Aim: Less than a dozen cases of psoas abscesses in pregnancy have been described in the literature. We reviewed the literature when treating a patient with a psoas abscess after ipsilateral double J-ureteral stent placement (in the following: “double J-stent”) due to infected hydronephrosis. Methods: In January 2022, this review was searched using the Pubmed/MEDLINE database and the mesh terms “Psoas Abscess” AND “Pregnancy”. Studies were included in any language and of all years, describing a psoas abscess during pregnancy. When patients did not have a psoas abscess, the abscess occurred after pregnancy, or when there was no full text available, the article was excluded. Main results: Ten case reports about patients with psoas abscesses during pregnancy were included. The classical symptomatic triad of psoas muscle abscess included lower back pain, limping and persistent fever with daily spikes. However, in most cases, not all three symptoms can be found. Especially, fever is absent in more than half of the patients. Psoas abscesses are described between 13 and 39 weeks of gestation. Primary psoas abscesses with haematogenous spread are more common during pregnancy than secondary with spread per continuitatem. In the literature, the main reasons for psoas abscess are spinal tuberculosis, drug abuse or underlying diseases such as Crohn’s disease. It is not uncommon for the definite cause to be unclear. Regarding the patient's symptoms, pyelonephritis is often considered a possible aetiology. In general, the main treatment options include antibiotic treatment and abscess drainage. There is no higher caesarean section rate, and no negative outcome for the foetus has been described. Case presentation: In our patient, a 38-year-old obese Caucasian woman, who had received a left double J-stent for infected hydronephrosis at 15 weeks of gestation, we successfully treated a psoas abscess of 20 × 10 cm with a sonographically assisted abscess drainage and antibiotics. The further course of pregnancy and the elective repeat caesarean section at 38 + 0 weeks of gestation were without any problems. Double J-stent placement and laser stone lithotripsy during puerperium were performed because of recurrent urolithiasis. Conclusions: Although rare, psoas abscesses can occur during pregnancy, and it has often been treated surgically in the past. A psoas abscess as a complication after infected hydronephrosis and intervention during pregnancy has never been reported in the literature. Even for obese patients, minimally invasive therapy may be a treatment option that has rarely been reported in the literature.

Purpose: Anterior enterocele is a rare but potentially serious complication after cystectomy with heterogeneous treatment options. Methods: Here we report on the management of a 71-year-old patient with recurrence of anterior enterocele after cystectomy and provide a systematic review of the literature using the PubMed/MEDLINE database. Results: The 71-year-old patient with recurrence of anterior enterocele after cystectomy was successfully treated with colpocleisis and anterior colporrhaphy at the Department of Gynecology and Gynecological Oncology, University Hospital Bonn. The use of a synthetic mesh was not needed. At 16-month follow-up postoperatively, the patient was asymptomatic and had no signs of recurrence. n = 14 publications including n = 39 patients were identified for the systematic review including case reports and reviews. The median duration of developing an anterior enterocele after cystectomy was 9 months (range 3 months to 8 years). Patients had a median age of 71 years (range 44–84). In all cases, a surgical approach was described using a wide variety of surgical procedures. In total, 36% of all patients developed a recurrence with an average time period of 7 months after primary surgery. A rare complication represents a vaginal evisceration with the need of urgent surgery. Furthermore, the occurrence of a fistula is a possible long-term complication. Conclusion: Anterior enterocele after cystectomy is a rare complication requiring an individual and interdisciplinary treatment.

Background: Pelvic organ prolapse (POP) affects nearly half of women, highly influencing quality of life. When conservative treatment fails, surgical repair is indicated, with sacropexy representing the current gold standard for apical POP (aPOP) repair. Methods: Prospective single-centre cohort study including patients (pts) with aPOP and indication for surgery using polyvinylidene fluoride (PVDF) mesh (DynaMesh ^® ) for sacrocervicopexy, sacrocolpopexy, or sacrohysteropexy at the University Hospital Bonn. Clinical data, peri- and postoperative outcomes, and follow-ups at 8 weeks (FU2), 6 months (FU3), and 12 months (FU4) postoperatively were analysed. The primary endpoint was the recurrence at FU4, defined as aPOP-Q ≥ grade II. Secondary endpoints included quality of life using the German Pelvic Floor Questionnaire (GPFQ), International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI-SF), and a study-specific questionnaire. Results: A total of 90 women (median age 60 years [range 34–83], median body mass index 24.5 kg/m² [range 19.5–40.3]) underwent POP surgery between 2022 and 2024. Most procedures were robotic-assisted sacrocervicopexies (77.8%). Perioperative complications occurred in 4.4% (intraoperative) and 6.7% (postoperative) of cases. Median hospital stay was 5 days (range 3–9). Until FU4, no apical recurrences were observed; cumulatively, de-novo mesh erosion occurred in 4.4% of pts, with 2.2% requiring surgical revision. De-novo urinary incontinence was rare (5.5%). Subjective outcomes included scores of GPFQ and ICIQ-UI-SF, which improved significantly at all follow-up visits compared to preoperatively. 93% of pts were satisfied with the operation, 94% would choose it again, and 95% of pts would recommend this operation to a friend. Conclusions: Mesh-assisted sacropexy was associated with high apical success rates and favourable patient-reported outcomes at 12 months. Complication and reoperation rates were low within the observed follow-up period. However, longer-term data are required to fully evaluate durability and safety. Trial registration: Registration number: DRKS00038856. Registration date: 08th January 2026, registered retrospectively

Introduction and Hypothesis: This video demonstrates a robotic-assisted sacrocervicopexy using the semitendinosus tendon. Methods: Between June 2022 and February 2023, we performed the worldwide first Da Vinci robotic-assisted sacrocervicopexies (SCP) for apical organ prolapse using the semitendinosus tendon of the left knee. Analysis of safety, feasibility, and clinical outcome of the first ten patients operated on using this new surgical technique included the German pelvic floor questionnaire (GPFQ) as well as a clinical examination. Results: Ten patients with a follow-up of 12 months were included. There was a significant reduction of the patient’s symptoms according to the GPFQ regarding the domain bladder (preoperatively versus 3 months postoperatively, mean 3.85 vs 1.61, p = 0.034), total score (preoperatively versus 3 months postoperatively, mean 12.79 vs 3.28, p = 0.034), and descensus symptoms (preoperatively versus 12 months postoperatively, mean 4.74 vs 0.67, p = 0.022). POP-Q stage (point C) was significantly reduced between the preoperative period and at the time of discharge (mean 2.2 vs 0, p = 0.004). No serious intra- and postoperative complications occurred. Conclusions: This pilot study showed satisfying clinical outcomes after a follow-up of 12 months, with a low mid-term complication rate.

Background: Vaginal cuff dehiscence (and evisceration, VCDE) after hysterectomy is a rare, but potentially serious complication. Current medical literature describes the most critical risk factors for VCDE after hysterectomy as surgical technique, use of thermal energy, early mechanical stress (especially sexual intercourse), infection, smoking, and obesity. There is currently no evidence regarding a potential association between VCDE and anti-HER2 therapy. We report a late-onset VCDE in a patient receiving combined antihormonal and anti-HER2 therapy, and discuss the hypothesis-generating question of a potential association, as well as the bowel-preserving surgical management. Case presentation: We report the case of an 81-year-old White woman with hormone receptor-positive breast cancer receiving antihormonal therapy with anti-HER2 treatment and recurrent vaginal vault prolapse who presented with acute vaginal evisceration of the small bowel. She had undergone a vaginal hysterectomy for pelvic organ prolapse 3 years earlier. Emergency surgical management was performed via laparotomy with repositioning of the small bowel, vaginal cuff closure, and concomitant sacrocolpopexy. One week later, re-laparotomy was required due to an open abdomen associated with paralytic small bowel ileus; bowel resection was not necessary. The last follow-up was carried out 21 months postoperatively. The patient was asymptomatic and showed no evidence of recurrent prolapse. Conclusions: This case highlights a rare late-onset VCDE in a patient receiving combined antihormonal and anti-HER2 therapy, a clinical context not previously described. While causality cannot be established, this report raises the hypothesis of a potential association between targeted therapy and impaired tissue integrity.

Background The da Vinci robotic system is a new operative tool and its exact role in a highly specialised centre for surgical cancer therapy has yet to be defined. Materials and Methods In a monocentric study, the first patients who underwent robot-assisted gynecological surgery between February 2014 and July 2015 by one surgeon at Charité Universitätsmedizin Berlin Campus Mitte have been compared 1:1 to patients, operated conventionally by laparoscopy. Matching was done by one of the principal investigators. The measured parameters were surgery time (ST), total surgery time (TST), loss of haemoglobin level, estimated blood loss and length of hospitalisation. The postoperative complications were evaluated using the international Clavien-Dindo classification. A learning curve was evaluated and thecomplication parameters of the robot-assisted group were compared within different learning phases. Results For the robot-assisted group, TST was longer (mean [SD] minutes, 212 [87], 185 [89], p = 0.005). There were no differences in blood loss (mean [SD] loss of haemoglobin in g/dl, 1.7 [1.1], 0.9 [1.6], p = 0.60; mean [SD] estimated blood loss in ml, 215 [190], 204 [195], p = 0.375) and length of stay (mean [SD] days, 7 [2], 7 [3], p = 0.972). The learning curve showed a three-phase division after an initial learning curve of only twelve robot-assisted surgeries. There was no difference in the overall complication rates between the two groups as well as between the three learning phases of the robot group. Conclusion Robot-assisted gynecological surgeries are associated with longer operating times. Differences regarding complication parameters and postoperative recovery were not observed.