Presentation Authors: Jeremy Lai*, Antoinette Oot, Diana Bowen, Stephanie Kielb, Chicago, IL
Introduction: In the adult congenital genitourinary patient population, pelvic organ prolapse and its management is not well described. In these patients, high BMI, insufficient pelvic floor innervation, and chronic straining may increase prolapse risk. Our objective is to assess and present our experience with the management and outcomes of prolapse in these women.
Methods: Retrospective review of our adult congenital GU patients with a documented Pelvic Organ Prolapse Quantification (POP-Q) from 2006 - 2014 was undertaken. Patients had spina bifida or bladder exstrophy/epispadia complex. Prolapse stage, dominant prolapse component, and parity were reviewed. Outcomes of treated patients are from most recent follow up.
Results: 35 congenital GU patients were identified. 25 (71%) were nulliparous and showed advanced prolapse compared to the general population. By POP-Q, only 20% were stage 0, indicating no prolapse. 52% had advanced prolapse â‰¥ stage 2, with one complete procidentia despite no pregnancy history. 50% of parous patients also had advanced prolapse. When evaluating the dominant prolapse compartment in â‰¥ stage 2 patients regardless of parity, a significant portion were apical (cervical) dominant (8/17, 47%). _x000D_
Among our 35 patients, 13 had symptomatic prolapse, most with vaginal bulge (6) or noticed bulge with catheterization (6). One patient had complete prolapse. 5 patients underwent surgery: 2 vaginal hysterectomy and uterosacral suspension, 2 cervicectomy, and 1 uterosacral hysteropexy. 3 of the 5 saw a decrease in POP-Q score.
Conclusions: Congenital GU patients may have more advanced prolapse at younger ages and nulliparity and are frequently apical dominant. Our small series illustrates the need for individualized treatments when patients are symptomatic and desire surgical intervention.