Vaginal reconstruction is limited by the lack of biomaterials that replicate the structure, biomechanics, and biochemistry of the native tissues. Synthetic meshes, xenografts, and autologous skin or bowel grafts are hindered by their immunogenicity, poor integration, and non-physiological properties. We report a scalable platform for the fabrication of patient-specific living vaginal grafts from autologous fibroblasts.Using scaffold-free micromolding and automated assembly, fibroblasts from small full-thickness vaginal biopsies self-assembled into a collagen-rich, highly aligned extracellular matrix that mimicked the native architecture. The twisted subunit assemblies displayed highly aligned collagen, dense cellularity, and a predominantly quiescent fibroblast phenotype with minimal myofibroblast activation. This autologous tissue-specific construct addresses the shortcomings of current materials and offers a customizable and biocompatible solution for regenerative gynecology. By combining tissue specificity, immunologic safety, and modular scalability, this approach has the potential to transform surgical options for congenital anomalies, sex-affirming surgeries, post-oncologic reconstruction, fistula repair, and pelvic organ prolapse.

Introduction - Genital prolapse is a common and disabling functional condition in women, affecting nearly one-third of women over 70 years of age in France. This descriptive study reviews the systematic use of laparoscopic double sacrocolpopexy (LDS) in our center, assessing its anatomical and functional benefits in the management of anterior or apical prolapse to prevent secondary rectocele. Materials and Methods - This retrospective, descriptive, single-center French study included 41 patients who underwent LDS between 2000 and 2019, with at least 5 years of follow-up. Patients were reassessed using a structured interview, self-administered questionnaires (MHU, PFIQ-7, I-QOL, UDI-6, USP) and a gynecological examination. The primary objective was the anatomical outcome of the posterior compartment after LDS with preventive pre-rectal mesh placement. Secondary objectives were the functional impact on overall and specific (urinary and digestive) quality of life, the anatomical outcomes of the anterior and middle compartments, and peri- and postoperative complications (Clavien-Dindo classification). Results - With an average follow-up of 11.2 years, the anatomical success rate (absence of rectocele stage > 2 according to Baden-Walker) reached 98% (40/41). At reassessment, 71% of the cohort (29/41) had no rectocele. Among the 12 patients with postoperative rectocele (29% with follow-up > 5 years), the vast majority had BW stage 1 rectocele (11/12). Furthermore, none of these patients required reintervention for rectocele following LDS (12/12), and no posterior colporrhaphy was performed. Functionally, urinary and digestive disorders were uncommon, as reflected by promising quality-of-life scores: MHU (2.75/28), I-QOL (104/110), PFIQ-7 (11/300), UDI-6 (2.6/18) and USP (1.2/9 ; 1.8/21 ; 0.7/9). In the long-term (follow-up > 5 years), 9% (4/41) had persistent anorectal discomfort, compared with 39% (16/41) in the early postoperative period (< 3 months), suggesting that persistent ano-rectal discomfort improves over time after surgery. Finally, no severe complications (Clavien-Dindo ≥ 3) were observed during follow-up. Regarding the anterior compartment, 65% (27/41) had grade 1 cystocele and 25% (10/41) had grade 2 according to Baden-Walker (BW). Overall, 85% reported satisfaction with the procedure, particularly regarding the correction of their initial urogenital prolapse and the resolution of pelvic heaviness. Conclusion - Our study shows that laparoscopic double sacrocolpopexy (LDS) achieves high anatomical success rates following preventive posterior mesh placement in patients with anterior urogenital prolapse. In our study population, this technique is associated with a very low incidence of rectocele and resulted in minimal long-term functional sequelae, with limited impact on both overall quality of life and urinary and digestive function. Nevertheless, the lack of a control group limits the interpretation of these findings and does not allow any conclusion to be drawn regarding the preventive effect of posterior mesh placement on rectocele development. Category : Urology.

To evaluate the feasibility and safety of uterus-preserving pelvic reconstruction (PRC) performed via extraperitoneal vaginal natural orifice transluminal endoscopic surgery (vNOTES) for multicompartment pelvic organ prolapse (POP). We describe a novel retroperitoneal, uterus-preserving PRC technique for multicompartment POP, demonstrated step-by-step using operative images and video. A representative case involved a 42-year-old woman with POP-Q stage III/III/II. Extraperitoneal access was obtained through a posterior vaginal approach using a transvaginal single-port platform. Presacral dissection enabled fixation of a tailored Y-shaped mesh to the anterior longitudinal ligament (S1-S2). The anterior and posterior mesh arms were then secured to the pubic fascial surfaces and posterior vaginal wall, respectively, providing uterine suspension and anatomic restoration. Between June 2024 and November 2025, 23 patients (mean age 49.2 ± 9.3 years) underwent uterus-preserving extraperitoneal vNOTES-PRC. The mean operative time was 97.7 ± 24.1 min, mean estimated blood loss was 126.4 ± 87.7 mL, and mean postoperative hospital stay was 4.1 ± 0.8 days. During a median follow-up of 9.4 months (range 6.3-22.4 months), all patients demonstrated significant anatomic improvement without recurrence, mesh erosion, or the need for reoperation. Uterus-preserving extraperitoneal vNOTES-PRC is a safe and effective surgical option for multicompartment POP, offering favorable anatomic outcomes while minimizing pelvic organ injury and operative duration.

A 58-year-old male with a history of type 1 diabetes, hypertension, smoking, and obesity, was seen by the inpatient neurology team for symptoms of dizziness and diplopia after cardiac catheterization. His symptoms caused him to feel nauseated and vomit and were improved with closing his right eye. It was noted that he was unable to adduct his right eye and had nystagmus of his left eye on exam. He had no ptosis, and convergence was preserved. The remaining physical exam was normal. Initial limited magnetic resonance imaging (MRI) was within normal limits; however, repeat limited brain MRI without contrast with brainstem cuts revealed punctate focus on restricted diffusion in the right dorsal pons compatible with a small acute infarct. He was started on dual antiplatelet therapy for 21 days followed by aspirin monotherapy daily, and rosuvastatin 40 mg daily. The patient was scheduled to follow up in the stroke clinic in 3 months and was also referred to ophthalmology, who recommended monitoring symptoms, which were gradually improving with an eye patch, indicating that he would likely slowly improve on his own.

Although endovascular repair is preferred over open techniques for chronic dissection-related thoracoabdominal aneurysms, specific adjunctive maneuvers are frequently required to optimize the distal landing zone of the thoracic endovascular aortic repair (TEVAR) or to enlarge the narrowed true lumen to deploy a branched endograft. Recently, transcatheter endovascular septotomy (TES) has gained attention as an evolving minimally invasive technique to optimize complex TEVAR procedures creating a better apposition of the endograft to the native aortic wall with the primary aim to block the retrograde perfusion of the false lumen. Initial results have been described satisfactory, but not negligible rates of intraprocedural complications in the form of lamella prolapse/migration leading to branch vessels occlusion have been described too. Herein we describe a complication that occurred after TEVAR with TES, causing static malperfusion of the reno-visceral vessels.