Recurrent pelvic organ prolapse in a patient with history of bladder exstrophy

BACKGROUND: Increased risk of pelvic organ prolapse in women with a history of bladder exstrophy poses difficult management owing to the absence of anterior support and pelvic angle. We present a case of recurrent prolapse in the setting of bladder exstrophy and discuss factors that may warrant consideration during the evaluation of such patients. CASE: A 26-year-old nulliparous woman with a history of bladder exstrophy and pelvic organ prolapse initially repaired with a porcine graft sacral hysteropexy presented with suspected recurrent apical prolapse. After counseling, she elected to undergo second surgery. During exploration, cervical elongation rather than recurrent prolapse was noted. Therefore, the decision was made to perform a trachelectomy. CONCLUSIONS: When recurrent pelvic organ prolapse is reported, especially in the setting of complicating factors such as a history of bladder exstrophy, other differential diagnoses for prolapse, such as cervical elongation, should be considered. Initial evaluation of such patients can be tailored to evaluate for other possible diagnoses, clarifying the choice of options for optimal medical or surgical management.