Transvaginal single-pathway composite reconstruction for pelvic organ prolapse combined with rectal prolapse: a case report.

Concomitant pelvic organ prolapse (POP) and rectal prolapse (RP) is a relatively rare and often underrecognized clinical condition, typically managed as two separate entities within a single-disciplinary framework. Historically, transvaginal mesh (TVM), although widely used in pelvic floor reconstruction, has not been applied to treat RP. We report a 76-year-old female with severe POP and concomitant RP. Guided by the integral theory of pelvic floor, we innovatively cut and assembled TiLOOP Total 4 mesh into Total 6 configuration, connected it to a trimmed TiLOOP mesh (10 × 15 cm), and performed transvaginal fixation of the anterior rectal wall using the mesh during TVM pelvic floor reconstruction. This modified TVM pelvic floor reconstruction with concurrent TVM rectopexy achieved unexpectedly favorable outcomes, with no recurrence or mesh-related complications at 18 months of follow-up.Our findings suggest that, in selected cases meeting the indications, combined TVM pelvic floor reconstruction with concurrent TVM rectopexy appears to be feasible and may represent a potential effective treatment option for colorectal and gynecologic surgeons managing concurrent POP and RP. It should be noted, however, that this is a single case report with limited sample size, no control group, and short-term follow-up. Future studies with cohort designs or extended follow-up are warranted to further validate the efficacy of this procedure.