Complete genital prolapse complicated by acute pelvic organ dysfunction (a case report)

The prevalence of pelvic organ prolapse (POP) worldwide varies significantly depending on whether its presence is confirmed by symptoms, objective pelvic examination. Its rate is 20–60%. The most significant risk factors for POP are older age of the woman, vaginal delivery (especially instrumental vaginal delivery), the birth of a child with a high body weight, high parity, heavy physical activity and obesity.The objective of publication: an analysis of a rare case of complicated complete POP with acute dysfunction of the pelvic organs, pronounced edema, and impaired trophicity of the vaginal mucosa.The patient was hospitalized to the gynecological department of the clinical base of the Department of Obstetrics and Gynecology No. 1 with the presence of a tumor-like formation protruding beyond the vulvar for 2 years. A woman complained on aching pain in the lower back and lower abdomen, urinary retention, defecation disorders, and periodic increase in body temperature to 38 °C.In the gynecological department, under intravenous anesthesia, a reposition of the prolapsed and pinched pelvic hernia was performed, a catheter was installed in the bladder, as well as a clinical, laboratory and ultrasound examinations were performed. The patient was consulted by medical specialists. Given the acute inflammatory process of the tumor-like formation, significant edema, increased body temperature of the patient, and exacerbation of chronic pyelonephritis, it was decided to conduct conservative treatment in order to ensure conditions for further planned surgical correction of the POP.Antibacterial, anti-inflammatory and local therapy was performed for 3 weeks, which progressively improved the patient’s condition with a decrease of complains’ intensity, absence of edema, normalization of body temperature and vaginal biocenosis. This lead for the conditions for surgical correction of complete genital prolapse in 10 steps according to the method of M. Stark et al. (2022) with our modification, which involved the use of modern energy technologies, in particular, a monopolar radio wave scalpel and argon plasma coagulation of tissues. The operation included a total vaginal hysterectomy with removal of the uterine appendages. The postoperative period was without complications. Postoperative tissue repair was per primam. The patient was discharged under the supervision of a family doctor with recommendations for a healthy lifestyle and adherence to hygiene measures.Conclusions. Successful treatment of a case of complete genital prolapse with pelvic hernia incarceration and pelvic organ dysfunction was possible thanks to a correctly chosen two-stage approach: initial hernia reduction, antibacterial, anti-inflammatory and local therapy, and later surgical correction.