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Management of anterior vaginal prolapse with enterocele after radical cystectomy
IUGA Academy. wang j. Jun 30, 2018; 213259
Topic: Pelvic Organ Prolapse
jianliu wang
jianliu wang

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235

Management of anterior vaginal prolapse with enterocele after radical cystectomy

Yang, Y1;Wang, J1

1: Peking University People's Hospital

Introduction: Because of the damage of pelvic fascia, pelvic organ prolapsed could take place after radical cystectomy for the treatment of bladder diseases, which seriously affect the patients’ life quality. However, the disease is lack of effective treatment and is difficult to handle.

Objective: This aimed of this study is to describe our experience in the management of anterior vaginal prolapse with enterocele after radical cystectomy.

Methods: A 75 year-old female complained about prolapse of mass from vagina for 6 months after receiving laparoscope radical cystectomy and ureteral-skin ostomy for the treatment of bladder cancer. The mass became serious when standing or moving, but could return when lying down. Physical examinations showed that the mass was covered with vaginal skin, with ulcer and bleeding. The Pop – q was Aa +2, Ba +6, C -5, Ap-2, Bp-2, D -4, gh5, Pb3, TVL 8. MRI showed the appearance of anterior vaginal prolapse combined with enterocele. To solve the disorder, laparoscopy was performed. During the surgery, with the help of laparoscope, the abdominal and pelvis cavities were explored. The adhesion of the intestinal canal and peritoneum was decomposed and the enterocele was restored to the abdominal cavity. Because of the lack of fascia for tissue repairing, the hernia mesh was used to close the pelvis cavity. The mesh was trimmed to form the colon notch, placed in the cavity and fixed to the bony tissue of the pelvic wall with a nail gun. Finally, we opened the vaginal wall, cut off the bad brittle tissue and repaired the vaginal wall.

Results: The patient recovered well after the surgery without unexpected complications. The post-operative MRI showed normal position of intestine without vaginal prolapse, and no recurrence was noticed during the 2-year follow-up.

Conclusions: Regaining the normal anatomical structure is the most important step for the management of anterior vaginal prolapse with enterocele. Hernia mesh can be used to reconstruct the supportive function of pelvis cavity.

Disclosure:

Work supported by industry: no.

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