Pelvic organ transplantation: a new proposal for treatment of fecal and urinary incontinence

Abstract

Fecal and urinary incontinence (FUI) is a current public health problem with enormous social and economic impact. Treatments for FUI are insufficient. After anatomic investigation we perceived pelvic floor as an independent block composite tissue sharing a common vascular pedicle (external iliac) and neuronal trunk (pudenda). In this report, we describe pelvic organs transplantation in cadavers and rats. Donor operation – A combined perineal and abdominal incision was performed. The dissection progress near the pelvic ring and pudendal nerves and vessels were divided allowing the total pelvic floor mobilization. Through the abdominal incision, the genitalia, bladder and rectum were mobilized. The aorta and vena cava were isolated preserving the internal iliac vessels and the spermatic vessels. The graft containing skin, muscular complex, ligaments, bladder, ureter, vagina or penile, rectum, anus, uterus, ovarian, testis and its ducts was removed. Recipient operation – The same donor’s incision and dissection strategies were performed. The internal iliac vessels including rectal vessels and pudendal nerves were divided and the pelvic floor block tissues are removed. The infrarenal aorta and vena cava were isolated, the graft was positioned in the abdomen and an aorta-aorta such as a cava-cava anastomosis were performed. We also performed anastomosis between donor and recipient ureter, rectum and pudenda nerves and vessels. The pelvic floor was repositioned in its original position by stitches between pelvic floor ligaments, pudendal nerves and vessels, peritoneum and skin, completing the operation. In this survey, we show that pelvic floor transplantation surgery is feasible.