Application of single-incision transvaginal mesh in a woman undergoing peritoneal dialysis and suffering from refractory advanced stage pelvic organ prolapse

Abstract

Objective:We would like to provide an option of minimal invasive surgical intervention for a patient with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis, who was at the advanced-stage pelvic organ prolapse (POP) and who also failed to be treated conservatively.Materials and method:We present a case of uterine prolapse stage IV in a woman who underwent continuous ambulatory peritoneal dialysis due to end-stage renal disease. Her severity of POP had only limited improvement after being switched to hemodialysis and vaginal cream use. After her informed consent, we performed a uterus-sparing transvaginal mesh procedure to adjust the anterior, apical, and posterior defects of pelvis.Results:There has been no recurrence of any compartment of POP during the 16-month follow-up period, nor any mesh-related complications. The perineal swelling subsided after switching to nocturnal automated peritoneal dialysis only in the supine position.Conclusion:Patients with POP at an advanced stage during peritoneal dialysis who failed to be treated conservatively may require a surgical intervention. Uterus-sparing transvaginal mesh was a feasible minimal invasive option.

When end‐stage kidney disease complicates abdominal surgery

“…Moreover, the use of mesh has been associated with higher rates of surgical complication. A transvaginal mesh implantation presents as a minimally invasive option that avoids the intraperitoneal approach, and introduces less mesh‐related complications 94 . In this case, continuous ambulatory peritoneal dialysis (CAPD) was associated with perineal swelling.…”

“…In this case, continuous ambulatory peritoneal dialysis (CAPD) was associated with perineal swelling. The authors suggest that in women at risk or who have POP, CAPD should be avoided and HD or APD be used as an alternative 94 . Surgical intervention can be performed using a vaginal extraperitoneal approach without hysterectomy.…”

“…Surgical intervention can be performed using a vaginal extraperitoneal approach without hysterectomy. This uterus‐sparing transvaginal mesh approach proved to be a feasible minimally invasive option that provides a shorter operative duration, less blood loss, and relatively low recurrence rate 94 …”