Pelvic organ prolapse at its extreme: a case of complete bladder eversion necessitating multidisciplinary management including cystectomy with urinary diversion

Abstract

Pelvic organ prolapse (POP) is a prevalent condition among women, with clinical presentations ranging from asymptomatic to life-threatening. Complete bladder eversion is an exceptionally rare and morbid manifestation, typically observed in elderly women with advanced POP. Prompt recognition and intervention are critical, with management strategies spanning from bedside manual reduction to radical surgical procedures such as cystectomy with urinary diversion. Methods We report the case of an elderly multiparous woman who presented in septic shock with acute kidney injury secondary to complete bladder eversion involving the trigone and advanced pelvic organ prolapse. Initial attempts at manual reduction of the bladder were unsuccessful. Operative exploration by a multidisciplinary team involving Urology and Urogynecology revealed necrosis of the bladder neck and trigone. While the uterus was successfully reduced with pessary placement, the bladder could not be repositioned. Due to the risk of pressure necrosis on the already necrotic bladder neck and trigone, the pessary was not retained. Results Following shared decision-making, the patient underwent a combined surgical approach including cystectomy with ileal conduit urinary diversion, LeFort colpocleisis, and perineorrhaphy. Postoperatively, the patient recovered well and returned to her baseline functional status. Conclusion This case underscores the importance of urgent evaluation and stabilization in patients with bladder eversion and concurrent POP. Intraoperative assessment of bladder viability and timely involvement of multidisciplinary surgical teams are essential to optimize outcomes in these complex cases. Early recognition and treatment of pelvic organ prolapse may prevent bladder eversion.