The Manchester-Fothergill and the Elevate Posterior technique for the correction of a cervical elongation and large enterocele in a patient with bladder exstrophy and multiple surgeries.
Int Urogynecol J
; 26(8): 1239-42, 2015 Aug.
Article
em En
| MEDLINE
| ID: mdl-25578871
ABSTRACT
INTRODUCTION AND HYPOTHESIS:
A 60-year-old woman presented with congenital bladder exstrophy, urinary incontinence since birth, and pelvic organ prolapse since the menopause at the age of 46 years.METHODS:
The patient (gravida 2, para 2 by cesarean sections and tubal ligation) described an extensive past surgical history that included epispadias and neourethral procedures, anti-reflux surgery using the Lich-Grégoir technique, bilateral ureterosigmoidostomy achieving continence, uterine fixation after the Doléris operation, and neovaginal reconstruction. The physical examination revealed a fourth-degree enterocele with cervical elongation (POP-Q Aa-2, Ba-2, C + 3, D + 4, gh5, pb2.5, Tvl6, Ap + 3, Bp +6). Gynecological ultrasound and uro-CT were performed to ensure that the ureterosigmoidostomy had been successful, and CT-based 3D bone reconstructions were obtained to calculate the distance between the pubic rami and the ischial spines. Based on a literature review of the management options for these patients and the specific characteristics of our patient, a decision was made to perform trachelectomy (the Manchester technique with Fothergill stitches) and a polypropylene mesh placement with sacrospinous ligament anchor (Elevate Posterior® PC, AMS).RESULTS:
Six months after the surgery, we observed good anatomical and functional results with significant improvement in the patient's quality-of-life scale score.CONCLUSION:
We believed that the vaginal approach was minimally invasive with a low risk of morbidity in our patient, who had a very altered anatomy, but produced a satisfactory functional result.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Incontinência Urinária
/
Colo do Útero
/
Extrofia Vesical
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Prolapso de Órgão Pélvico
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Herniorrafia
/
Traquelectomia
Tipo de estudo:
Prognostic_studies
Limite:
Female
/
Humans
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Middle aged
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article