2023 Volume 19 Issue 1 Pages 56-60
Encountering patients aged over 90 years with pelvic organ prolapse (POP) is not uncommon currently. Although conservative treatment is considered first, colpocleisis may be necessary due to difficulties in pessary management. However, surgical treatment of coexisting stress urinary incontinence (SUI) remains controversial. We report a case of a 93-year old, gravida 2 para 2, woman with POP who underwent Le Fort colpocleisis and posterior pubourethral ligament plication (PPLP) with a good postoperative course. She presented with a chief complaint of vaginal pain and exhibited complete uterine prolapse and extensive painful erosions of the vaginal wall. She also had a severe stress urinary incontinence, and vulvar dermatitis. Although various types of pessaries were used, vaginal retention could not be achieved. Therefore, surgical treatment including Le Fort colpocleisis and posterior colporrhaphy for pelvic organ prolapse and PPLP for stress urinary incontinence was performed. The PPLP procedure comprised a 2-cm longitudinal incision in the vaginal wall at the level of the middle urethra and placement of delayed absorbable sutures in the pubourethral ligament on either side of the urethra. The patient was discharged on postoperative day three. One month postoperatively, the patient showed no prolapse recurrence, urinary disorder, or vulvar dermatitis, and mild urinary incontinence. Simultaneous performance of anti-incontinence procedures remains controversial in POP cases in which post-operative SUI could be expected. Although tension-free vaginal tape/transobturator tape placement is a minimally invasive procedure, the PPLP developed by Nichols et al. is less invasive and may be useful for very elderly patients.
