Leanza Vito, Di Stefano Alessandra, Paladino Erika Carlotta, Rivoli Luca, Distefano Rosario Emanuele Carlo, Palumbo Marco
Ist. Patologia Ostetrica e Ginecologica, Department of General Surgery and Medical Surgical Specialities, University of Catania, Via Santa Sofia 78, 95100, Catania, Italy.
J Med Case Rep. 2022 Apr 28;16(1):173. doi: 10.1186/s13256-022-03405-8.
The most common complication of pelvic organ prolapse is stress urinary incontinence, whereas hydronephrosis or stasis ulcers are quite rare and typical of severe stages. The best treatment for this unusual presentation is still controversial. Here we present our approach.
Here we present the case of a 70-year-old White/Caucasian woman who presented to our hospital with genital procidentia lasting for 10 years that was associated with both hydronephrosis and stasis ulcers.
The Pelvic Organ Prolapse Quantitation system was used to assess the severity of the prolapse, being evaluated as stage IV with the apical compartment leading. A thorough search of the literature was conducted to find any similar cases and evaluate the best evidence treatment.
A no-mesh procedure comprising vaginal hysterectomy, axial apex suspension, and anterior and posterior repair with ulcerated skin removal resulted in complete resolution of both mechanical and functional symptoms. At 3- and 6-month follow-up visits, a satisfying vaginal profile without hydronephrosis was seen. The Pelvic Organ Prolapse Quantitation at 6 months follow-up was as follows: Aa -3, Ba -3, C -7; gh 2, pb 3, tvt 9; Ap -3, Bp -3.
Pelvic organ prolapse involves many organs and causes further complications, leading seldom to renal insufficiency and stasis ulcers. A temporary solution to the obstruction can be achieved by utilizing a pessary, but this device cannot be applied when a stasis ulcer has been previously established. The use of mesh for pelvic floor repair is controversial, but a previous vaginal ulcer may represent a contraindication. A complete evaluation and a challenging surgery may allow the recovery of complicated and severe pelvic organ prolapse. Native tissue pelvic repair gives no erosion postsurgical risk, which is the typical complication of the prosthesis.
盆腔器官脱垂最常见的并发症是压力性尿失禁，而肾积水或淤滞性溃疡则相当罕见，且多见于严重阶段。对于这种不常见表现的最佳治疗方法仍存在争议。在此我们介绍我们的治疗方法。
我们在此介绍一位70岁的白人女性病例，她因生殖器脱垂长达10年并伴有肾积水和淤滞性溃疡前来我院就诊。
采用盆腔器官脱垂定量系统评估脱垂的严重程度，评估为顶端隔室为主的IV期。对文献进行了全面检索，以寻找任何类似病例并评估最佳的循证治疗方法。
一项不使用网片的手术，包括阴道子宫切除术、轴向顶端悬吊术以及切除溃疡皮肤的前后壁修补术，使机械性和功能性症状均完全缓解。在3个月和6个月的随访中，阴道外形令人满意，且无肾积水。6个月随访时的盆腔器官脱垂定量结果如下：Aa -3，Ba -3，C -7；gh 2，pb 3，tvt 9；Ap -3，Bp -3。
盆腔器官脱垂涉及多个器官并引发进一步并发症，很少导致肾功能不全和淤滞性溃疡。使用子宫托可暂时解决梗阻问题，但在先前已出现淤滞性溃疡时无法应用该装置。用于盆底修复的网片使用存在争议，但先前的阴道溃疡可能是禁忌证。全面评估和具有挑战性的手术可能使复杂严重的盆腔器官脱垂得以恢复。天然组织盆底修复无术后侵蚀风险，而侵蚀是假体的典型并发症。
