2026 Urogynecology for the Advanced Practice Provider-Panel: Prolapse/Surgery Case Studies

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The transcript covers two urogynecology cases. First, a woman with prior radical cystectomy and ileal conduit after bladder cancer develops stage 2 anterior-predominant vaginal vault prolapse with a very short, thin vagina. Expectant management is considered, along with pelvic floor physical therapy and vaginal estrogen. Pessary fitting fails because of the short vaginal length and risk of erosion; creative options like small pessaries, 3D-printed devices, or surgery are discussed. Surgical options include native tissue repair, mesh-based repair, and colpocleisis, with major attention to her extensive prior pelvic surgery and likely scarring.  <br /><br />Second, a 68-year-old patient calls one week after major pelvic reconstructive surgery with fevers, chills, and malaise. The discussion emphasizes asking about bowel function, bleeding, discharge, temperature, nausea/vomiting, urinary symptoms, and overall recovery. The recommendation is prompt in-person evaluation with vitals, labs, and exam, while considering complications such as infected pelvic hematoma, bleeding, bowel injury, obstruction, or port-site hernia.

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