Among the rapidly aging population in Japan, the number of older patients with pelvic organ prolapse (POP) is also increasing. We retrospectively studied the background and treatment outcomes of POP patients aged ≥ 85 years at our hospital. During the 3-year period from April 2019 to March 2022, 927 patients with POP visited our hospital, of whom 78 (8.4%) were ≥ 85 years old. Thirty-four patients (44%) had POP-Quantification stage 3 and 29 (37%) had stage 4 prolapse. Twenty two patients (28%) underwent surgical treatment because conservative treatment with a vaginal pessary was not feasible (17 with colpocleisis and 5 with transvaginal mesh surgery). Comorbidities in these surgical patients included hypertension, diabetes, heart disease, renal dysfunction, deep vein thrombosis, and psychiatric disorders . The median postoperative hospital stay was 4 (1-8) days, and no serious intraoperative or postoperative complications occurred. There was no postoperative recurrence, and Prolapse Quality of Life scores improved significantly in all categories. The POP-Q stage of the POP patients aged ≥ 85 years in our hospital is high, with all patients at stage 3 or higher, and when conservative management was difficult, surgical treatment was selected, with good outcome. Surgical treatment can be considered for very old patients with POP if appropriate evaluation and perioperative management of their general condition and comorbidities can be performed and may contribute to improvement of quality of life. This retrospective observational study evaluated outcomes in POP patients aged 85 years and older.

Introduction: Mesh infection and abscesses are uncommon complications following Laparoscopic Sacrocolpopexy (LSC), and mesh excision and intravenous antibiotic medication are general treatments.

Case presentation: Postoperative mesh infection occurred in a 68-year-old female patient who underwent LSC for pelvic organ prolapse. Intravenous antibiotic medication (CMZ 2g and MINO 200mg a day) was administered, but the patient was not recovering well. We suggested mesh excision and abscess drainage, she refused mesh excision but laparoscopic abscess drainage was administered.

Intra-operative findings revealed significant inflammation and edema along the graft bridge from the vagina to the sacrum. Incising into that area resulted in localization of the mesh material in a necrotic bed of tissue and a large amount of purulent material that we drained and two drainage tubes were left in place at the site of the pelvic and sacrum.

The cultures collected intraoperatively revealed Pseudomonas aeruginosa, and after the laparoscopic abscess drainage, we changed intravenous medication to MEPM 3g VCM 3g a day and her symptoms lessened and CRP became negative. After intensive physical therapy and pain management, at about two months after the initial surgery, the patient was doing well.

Upon discharge she recovered well after completing a 2-week course of LVFX antibiotics.

Conclusion: We experienced a case of mesh infection and abdominal and pelvic abscesses following LSC and we treated it by laparoscopic abscess drainage and intravenous antibiotic medication, not by mesh excision.

A 66-year-old woman underwent a laparoscopic sacrocolpopexy (LSC) with uterine preservation for pelvic organ prolapse (Cystocele Stage III) at another hospital in July 202X.

In September 202X, she visited our hospital for a routine examinations; no postoperative recurrence was observed. In October 202X, she reported hypogastric pain purulent vulvar discharges, and genital bleeding were repeated. After being diagnosed with pyometra, she preferred surgery because of repeated vaginal drainage and antibiotic administration .

In addition, since watery discharge was always observed, removal of the cervix was also necessary. In January 202X +3, she underwent a hysterectomy to preserve the mesh around the cervix, which was integrated with the uterus and could not be seen after peritoneal incision. A small incision was made between the uterine body and the cervix. The presence of the mesh stump was confirmed and supracervical hysterectomy was carried out. The cervix was then to obtain a cylindrical shape from the resection margin to the external cervix. Finally, the external uterine os was stitched up. The total operation time was 235 min, and the estimated blood loss was 30 ml. After the operation, the hypogastric pain, purulent discharge, and vaginal bleeding disappeared, and watery discharge also decreased. No recurrence of pelvic organ prolapse was observed 12 months postoperatively. Total hysterectomy may lead to recurrence of pelvic organ prolapse. Total hysterectomy for pyometra after laparoscopic sacrocolpopexy with uterine preservation and watery discharge was considered. For pyometra, supracervical hysterectomy was performed to prevent recurrence of pelvic organ prolapse. And watery discharge may be a symptom of malignant diseases, cervical gland enucleation from the stump was performed. Two surgeries allowed the treatment of pyometra and watery discharge without recurrence of pelvic organ prolapse.

Pelvic congestion syndrome (PCS) is a common but underdiagnosed cause of chronic pelvic pain (CPP) in women. However, it is not well recognized in Japanese urogynecological practice, and many cases are treated symptomatically and followed up. In this study, we encountered a case of PCS characterized by "bladder pain," which we cured through ovarian vein embolization. In 202X, a 78-year-old woman visited her previous doctor with a chief complaint of "nocturnal bladder pain." She underwent a thorough examination by cystoscopy and cytology, but no abnormality was found, and the cause was unknown. The symptoms temporarily improved with analgesic medication, but the bladder pain flared up 6 months later. Consequently, she was referred to our department for further examination and treatment in 202X+1. Contrast-enhanced computed tomography (CT) revealed early-phase staining of the left ovarian vein, leading to the suspicion of reflux from the left renal vein. The dilated left ovarian vein raised suspicions of PCS. The findings of the left renal vein and the left ovarian vein were consistent with PCS, according to venography. Since her bladder pain did not improve, we performed embolization of the left ovarian vein using a sclerosing agent and a coil. The Preoperative Visual Analogue Scale was 10; it decreased to 0 after the operation. There have been no symptoms since the operation six months ago.

Pessary therapy is often used to avoid surgery for pelvic organ prolapse (POP) in elderly patients; however, its effectiveness is limited. Increased intra-abdominal pressure due to ascitic fluid accumulation was also reported as an exacerbating factor. Here, we describe two cases of POP with refractory ascites, autoimmune hepatitis, and cirrhosis, in which Lefort colpocleisis was performed as a palliative treatment for pessary therapy.

Case 1 was of an 81-year-old G3P3 with refractory ascites who had been treated with pessary therapy for Uterine prolapse stage 3 and cystocele stage 3. She was diagnosed with acute ischemic heart failure and cirrhosis. She was expected to live for only one month and her PS deteriorated to 3; however, under spinal anesthesia, Lefort colpocleisis was performed. Her PS improved to 0 postoperatively, but she died two months later because of worsening primary disease.

Case 2 was of an 82-year-old G3P3 who was diagnosed with Uterine prolapse stage 3 and cystocele stage 3 when she was 81 years old. At the same time, thrombocytopenia and refractory ascites were observed, and her PS deteriorated to 2, with a diagnosis of autoimmune hepatitis and cirrhosis. Her condition was difficult to control with pessary therapy, requiring surgery. She received a platelet transfusion and underwent Lefort colpocleisis under general anesthesia. After the operation, her PS improved to 0, and she was discharged from the hospital; however, her primary disease worsened, and she died seven months later.

In both cases, PS worsened due to increased abdominal pressure caused by intractable ascites, which made it difficult to control POP. Lefort colpocleisis, even at the terminal stage, contributed to an improvement in PS and was considered safe and effective in patients with POP.