About Prof. Lü Qin
Prof. Lü Qin is a urogynecology specialist at the Obstetrics & Gynecology Hospital of Fudan University (Red House Hospital), specialising in pelvic organ prolapse (POP), urinary incontinence, and pelvic floor reconstruction surgery. Her multicentre research programme spanning 1,200 patients across ten tertiary hospitals underpins the Chinese Guidelines on POP Diagnosis and Treatment (2023 Edition), which recommends her modified lateral suspension technique as the preferred procedure for high-recurrence-risk patients. She pioneered China's first robot-assisted single-port laparoscopic sacrocolpopexy, holds three national invention patents, and leads the National Pelvic Floor Implant Registry — the world's largest pelvic floor surgery database, covering 29 provinces and over 20,000 cases.
Case Overview
Mrs. Shen (pseudonym), a 63-year-old postmenopausal woman, presented with a two-year history of progressive pelvic pressure, vaginal bulge, urinary urgency, and difficulty with defecation. She had undergone vaginal hysterectomy for uterine prolapse twelve years earlier; prolapse had recurred within three years and progressively worsened. Examination confirmed Stage III vault prolapse (POP-Q: Ba +2, C +4, Bp +1) with concurrent cystocele and rectocele; PFIQ-7 score was 186/300, reflecting severe impact on daily life. Prof. Lü recommended robot-assisted single-port laparoscopic sacrocolpopexy using her team's novel lightweight large-pore polypropylene mesh, guided by the Three-Level Vaginal Support Theory. Operative time was 88 minutes; blood loss 45 mL; she was discharged on day three. At one-year follow-up, anatomical restoration was complete (POP-Q: Ba −2, C −7, Bp −2); PFIQ-7 improved to 24; FSFI sexual function score improved 43% from baseline. Mrs. Shen reflected: "I had lived with this for years — the discomfort, the embarrassment, not being able to do the things I used to do. After the surgery I felt like myself again. I wish I had come sooner."
Diagnostic Workup
POP-Q staging: Stage III vault prolapse (Ba +2, C +4, Bp +1) with cystocele and rectocele. Pelvic floor ultrasound: bilateral levator ani defect; bladder neck hypermobility on Valsalva. Urodynamics: detrusor overactivity consistent with urgency urinary incontinence; no stress incontinence. MRI pelvis: vault prolapse confirmed; levator hiatus area 32 cm² on Valsalva (reference <25 cm²), consistent with levator ani deficiency. PFIQ-7: 186/300; FSFI: 14.2 (below sexual dysfunction threshold). Multidisciplinary review — urogynecology, colorectal surgery, and physiotherapy — confirmed the surgical indication and operative plan.
Prof. Lü's pre-operative assessment: Recurrent Stage III vault prolapse in a postmenopausal woman with bilateral levator defects and an enlarged levator hiatus — the anatomical substrate for high recurrence risk. Native tissue repair alone carries a 30–50% recurrence rate in this setting. Layered reconstruction addressing all three vaginal support levels, with the novel lightweight mesh, is the appropriate approach.
Treatment Strategy and Course
Diagnosis: Recurrent Stage III vault prolapse with cystocele, rectocele, and bilateral levator ani deficiency — severe quality-of-life impact (PFIQ-7 186/300), high recurrence risk.
Treatment principle: robot-assisted single-port laparoscopic sacrocolpopexy with novel lightweight large-pore mesh, guided by Three-Level Vaginal Support Theory layered reconstruction.
- Apical support (Level 1): Sacrocolpopexy with mesh fixation to anterior longitudinal ligament at S1; uterosacral and cardinal ligament complex reinforced
- Lateral support (Level 2): Bilateral levator ani fascia repair; paravaginal defect correction; mesh arms secured to arcus tendineus fascia pelvis
- Perineal support (Level 3): Bulbocavernosus muscle reconstruction; perineal body repair; posterior colporrhaphy for rectocele
- Operative outcomes: Single-port robot-assisted approach; 88 minutes; 45 mL blood loss; discharged day three; no complications
- One-year follow-up: Complete anatomical restoration; PFIQ-7 186 → 24; FSFI +43%; no mesh complications; no recurrence
Prof. Lü's clinical reflection: Complete anatomical restoration, PFIQ-7 from 186 to 24, sexual function improved by 43%, discharged day three — this is what layered reconstruction and the novel mesh achieve together. Recurrent prolapse with levator deficiency is a high-risk problem. The answer is not a simpler operation — it is a more precise one, addressing every level of support that has failed.
Expert Commentary — Prof. Lü Qin
1. The Three-Level Vaginal Support Theory and Layered Reconstruction
Traditional POP surgery frequently addresses only the dominant defect, leaving residual support failures that drive recurrence. Prof. Lü's layered reconstruction strategy systematically addresses all three DeLancey support levels in a single procedure: apical suspension via sacrocolpopexy (Level 1), lateral repair via paravaginal correction and levator fascia suturing (Level 2), and perineal reconstruction via bulbocavernosus repair (Level 3). In her multicentre cohort of 1,200 patients, the modified lateral suspension technique achieved a 5-year anatomical restoration rate of 92% (vs 78% for traditional sacrocolpopexy; P<0.01) and a recurrence rate of 8% (vs 20% for traditional techniques).
2. Novel Lightweight Mesh: Biological Rationale and Clinical Evidence
Standard polypropylene mesh with small pore diameter (<1 mm) impairs tissue ingrowth and generates chronic inflammation. Prof. Lü's novel lightweight large-pore mesh (pore diameter >1 mm) optimises tissue integration: fibroblast proliferation >90% in vitro; IL-6 secretion reduced 50%; collagen deposition 30% greater at 3 months in porcine model; no granuloma formation. In clinical series, the complication rate is 2.5% (vs 11.4% for standard mesh), with mesh exposure at 0.8% and no cases of mesh-related pain worsening at 5-year follow-up.
3. Robot-Assisted Single-Port Sacrocolpopexy
Prof. Lü pioneered China's first robot-assisted single-port sacrocolpopexy, performing the entire procedure through a single umbilical port. Compared with conventional laparoscopy, the robotic platform reduced operative time to 90 minutes (vs 120 minutes) and blood loss to 50 mL (vs 85 mL), with equivalent anatomical outcomes and no visible abdominal scarring. The approach is incorporated into the Chinese Guidelines on POP Diagnosis and Treatment (2023 Edition) for centres with robotic capability.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Mrs. Shen throughout her pathway at the Obstetrics & Gynecology Hospital of Fudan University, providing priority consultation coordination with Prof. Lü's urogynecology team, bilingual interpretation across all consultations and multidisciplinary review, bilingual explanation of staging, operative plan, and mesh rationale, coordination of all investigations with bilingual results communication, bilingual surgical consent, and one-year follow-up scheduling.
For international patients with pelvic organ prolapse, urinary incontinence, or complex pelvic floor disorders — particularly those with recurrent or high-risk prolapse — Prof. Lü Qin's team offers access to one of China's most advanced pelvic floor reconstruction programmes. CMCS ensures that expertise is accessible, in the patient's language, with every step coordinated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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