1–18.5 IQR) with the majority of closure events (47) closure events taking place in the newborn period. Median diastasis prior to primary closure was 6 cm (4.8–8 cm IQR). The median number of closure attempts needed to close the bladder was 2 (1–2 IQR). Of the 56 patients, 31 have >3 h of daytime continence, with the entirety of these patients catheterizing a stoma or below. ConclusionThese results highlight the critical role of osteotomy and lower limb immobilization in successful closure of the bladder and abdominal wall in CE. Type of StudyTreatment Study. Level of EvidenceLevel III.

Rectus Muscle Flap-augmented Closures in Wide-gap Exstrophy Bladder.

Wound dehiscence is one of the main complications in complete primary repair of exstrophy (CPRE). In our pediatric urology unit, we have switched to the use of inferior epigastric artery based rectus abdominis flap cover for abdominal wall closure in addition to measures like osteotomy and postoperative hip spica. to assess the efficacy of Recus abdominis flap in prevenion of wound dehisence. This study was conducted from June 2014 to June 2021 comparing two groups of the patients; group I consisted of thirty patients of CPRE with rectus flap repair of abdominal wall (CPRE-RF) and group II consisted of thirty patients with CPRE without rectus flap. Clinical and surgical details, including the outcome with regards to wound dehiscence and continence, were recorded. The mean age of the patients in CPRE-RF was 5 months and that with only CPRE was 4.6 months. Mean pubic diastasis in Group l was 4.8± 1.07 cm and that of Group II was 4.6±1.3 cm. None of the patients in CPRE-RF had wound dehiscence or bladder prolapse while as 6 patients in CPRE alone had wound dehiscence and 1 had bladder prolapse. This difference was statistically significant. Primary bladder continence was achieved in 4 patients in CPRE-RF and 3 patients in CPRE group. Hypospadias had almost similar occurrence in the two groups. One patient in each group had bladder neck fistula. Use of rectus muscle flap in complete Primary Repair ofExtrophy bladder helps in prevention of wound dehiscence and contributes in achievement of final goal of continence in wide gap pubic diatasis.

Role of ChatGPT and Gemini in the Urology Field: A Case-Based Study

Introduction The healthcare sector is witnessing a transformation with the advent of artificial intelligence (AI), exemplified by ChatGPT and Gemini AI. These AI systems emulate human conversation and provide accurate medical responses. This study explores their integration into medical decision-making in the urology field. Methods The study presented a collection of 20 medical case scenarios, carefully crafted and revised by a team of authors in the field of urology. Each case was presented to ChatGPT and Gemini in September of 2023, and their responses were recorded and analyzed. Results Both AI tools displayed varying accuracy in diagnoses and management recommendations. ChatGPT failed in identifying congenital penile curvature, while Gemini succeeded. Conversely, ChatGPT excelled in recommending a management plan for renal artery aneurysms. Gemini outperformed in explaining iodinated contrast material toxicity. Both struggled with a bladder prolapse prevention question. Conclusion AI integration in urology is promising but has limitations. AI provides valuable insights but cannot replace human expertise. Research is vital to improve AI's role in urology. Clinicians should view AI suggestions as supplements to their judgment, fostering collaborative healthcare decisions.

Apical defect - the essence of cystocele pathogenesis?

Lack of standardization causes misunderstandings in planning of cystocele treatment and the evaluation of surgical method effectiveness. The POP-Q System and DeLancey's three levels of pelvic support do not account for the phenomenon of cystocele caused by an apical defect. We aimed to evaluate the impact of level I defect on the formation of cystocele. Women reporting complaints related to bladder prolapse (cystocele) were subjected to a urogynecological examination. For this purpose, a simple and standardized method was used, based on the POP-Q System and DeLancey's three levels of pelvic support. Furthermore, it was expanded by evaluating the impact of level I defect (apical defect) on prolapse at level II of the anterior compartment. In total, contribution of an apical defect to the pathogenesis of cystocele was founded in 72.2% of 302 female patients included in this study. In 30.8% the cystocele was caused exclusively by an apical defect. In turn, in 41.4% of patients, it resulted from concomitant apical and level II defect of the anterior compartment (lateral or central). The results of this study indicate that an apical defect may play a significant role in the development of a cystocele. Hence, it could be essential to take the influence of an apical defect on level II in anterior compartment into account when planning a surgical procedure. The authors suggest that lack of such procedures potentially exposes some cystocele patients to ineffective treatment.

Partial cystectomy of prolapsed urinary bladder in yellow‐footed tortoise (Chelonoidis denticulata)

AbstractAn adult yellow‐footed female tortoise (Chelonoidis denticulata) weighing 7.6 kg was voluntarily surrendered to the environmental police. The history‐taking could not be obtained due to a lack of information. Upon physical examination, a fluid‐filled structure prolapsed through the cloacal opening was observed. The aspirated fluid had a citrine‐yellow colour, suggesting urinary bladder prolapse, which was successfully reduced back into the coelomic cavity with the hydrostatic reduction technique. The following day, prolapse recurrence was observed. In addition, distal two‐thirds of the organ had a darkened coloration. Whole‐body radiographs revealed four eggs ready for oviposition. Partial cystectomy of the prolapsed urinary bladder was done. Pretreatment with calcium followed by oxytocin was used for nonobstructive egg retention, and all eggs were laid. After 2.4 years of the surgery, the tortoise did not experience a recurrence of bladder prolapse.

Squeeze-and-excitation-attention-based mobile vision transformer for grading recognition of bladder prolapse in pelvic MRI images.

Bladder prolapse is a common clinical disorder of pelvic floor dysfunction in women, and early diagnosis and treatment can help them recover. Pelvic magnetic resonance imaging (MRI) is one of the most important methods used by physicians to diagnose bladder prolapse; however, it is highly subjective and largely dependent on the clinical experience of physicians. The application of computer-aided diagnostic techniques to achieve a graded diagnosis of bladder prolapse can help improve its accuracy and shorten the learning curve. The purpose of this study is to combine convolutional neural network (CNN) and vision transformer (ViT) for grading bladder prolapse in place of traditional neural networks, and to incorporate attention mechanisms into mobile vision transformer (MobileViT) for assisting in the grading of bladder prolapse. This study focuses on the grading of bladder prolapse in pelvic organs using a combination of a CNN and a ViT. First, this study used MobileNetV2 to extract the local features of the images. Next, a ViT was used to extract the global features by modeling the non-local dependencies at a distance. Finally, a channel attention module (i.e., squeeze-and-excitation network) was used to improve the feature extraction network and enhance its feature representation capability. The final grading of the degree of bladder prolapse was thus achieved. Using pelvic MRI images provided by a Huzhou Maternal and Child Health Care Hospital, this study used the proposed method to grade patients with bladder prolapse. The accuracy, Kappa value, sensitivity, specificity, precision, and area under the curve of our method were 86.34%, 78.27%, 83.75%, 95.43%, 85.70%, and 95.05%, respectively. In comparison with other CNN models, the proposed method performed better. Thus, the model based on attention mechanisms exhibits better classification performance than existing methods for grading bladder prolapse in pelvic organs, and it can effectively assist physicians in achieving a more accurate bladder prolapse diagnosis.

Wide-bore polyester sutures may create sufficient collagen for cure of prolapse/incontinence: a work in progress.

The main thrust of the Integral Theory Paradigm (ITP) is that inadequate ligament collagen causes pelvic organ prolapses (POP) and pelvic symptoms, a concept validated by multiple publications which cured POP and bladder/bowel/pain dysfunctions by collagen-creating slings. Sling surgery for surgical cure of these conditions was eliminated in the United States, Europe and other regulatory jurisdictions by banning all mesh products (including tapes) in about 2017. The aim of this work was to inform of the progress of a highly promising alternative method for collage creation for ligament repair: wide-bore polyester sutures accurately applied to weak ligaments. The scientific rationale for the wide-bore polyester plication method was a revisit and analysis of prior Instron testing data from a rejected polyester aortic graft from a doctoral thesis. The analysis indicated that the collagen produced by No. 2 polyester sutures would be sufficient to repair weakened pelvic ligaments. The surgical methodology consisted of application of wide-bore No. 2 or No. 3 polyester sutures to existing vaginal surgical techniques such as cardinal/uterosacral ligament (CL/USL) repair in the Fothergill operation, deep transversus perinei (DTP) ligamentous supports of the perineal body (PB) and uniquely, pubourethral ligament (PUL) repair for stress urinary incontinence (SUI). No vaginal tissue was excised. These operations are now being performed in several centres around the world. Because of this, the results detailed below are indicative only, and necessarily incomplete, as they are only from these units. Twelve month data (n=35) for SUI cure (83%) following PUL repair by the urethral ligament plication (ULP) operation has been submitted for publication; POP quantification (POPQ) points Ba, C, Bp, D were significantly improved at 6 weeks postoperative review following repair of CLs (cystocele) and USLs (uterine/apical prolapse) (n=56): deep transverse perinei ligament repair (descending perineal syndrome "DPS") (n=4) were cured at 6-12 months review. Though numbers are few, in the context of DPS being considered incurable, these numbers are significant. Except for the ULP operation, the techniques for cystocele, uterine prolapse, perineocele were essentially evolved versions of the Fothergill and standard PB repairs without any vaginal or ligament excisions. Though promising, more extensive and longer-term results are clearly required before this wide-bore polyester ligament repair method can become mainstream.

Prevention and treatment of preterm delivery in pregnant women with isthmic-cervical incompetence

Preterm delivery (PD) is a global public health problem, being the leading cause of perinatal morbidity and mortality in many countries. Despite numerous studies on the etiology of this condition, PD incidence has been increasing annually, and about 15 million infants are born prematurely (before the week 37 of gestation) worldwide. One of the main risk factors for PD is isthmic-cervical incompetence (ICI), which leads to microbial invasion of the amniotic cavity, prolapse of the fetal bladder, premature discharge of amniotic fluid and PD. Currently, several methods for ICI prevention and treatment are available: conservative (use of progesterone, obstetric pessary) and surgical (transvaginal cerclage and transabdominal cerclage).

Pathology of the pelvic bones and its correction in bladder exstrophy

There are many studies regarding treatment methods for bladder exstrophy, but it is impossible to single out the only correct one. When treating bladder exstrophy, all defects can be eliminated separately, but the effect of such interventions will be incomplete. When analyzing the anatomy of patients with this pathology, pronounced splitting and divergence of the pelvic muscles is noted due to dysplasia and the wide position of the iliac and pubic bones. Due to the inferiority of the pelvic bones, the functions of all its organs are disrupted. Modern methods of radiation research have made it possible to better understand the main causes of such changes: outwardly rotated iliac bones, retroversion of the acetabulum and femur, shortened branches of the pubic bones, a backward curved acetabulum and flabby sacroiliac joint, increased distance between the triradial cartilages. Such changes are difficult to eliminate with soft tissue plastic surgery, so specialists who use osteotomy of the pelvic bones in the treatment of this pathology have more positive results. Since 1958, in the treatment of children with exstrophy of the bladder, osteotomy has been used in various versions, which makes it possible to restore the pelvic ring, improve the results of soft tissue plastic surgery and urinary continence. The authors noted a high rate of continence success in patients who underwent primary bladder closure without complications such as wound infection, dehiscence, or any degree of bladder prolapse. Thus, correction of the skeletal system serves as a basic element in the correction of bladder exstrophy.

Classic Bladder Exstrophy Closure Without Osteotomy or Immobilization: An Exercise in Futility?

To review the outcomes of classic bladder exstrophy (CBE) closure without the use of osteotomy or lower extremity/pelvic immobilization. A prospectively maintained institutional approved exstrophy-epispadias complex database of 1487 patients was reviewed for patients with CBE who had undergone closure without osteotomy nor immobilization. All patients were referred to the authors' institution for reconstruction later in life or for failed closure. Of a total of 1016 CBE patients, 56 closure events were identified that met inclusion with a total of 47 unique patients. Thirty-eight closures were completed prior to 1990 (67.9%). Forty-five closure events developed eventual failure (45/56, 80.4%) (Table 1). Thirteen closure events were secondary closures (13/56, 23.2%). The primary closure failure rate was 83.7% (36/43) while the secondary closure failure rate was 69.2% (9/13). Failures were attributed to one or more of dehiscence, bladder prolapse, and vesicocutaneous fistula (25/45, 55.6%) (23/45, 51.1%) (6/45, 13.3%), respectively. Thirty-seven patients developed social continence (37/47, 78.7%), while only 8 patients developed spontaneous voided continence (7/47,17.0%) (Table 2). The most common methods of voiding were continent catheterizable channels (25/47, 53.2%) of which all were socially continent. These results illustrate the critical role osteotomy and postoperative immobilization can play in both primary and secondary exstrophy closure. While this is a historical case series, the authors believe that these results remain relevant to contemporary exstrophy surgeons.

Multi-staged vs Single-staged Pelvic Osteotomy in the Modern Treatment of Cloacal Exstrophy: Bridging the Gap

PurposeStaged pelvic osteotomy has been shown in the past to be an effective tool in the closure of the extreme pubic diastasis of cloacal exstrophy. The authors sought to compare orthopedic complications between non-staged pelvic osteotomies and staged pelvic osteotomies in cloacal exstrophy. MethodsA prospectively maintained exstrophy-epispadias complex database of 1510 patients was reviewed for cloacal exstrophy bladder closure events performed with osteotomy at the authors' institution. Bladder closure failure was defined as any fascial dehiscence, bladder prolapse, or vesicocutaneous fistula within one year of closure. There was a total of 172 cloacal exstrophy and cloacal exstrophy variant patients within the database and only closures at the authors’ institution were included. Results64 closure events fitting the inclusion criteria were identified in 61 unique patients. Staged osteotomy was performed in 42 closure events and non-staged in 22 closures. Complications occurred in 46/64 closure events, with 16 grade III/IV complications. There were no associations between staged osteotomy and overall complication or grade III/IV complications (p = 0.6344 and p = 0.1286, respectively). Of the 46 total complications, 12 were orthopedic complications with 6 complications being grade III/IV. Staged osteotomy closure events experienced 10/42 orthopedic complications while non-staged osteotomy closures experienced 2/22 orthopedic complications, however this did not reach significance (p = 0.1519). Of the 64 closure events, 57 resulted in successful closure with 6 failures and one closure with planned cystectomy. ConclusionThis study confirms, in a larger series, superior outcomes when using staged pelvic osteotomy in cloacal exstrophy bladder closure. Staged osteotomy was shown to be a safe alternative to non-staged osteotomy that can decrease the risk of closure failure in this group. Staged pelvic osteotomy should be considered in all patients undergoing cloacal exstrophy bladder closure. Type of StudyTreatment study. Level of EvidenceLevel III.

Correlation between clinical examination and perineal ultrasound in women treated for pelvic organ prolapse

IntroductionLifetime risk of surgery for female pelvic organ prolapse (FPOP) is estimated at 10 to 20%. Prolapse assessment is mostly done by clinical examination. Perineal ultrasound is easily available and performed to evaluate and stage FPOP. This study's aim is to evaluate the agreement between clinical examination by POP-Q and perineal sonography in women presenting pelvic organ prolapse. Materials and methodsWe carried out a prospective study from December 2015 to March 2018 in the gynecologic department of a teaching hospital. Consecutive woman requiring a surgery for pelvic organ prolapse were included. All women underwent clinical examination by POP-Q, perineal ultrasound with measurements of each compartment descent, levator hiatus area and posterior perineal angle. They also answered several functional questionnaires (PFDI 20, PFIQ7, EQ-5D and PISQ12) before and after surgery. Data for clinical and sonographic assessments were compared with Spearman's test and correlation with functional questionnaires was tested. Results82 women were included. We found no significant agreement between POP-Q and sonographic measures of bladder prolapse, surface of the perineal hiatus or perineal posterior angle. There was a significant improvement of most of the functional scores after surgery. DiscussionOur study does not suggest correlation between clinical POP-Q and sonographic assessment of bladder prolapse, hiatus surface or perineal posterior angle. Ultrasound datasets were limited by an important number of missing data resulting in a lack of power.

Images - Management of complete bladder prolapse through the urethra.

Images - Management of complete bladder prolapse through the urethra.

Correction of cervical insufficiency during prolapse of the fetal bladder and intrauterine infection

This article describes a clinical case of the course and management of pregnancy complicated by cervical insufficiency with prolapse of the fetal bladder and formation of “sludge” in the amniotic fluid at 20–21 weeks of pregnancy. Gradual use of antibacterial therapy and hormonal support with micronized progesterone, subsequent surgical serclage and the installation of an unloading obstetric pessary allowed to prolong pregnancy to 284 days and to deliver through the natural birth canal with a newborn without signs of intrauterine infection.

Successful surgical treatment of omphalocele with umbilical evagination of the bladder: an extremely rare presentation of neonatal case

BackgroundA few cases of small omphalocele with umbilical evagination of the bladder have been reported. However, its embryology is yet to be elucidated. Only a few reports have indicated the existence of urachal anomalies and umbilical cysts related to bladder evagination. The incidence of urachal anomalies at birth is reported to be 1 in 5000–8000 live birth, and urachal aplasia is rare. Herein, we report a rare, novel case of urachal aplasia.Case presentationWe encountered a small omphalocele with bladder evagination associated with urachal aplasia for which the neonate underwent surgery one day after birth. The patient was a one-day-old boy with a prenatally diagnosed omphalocele. A fetal magnetic resonance image (MRI) scan (25 weeks of gestation) revealed a 30 × 33 mm (approximately 1.3 in.) cystic lesion which was suspected to be an umbilical cyst. The baby was born vaginally at 38 weeks, weighing 2956 g. An omphalocele (hernial orifice diameter, 4 cm × 3 cm) with bladder prolapse was recognized. After sac excision, the prolapsed bladder was resected and closed with two-layer sutures. In order to secure sufficient bladder capacity, we estimated the minimum residual volume as 21 ml after bladder plasty. The remaining bladder capacity was confirmed to be 30 ml by injecting a contrast dye and saline into the bladder. The neonate had no associated cardiac urogenital or skeletal anomalies. Postoperative course was uneventful. The patient was regularly followed up for two years after surgery and underwent umbilicoplasty. He had no trouble with urinary function.ConclusionIn this case, we experienced extremely rare condition of a small omphalocele with bladder evagination associated with urachal aplasia and reviewed 7 case reports of anomalies similar to those in the present case. Umbilical cord cysts may be an informative indicator of these symptoms in utero. Therefore, ultrasonography scans should be conducted until delivery, despite the spontaneous disappearance of cord cysts.

Bladder prolapse with simultaneous entrapment of a portion of the descending colon through the urethral sphincter secondary to dystocia in a mare

SummaryBladder prolapse is rare in mares but may occur as a result of excessive straining during parturition or postpartum. We report a case of dystocia‐associated prolapse and entrapment of the small colon through the external urethral opening into a prolapsed urinary bladder. No previous reports of this condition were found. An 11‐year‐old Thoroughbred mare was presented to The Equine Hospital of the Jockey Club of Saudi Arabia for evaluation and treatment of dystocia. Prolapse of the urinary bladder was concomitantly diagnosed. After initial assessment, replacement of the urinary bladder in the normal position did not appear possible. The mare was immediately prepared for caesarean section. The foal was successfully delivered and resuscitated. Detailed assessment of the bladder during surgery revealed that the small colon had prolapsed through the external urethral opening and was inside the space formed by the everted bladder. The urinary bladder was opened. The small colon was replaced into the abdominal cavity; a surgeon gently replaced the small colon through the external urethral sphincter and a second surgeon retrieved the small colon by gentle traction until normally aligned. The bladder was closed and replaced. The mare recovered uneventfully. The mare and the foal were discharged from the hospital 17 days post‐operatively.

Eversão completa de bexiga no pré-parto em vaca Nelore - relato de caso

ABSTRACT Partial or complete bladder eversion is a rare condition of poor prognosis in cows, commonly associated with intense tenesmus observed in the peripartum period. A 14-year-old obese Nellore cow at 280 days of gestation was referred with 24-hour bladder prolapse. The bladder was complete eversion through the vulvar vestibule showing a thick congested wall and small residual urine volume. After clinical examination, the cow received scopolamine butylbromide and intercoccygeal epidural anesthesia, and the externalized bladder segment was partially reduced, remaining only 10 cm externalized. The cow was maintained with an intravesical human gastric tube number 16 and constant monitoring. The eversion was fully reduced after 12 hours of local treatment, and as the cow presented subclinical ketosis, hypocalcemia and cystitis, antibiotic, glucose, calcium and propylene glycol therapy were performed. We opted for induction of parturition, and after 24 hours, a healthy 52kg calf was born and the placenta was delivered 16 hours after calving. The cow and calf were discharged on the sixth day of hospitalization, with no recurrences or secondary complications after treatment.

V12-10 COMPLETE BLADDER PROLAPSE THROUGH THE URETHRA: ROBOTIC-ASSISTED LAPAROSCOPIC BURCH COLPOSUSPENSION AND BLADDER NECK RECONSTRUCTION

You have accessJournal of UrologyCME1 Apr 2023V12-10 COMPLETE BLADDER PROLAPSE THROUGH THE URETHRA: ROBOTIC-ASSISTED LAPAROSCOPIC BURCH COLPOSUSPENSION AND BLADDER NECK RECONSTRUCTION Connie Wang, Rainjade Chung, Miyad Movassaghi, and Doreen Chung Connie WangConnie Wang More articles by this author , Rainjade ChungRainjade Chung More articles by this author , Miyad MovassaghiMiyad Movassaghi More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We present a unique case report of complete bladder prolapse through the urethra. We additionally demonstrate the surgical technique of robotic-assisted Burch Colposuspension and bladder neck reconstruction to address multiple urologic problems for a patient who was not a candidate for a mid-urethral sling, and who required concomitant pelvic organ prolapse repair. METHODS: The patient’s initial presentation of bladder prolapse through the urethra was repaired with manual reduction, urethroplasty, bladder neck closure, and cystorrhaphy. Her subsequent Burch Colpopsuspension was performed robotically. The Da Vinci Xi robot was used with a 5-port configuration, including an assistant port. Surgical steps described in this video include dissection of vagina off bladder, apical uterosacral ligament suspension, dropping the bladder, bladder neck reconstruction, Burch Colposuspension, paravaginal repair, and new suprapubic tube placement. RESULTS: A successful treatment of a freely mobile, prolapsing bladder and near absent urethra causing severe urinary incontinence is achieved. The patient remains continent and her bladder remains well reduced post-operatively. CONCLUSIONS: Robotic-assisted laparoscopic Burch Colposuspension represents a minimally-invasive, effective option for patients who present with multiple different urologic issues, including pelvic organ prolapse and stress urinary incontinence. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1067 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connie Wang More articles by this author Rainjade Chung More articles by this author Miyad Movassaghi More articles by this author Doreen Chung More articles by this author Expand All Advertisement PDF downloadLoading ...