EC Clinical and Medical Case Reports

Background: Pelvic organ prolapse (POP) can substantially impair quality of life and may require individualized surgical management based on anatomy, symptoms, and patient preference.

Case Presentation: A 58-year-old postmenopausal nulligravid woman presented with recurrent symptomatic uterovaginal prolapse after prior sacrospinous hysteropexy. Her presentation was complicated by a fibroid uterus, marked cervical elongation, and a severe introital stricture causing dyspareunia. She desired uterine preservation and declined allogeneic blood transfusion. Imaging demonstrated multiple uterine fibroids, including a large pedunculated posterior fibroid.

Interventions: A single-stage, customized procedure was performed consisting of perineoplasty, vaginal partial trachelectomy with modified Sturmdorf sutures, robotic-assisted laparoscopic myomectomy, and robotic sacrohysteropexy with mesh fixation to the anterior longitudinal ligament.

Results: The procedure was completed without intraoperative complications. Estimated blood loss was 20 mL. At 2 weeks and 3 months postoperatively, the patient reported high satisfaction, improved introital comfort, and resolution of prolapse symptoms. POP-Q point C improved from +2.5 to -9.

Conclusion: In selected patients with complex recurrent POP and coexisting pelvic pathology, a tailored combined vaginal and minimally invasive abdominal approach may safely achieve anatomic restoration while respecting patient goals.

Keywords: Pelvic Organ Prolapse; Sacrohysteropexy; Uterine Preservation; Cervical Elongation; Myomectomy; Perineoplasty

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