Int Urogynecol J (2011) 22:889–891 DOI 10.1007/s00192-011-1368-5 CASE REPORT Surgical treatment of uterine prolapse in women with bladder exstrophy: report of two cases with modified Prolift™ procedure Lidewij R. Bartelink & Wouter F. Feitz & Kirsten B. Kluivers & Mariella I. J. Withagen & Mark E. Vierhout Received: 15 October 2010 / Accepted: 22 January 2011 / Published online: 1 March 2011 # The Author(s) 2011. This article is published with open access at Springerlink.com Abstract The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal technique to correct the prolapse may be preferable in these women with multiple abdominal operations in their histories. We have performed a modified Prolift™ procedure for the repair of severe uterine prolapse in two young women. A review of the literature is presented. Keywords Bladder exstrophy . Fertility . Surgical mesh . Uterine prolapse Introduction Bladder exstrophy is a congenital urinary tract, pelvis, and pelvic floor anomaly which is thought to be due to a premature rupture of the cloacal membrane during fetal development. In females, this disorder is characterized by an open bladder, abdominal wall defect, separation of the pubic bones, bifid clitoris and an abnormal pelvic dia- phragm musculature. The vagina is shortened and placed anteriorly. The cervix enters the anterior vaginal wall more L. R. Bartelink : K. B. Kluivers : M. I. J. Withagen : M. E. Vierhout (*) 791 Department of Obstetrics and Gynaecology, UMC St Radboud Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands e-mail: m.vierhout@obgyn.umcn.nl W. F. Feitz Department of Urology, Pediatric Urology Centre Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands caudally and is therefore positioned closer to the often narrow introitus. Due to the altered anatomy, severe genital prolapse may be present in these women. Pessary treatment may be first choice treatment, but it is not always possible because of the short vagina and lack of support from the pelvic floor. We present two cases with surgical treatment of severe uterine prolapse in young women with bladder exstrophy. Patients Patient A, a 14-year-old female with congenital bladder exstrophy was referred to our department because of pelvic organ prolapse. She had a history of multiple surgeries, including bladder closure, bladder neck reconstruction, ileovesicostomy (Monti catheterizable stoma), introito- plasty and abdominal wall reconstruction. Physical examination revealed an isolated stage-2 uterine prolapse with the cervix at the hymen. She had a shortened vagina of 5–6 cm and no additional anterior or posterior compartment prolapse. A modified Prolift™ posterior procedure was used (Fig. 1). The posterior vaginal wall was opened in the midline after hydrodissection with normal saline. The rectum was separated from the vaginal wall. The sacrospi- nal ligaments were freed. An incision was made 3 cm lateral and inferior from the anus on both sides, through which the trocars were inserted. The trocars were fixed through the sacrospinal ligaments at 2–3 cm from the ischial spines. The posterior mesh was modified in such a way that the central portion, usually covering the rectocele, was removed and a broad loop with a 2-cm central part was left (Fig. 1). This modified mesh was implied and fixed