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      Transvaginal repair of enterocele following robot‐assisted radical cystectomy using a mesh for abdominal wall hernia repair

      case-report

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          Abstract

          Introduction

          This report aims to describe our experience in the pelvic floor reconstruction of anterior enterocele following radical cystectomy by transvaginal surgery using a mesh for abdominal wall hernia repair.

          Case presentation

          An 84‐years‐old woman developed pelvic organ prolapse 4 months after undergoing robot‐assisted radical cystectomy. After examination, she was diagnosed with a midline anterior enterocele. Considering the thinness of the vaginal wall and the large defect of the vaginal wall muscle layer, we performed transvaginal repair using a mesh for abdominal wall hernia repair designed to reduce the adhesion to the intestinal tract.

          Conclusion

          At the 1‐year follow‐up, neither recurrence nor complications were observed. This showed that transvaginal mesh surgery for abdominal wall hernia repair could be a treatment option for pelvic organ prolapse with a vaginal wall muscle layer defect after radical cystectomy.

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          Most cited references8

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          Biomechanical and histological evaluation of abdominal wall compliance with intraperitoneal onlay mesh implants in rabbits: a comparison of six different state-of-the-art meshes.

          M.A. Konerding, P Chantereau, V Delventhal … (2012)
          An ideal prosthetic mesh for incisional hernia repair should mimic the anisotropic compliance of the abdominal wall, and at lower loads should exhibit higher distensibility without impairment of safety at higher loads. This study evaluated the biomechanical properties of six meshes in a rabbit model. New Zealand white rabbits were used for this study. Two meshes of the same brand (Ethicon Physiomesh™, Bard Composix(®) L/P, Gore Dualmesh(®), Bard Sepramesh(®), Ethicon Proceed(®) or Parietex™ Composite) were implanted into each animal for assessment of intra-abdominal hernia repair, with a total of ten meshes per group. Twelve weeks after implantation, the abdominal walls with ingrown meshes were harvested and examined biomechanically with a plunger test. The mesh-tissue compliance was evaluated by the forces exerted at given displacements and also described through a simple mathematical approximation. Abdominal wall samples were collected for histopathology, cell turnover and morphometry. No mesh-related complications were seen. The adhesion score was significantly higher in Bard Composix(®) L/P and Ethicon Proceed(®) meshes. Significant shrinkage was seen in Gore Dualmesh(®) and Parietex™ Composite meshes. Physiomesh™ exhibited the highest compliance during plunger testing, characterized by lower, more physiological reaction forces against tissue displacement than the competitor meshes. In contrast, the safety modulus was comparable in all groups. Histology showed less collagen and less foreign body reaction in the Physiomesh™ samples contributing to patient's comfort. In terms of safety, this study showed no superiority of any single mesh. The comfort modulus however differed, being lowest in the newly developed Physiomesh™. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.
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            Transvaginal pelvic organ prolapse repair of anterior enterocele following cystectomy in females.

            Kobi Stav, Peter L Dwyer, Anna Rosamilia … (2009)
            This study aims to highlight pelvic organ prolapse (POP) in females following radical cystectomy and to describe our experiences with their management. This is a retrospective case series of five women who had symptomatic POP following radical cystectomy and ileal conduit urinary diversion. All patients presented with a midline anterior enterocele with atrophic ulcerated vaginal skin. One patient presented with small bowel evisceration and required an emergency surgical repair. The average time for presentation was 10.6 +/- 6.5 months after cystectomy. In all cases, repair was done via a transvaginal approach. Three patients underwent fascial repair, one colpocleisis, and one bilateral iliococcygeal repair. In three cases, we had to use mesh for reinforcement. Two patients underwent ancillary procedures because of POP recurrence. Surgical repair of POP in women following radical cystectomy is challenging especially if vaginal length is to be maintained. Transvaginal repair is feasible and using synthetic mesh may be necessary.
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              Management of Pelvic Organ Prolapse After Radical Cystectomy.

              Dominic Lee, Philippe Zimmern (2019)
              This article explores the anatomy, management options, and outcomes of pelvic organ prolapse with a female cystectomy patient.
              Article 0 comments Cited 4 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Tomoko Kuwata:
                ORCID: https://orcid.org/0000-0002-7537-0925
                kuwatomo1180@gmail.com
                Journal
                Journal ID (nlm-ta): IJU Case Rep
                Journal ID (iso-abbrev): IJU Case Rep
                Journal ID (doi): 10.1002/(ISSN)2577-171X
                Journal ID (publisher-id): IJU5
                Title: IJU Case Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2577-171X
                Publication date (Electronic): 05 July 2022
                Publication date Collection: September 2022
                Volume: 5
                Issue: 5 ( doiID: 10.1002/iju5.v5.5 )
                Pages: 389-392
                Affiliations
                [ 1 ] Head of Urogynecology Center Daiichi Towakai Hospital, The Department of Urology Takatsuki City Osaka Japan
                Author notes
                [*] [* ] Correspondence: Tomoko Kuwata M.D., Head of Urogynecology Center, Daiichi Towakai Hospital, The Department of Urology, 2‐17 Miyanocho, Takatsuki City, Osaka 5690081, Japan. Email: kuwatomo1180@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-7537-0925
                Article
                Publisher ID: IJU512497 Other ID: IJUCR-2022-0042.R1
                DOI: 10.1002/iju5.12497
                PMC ID: 9436666
                PubMed ID: 36090932
                SO-VID: 4aeeefa6-cb30-4753-9457-ac26d346d727
                Copyright © © 2022 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 March 2022
                Date accepted : 08 June 2022
                Page count
                Figures: 4, Tables: 0, Pages: 4, Words: 1806
                Categories
                Subject: Case Report
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                cover-date September 2022
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:01.09.2022

                Keywords: pelvic organ prolapse,radical cystectomy,transvaginal mesh
                Data availability:
                Keywords: pelvic organ prolapse, radical cystectomy, transvaginal mesh

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