V12-09: Sacrocolpopexy in Patients with Bladder Exstrophy and Genital Prolapse after Urinary Diversion
Genital prolapse in female patients with bladder exstrophy is common, especially after removal of the primary bladder and urinary diversion. There are some techniques existent addressing prolapse, even preemptively, with rather unsatisfying results. Sacrocolpopexy with mesh is an option to fix the prolapse in female urology. _x000D_ During intervention, the course of the ureters have to be highly regarded to prevent trauma, particularly in patients with a classical ureterosigmoidostomy or a rectosigmoid pouch._x000D_ Since 2007, the department of Urology at Mainz University established a method of urogynecological surgery, the sacrocolpopexy. This procedure is performed on patients with genital prolapse and bladder exstrophy, adapting it to the urinary diversion and its anatomic conditions.
Four patients had a classical ureterosigmoidostomy or a rectosigmoid pouch (Mainz Pouch II), two a heterotopic pouch (Mainz Pouch I) and one patient had an incontinent colon conduit. All patients had multiple preliminary operations. _x000D_ The video demonstrates a sacrocolpopexy with mesh procedure on a 40 year-old patient with congenital bladder exstrophy who received a rectosigmoid pouch at the age of two. The patient had a fulminant genital prolapse after giving birth of one child via caesarian section.
After a relatively short follow up with a median of 1.9 years (0.25 - 8.25 years) no prolapse recurred. The upper urinary tract was unimpaired in all patients. One patient developed a paralytic ileus postoperatively and one reported on dyspareunia 6 years after sacrocolpopexy.
All in all the sacrocolpopexy with mesh for these complex patients with multiple preliminary operations, is a good option. Even after continent anal urinary diversion it is a safe procedure. A longer follow-up in a greater cohort of patients is necessary to prove if this technique holds the test of time.
Funding: None._x000D_ ------------------------------_x000D_ NOTE: Please see the note of the Video Abstract with the ID 16-2759 for further information regarding the double submission of the abstract.