Medical History Overview
Basic Information
Patient, female, 52 years old.
Chief Complaint
Subjective prolapse of vaginal mass for more than 10 months.
Present Illness History
The patient developed a prolapsed vaginal mass without obvious inducement in early September 2024, which aggravated after physical activity accompanied by discomfort during walking and could retract spontaneously after rest. She occasionally experienced involuntary urine leakage when coughing or laughing. There was no frequent micturition, urgent micturition, dyschezia or irregular vaginal bleeding. She visited the outpatient department of The Sixth Affiliated Hospital of Jinan University on July 18, 2025, and was admitted with the diagnosis of Grade III anterior vaginal wall prolapse and Grade III uterine prolapse.
Past Medical History
No significant past illnesses.
Special Physical Examination
Normal vulvar development; partial anterior vaginal wall protruding outside the vaginal orifice; widened vaginal hiatus; collapsed perineal body skin; intact levator ani muscle. Urine leakage was observed when the patient strained, with positive bladder neck pressure test. The cervix prolapsed outside the vaginal orifice while the uterine corpus remained inside the vagina. No obvious vaginal discharge was seen. Cervical hypertrophy and mild cervical erosion were present without contact bleeding. The uterus was retroverted with normal size and no tenderness. No obvious masses or tenderness were palpated in bilateral adnexal areas.
Auxiliary Examinations
No ultrasonographic signs of laceration of levator ani muscle or anal sphincter. Dilated levator ani hiatus. Hypoechoic mass in uterine wall, suspected uterine leiomyoma (FIGO Type 4). Nabothian cysts of cervix.
POP-Q Score
| Aa (+1.5) | Ba (+2) | C (+3) |
|---|---|---|
| gh (6) | Pb (3) | TVL (7) |
| Ap (-3) | Bp (-1) | D (-1) |
Diagnosis and Treatment
Admission Diagnoses
- Grade III anterior vaginal wall prolapse (POP-Q staging)
- Grade II uterine prolapse (POP-Q staging)
- Grade I posterior vaginal wall prolapse (POP-Q staging)
- Stress urinary incontinence
Old perineal laceration
Surgical Procedure
Single-strip mesh total urethral suspension + modified posterior pelvic reconstruction.
Key Surgical Points
- Anterior pelvic mesh placement combined with vaginal mucosal plication repairs the damaged arcus tendineus levator ani, completing bladder neck suspension and total urethral suspension to treat anterior compartment prolapse and stress urinary incontinence.
Modified physiological posterior pelvic reconstruction includes posterior fornix reconstruction, levator plate repair and perineal body reconstruction to restore the physiological prenatal morphology of the vagina.
Surgeon Profile
Chen Yuanhong
Graduated from Shantou University Medical College, she has been engaged in clinical practice, scientific research and teaching of obstetrics and gynecology for more than 20 years. She has presided over multiple provincial and municipal scientific research projects, published 3 SCI papers and more than 10 core and other academic articles. She received further training in gynecologic oncology and endocrinology at the Second Affiliated Hospital of Sun Yat-sen University, and gynecologic laparoscopy at the First Affiliated Hospital of Sun Yat-sen University. She is proficient in diagnosis and management of various obstetric and gynecological diseases, with extensive experience in gynecologic oncology, pelvic floor disorders, endocrine diseases, infertility and recurrent spontaneous abortion. She specializes in laparoscopic, hysteroscopic and transvaginal gynecological surgeries.
