title: Pelvic organ prolapse management in female kidney transplant recipients.
abstract: OBJECTIVE
  Pelvic organ prolapse in female postmenopausal kidney transplant recipients may be complicated by adverse events affecting graft function. We describe our experience with pelvic reconstructive surgery in renal transplant recipients.
  
  
  METHODS
  Pelvic reconstructive surgery was done in 16 female renal transplant recipients with pelvic organ prolapse with or without stress urinary incontinence. Intraoperative and postoperative data were recorded prospectively, including medical and surgical history, pelvic organ prolapse quantification measurement, 24-hour pad count, quality of life measurements and graft outcome. Patients were followed up to 12 months.
  
  
  RESULTS
  Mean +/- SD age at surgery was 58.3 +/- 7.7 years (range 50 to 66). Mean time to renal transplantation was 54.2 +/- 15.1 months (range 38 to 123). A total of 12 anterior and 4 combined anterior/posterior colporrhaphies were done. A concomitant suburethral single incision transobturator sling procedure was performed in 8 women. We noted no bladder or rectal injury, bleeding necessitating transfusion or infection. Pelvic floor testing at 12-month followup showed stage I vaginal wall prolapse in only 4 patients (25%). No patient had evidence of de novo incontinence, synthetic sling infection, erosion or rejection. All women reported improved quality of life on the SF-36 questionnaire. Renal graft function remained stable in all patients.
  
  
  CONCLUSIONS
  Pelvic reconstructive surgery is feasible for pelvic organ prolapse in patients with a kidney allograft on immunosuppression. However, concern about impaired graft function, infection and wound healing remains important.
authors.affiliation: Clinic for Urology and Kidney Transplantation Center, University Medical School of Halle/Wittenberg, Halle (Saale), Germany. rhoda@ucsd.edu
authors.forename: M Raschid
authors.initials: MR
authors.lastname: Hoda
authors.forename: Sigrid
authors.initials: S
authors.lastname: Wagner
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
authors.forename: Hans
authors.initials: H
authors.lastname: Heynemann
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011446:Prospective Studies; D053825:Suburethral Slings