Modified colpocleisis for repair of pelvic organ prolapse post-radical cystectomy

• Published in: International Urogynecology Journal Vol. 31; no. 2; pp. 409 - 410
• Main Authors: Halberthal-Cohen, Adi, Burke, Yechiel Z., Matanes, Emad, Amiel, Gilad, Lowenstein, Lior
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.02.2020; Springer Nature B.V
• Subjects: Aged; Chemotherapy; Colpotomy - methods; Cystectomy - adverse effects; Female; Gynecology; Humans; IUJ Video; Medicine; Medicine & Public Health; Middle Aged; Patients; Pelvic organ prolapse; Pelvic Organ Prolapse - etiology; Pelvic Organ Prolapse - surgery; Postoperative Complications - etiology; Postoperative Complications - surgery; Surgery; Treatment Outcome; Urology; Vagina - surgery; Prolapse repair; Radical cystectomy; POP recurrence; POP repair
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-019-03996-9

Introduction and hypothesis Since the era of neoadjuvant chemotherapy, complications of pelvic organ prolapse (POP) post-radical cystectomy have become more common; however, the exact incidence is not documented in the literature. The objective was to repair post-radical cystectomy POP, despite the lack of endopelvic fascia normally needed for this type of repair. Methods Three patients aged 60 to 80 had symptomatic POP (of all three compartments: apical, anterior, and posterior) following radical cystectomy and ileal conduit urinary diversion, and no interest in maintaining their coital abilities. Two of the three women were status post-hysterectomy. Colpocleisis, which is known to have a success rate of almost 100%, was performed on the first two patients, with a recurrence of the prolapse shortly after this correction (2–4 months), probably due to the lack of endopelvic fascia. Following the failure of the procedure, a side-to-side closure of the vagina was performed. The latter was the procedure of choice performed on the third patient. We present a video clip of the vaginal closure to demonstrate the procedure performed. Results Repair was successful in all three cases, with no relapse to date (4 months post-surgery). Conclusions Closure of the vaginal canal successfully treated POP in our case series. There were no intra- or postoperative complications in any of the cases. Patients were discharged the following day and did not show any signs of recurrence at follow-up (3, 5, and 6 months post-surgery).