Abdominal Sacrocolpopexy for Repair of Pelvic Organ Prolapse after Radical Cystectomy

Introduction Most case series describing surgical repair for pelvic organ prolapse (POP) after radical cystectomy (RC) focus on transvaginal repairs. We present our experience of POP after RC repaired by abdominal mesh sacrocolpopexy (ASC) with long-term follow-up. Methods Two women with previous RC with ileal conduit diversion underwent open ASC for repair of apical prolapse with concomitant enterocele. Prolapse severity was assessed using the POP quantification staging system, whereas pelvic imaging was performed with magnetic resonance imaging defecography. Results One patient had no POP recurrence at follow-up of 45 months after ASC. The other patient had anterior enterocele recurrence at 11 months after ASC and was treated with a limited outpatient transvaginal repair. She had no POP recurrence at 12 months after secondary repair. Both ASC procedures had technical challenges related to pelvic dissection of adhesed loops of bowels, access to the promontory, and retroperitonealization requiring the assistance of a general surgeon. Neither case had perioperative complications. Conclusion In women with large enterocele or vaginal vault prolapse after RC, repair with ASC, although technically challenging, can offer durable POP outcomes.