Featuring: Stephanie J. Kielb, MD
A 33-year-old female with a history of bladder exstrophy/epispadias presented with recurrent admissions for urosepsis, incontinence and prolapse. As a child, she had undergone a bladder augmentation with colon and bladder neck reconstruction using her native bladder. She also had a supracervical hysterectomy and uterosacral prolapse repair in her early 20s. She desired to be dry and was very bothered by her recurrent prolapse as she is sexually active with a male partner.
On exam, she had complete eversion of her vaginal vault but no leak with the prolapse reduced. Video urodynamics testing revealed a small-capacity, highpressure augmented bladder with early reflux. She had no stress leakage although was scheduled for a prolapse repair and mesh sling at another facility without any assessment of her bladder compliance or outlet urodynamically.
We performed an open abdominal sacrocolpopexy with fascia lata and an augmentation of her bladder augment. She is now dry with significantly improved bladder capacity and pressures, and has had no symptomatic infections for six months.
This case demonstrates the importance of comprehensive evaluation and management by experienced urologists for these complex, congenital patients; the original proposed treatment plan would not have addressed the true underlying issues and could have had devastating consequences to the patient’s continence and renal function.
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Stephanie J. Kielb, MD Northwestern Medical Group Urology
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