A 75-year-old woman complained of anuria and a sense of discomfort with\nsevere pelvic organ prolapse (POP). We planned tension-free vaginal mesh\n(TVM) surgery after curing mucosal defects and completing treatment for\ndiabetes mellitus. Anuria and pyelonephritis relapsed repeatedly due to the\nfailure of ring pessary therapy. Surgical treatment was required emergently.\nWe performed a total laparoscopic hysterectomy and uterosacral ligament\ncolpo-suspension (Shull�s method). Although the vaginal apex was supported\nto a good position, cystocele occurred six months after the initial surgery. A\nTVM procedure for recurrent cystocele was performed after curing the mucosal\ndefects, and after the improvement of glycemic control. Transvaginal\nnative tissue repair has the advantages of low risk of ureter injury, firm colpo-\nsuspension, and no need for mesh usage. On the other hand, it is not good\nat treating cystocele. Transvaginal native tissue repair should prove to be a\nuseful surgical option for apical support without mesh.
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