There is limited data regarding the use of mesh for pelvic organ prolapse (POP) repair in young women of childbearing age who wish to preserve their uterus.<sup>1Kow N, Goldman HB, Ridgeway B. Management options for women with uterine prolapse interested in uterine preservation Curr Urol Rep 2013 ;  14 : 395-40210.1007/s11934-013-0336-7PMID: 23700096.  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Sacrohysteropexy with concurrent rectopexy can be performed in this population with a biologic graft, to decrease the risk of contamination with colorectal surgery and allow for future pregnancy.<sup>2Grinstein E, Abdelkhalek Y, Veit-Rubin N, Gluck O, Deval B. Long term outcomes of laparoscopic sacro/colpo-hysteropexy with and without rectopexy for the treatment of prolapse Int Urogynecol J 2022 ;  33 : 343-35010.1007/s00192-021-04868-xEpub 2021 Jun 14. PMID: 34125240.  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 3Zucchi A, Lazzeri M, Porena M, Mearini L, Costantini E. Uterus preservation in pelvic organ prolapse surgery Nat Rev Urol 2010 ;  7 : 626-63310.1038/nrurol.2010.164PMID: 21068763.  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 4Merriman AL, Kennelly MJ Biologic grafts for use in pelvic organ prolapse surgery: a contemporary review Curr Urol Rep 2020 ;  21 : 5210.1007/s11934-020-01013-x

Cliccare qui per andare alla sezione Riferimenti</sup> The objective of this video is to present the surgical management of prolapse repair in a young woman with uterine and rectosigmoid prolapse, causing rectal outlet obstruction.

Our patient is a 21-year-old woman with over a decade of severe constipation. Her past medical history includes anxiety, depression and sexual abuse. She previously underwent robotic rectopexy for intra-rectal intussusception and mucosal prolapse with immediate improvement in her symptoms; however, two months after rectopexy, she suffered from persistent abdominal pain and severe difficulty passing stool. Dynamic resonance imaging demonstrated descent of the bladder with significant uterine prolapse, causing impingement of rectum and rectocele, blocking the evacuation of stool. The patient was thus indicated for concurrent sacrohysteropexy and rectopexy.

She underwent a robotic procedure. Given her age, in an effort to preserve future child-bearing potential, we performed the surgery with a biologic graft made of fascia lata. For the sacrohysteropexy, the graft was sutured to the posterior cervix. Intraoperatively she was noted to have an intact enterocele repair and posterior rectopexy from her previous surgery; however, there was an angulation at the recto sigmoid. This was corrected by performing a rectopexy to the fascia lata graft. She discharged home the day of surgery without incident.

Biologic grafts can be used for multi compartment prolapse repair in women of child-bearing age. Fascia lata provides a safe alternative to mesh to allow for future pregnancy. Also, sacrohysteropexy with concurrent rectopexy can be performed with same day discharge.