Laparoscopic Management of Pelvic Organ Prolapse in a Kidney Transplant Recipient

Abstract

This is a report of a laparoscopic double mesh sacrocolpopexy performed in the setting of a 73-year-old woman carrying a grafted kidney. The patient had a vaginal prolapse of the anterior and posterior floor without urinary incontinence. Despite immunosuppression due to anti-rejection treatments and the presence of kidney transplant in left iliac fossa, laparoscopic intervention with the introduction of prosthetic material was conducted. The intervention showed no major difficulty in its implementation and the postoperative course was uneventful. The long-term follow-up will confirm the tolerance of a prosthetic material.

Surgical Management of Pelvic Organ Prolapse in a Woman with Right Pelvic Kidney

“…Up to date, there are no published data available regarding the safety/efficacy/choice of POP repair surgical procedures in women with a congenital pelvic kidney, although there are some published articles available in renal transplant patients [5][6][7]. It appears that POP surgery in renal transplanted women is technically possible with reportedly good outcomes.…”

“…At 12 months follow-up, only 25% (4 out of 16 women) exhibited stage 1 POP. Unlike the case series by Shveiky et al (2009) and Hoda et al (2010), which present vaginal repairs only in renal transplant patients, Rouffilange et al (2017) reports a laparoscopic double mesh SCP in a 73-year-old woman with a grafted kidney [7]. Despite immunosuppression due to anti-injection treatments, the postoperative course was uneventful.…”

“…Volume 4(3): 5-5 location in the pelvis; ii) Although the vaginal approach with natural tissue repair has been a mainstream of POP surgical repair for women with a transplanted kidney, laparoscopic SCP with mesh may be an option as well despite the immunosuppression status; iii) Compared to women with a transplanted kidney and in the presence of immunosuppressive treatments, women with a congenital pelvic kidney would less likely suffer from impaired wound healing or prosthesis infection from the laparoscopic SCP; iv) Compared to the vaginal approach, the laparoscopic approach would provide more precise surveillance of the pelvic structures and better aid hysterectomy and adnexa removal (for the presence of complex hyperplasia with atypia), under direct visualization, while avoiding damage to the pelvic kidney, and v) Even if the laparoscopic apical suspension after hysterectomy was planned, it might not be feasible depending on the intraoperative findings and vaginal apical suspension with vaginal wall repairs would be necessary [5][6][7]. Thorough preoperative counseling and surgical planning are necessary to manage women with a congenital pelvic kidney and symptomatic POP.…”

“…Although there are some studies published on pelvic reconstruction surgery in renal transplant recipients, there is no article available on how to manage a woman with pelvic organ prolapse (POP) with a pelvic kidney [5][6][7]. Despite the rarity of pelvic kidney, it is imperative to be aware of this anatomical variation when managing a patient with pelvic kidney.…”