In recent years, reports of vaginal-related complications following robot-assisted radical cystectomy (RARC) in female patients have increased. However, there is no established consensus on their management.

We report a case of recurrent enterocele following RARC.

A 78-year-old woman with muscle-invasive bladder cancer (cT2N0M0) underwent two cycles of neoadjuvant chemotherapy with GC therapy, followed by RARC and ileal conduit urinary diversion. Four months postoperatively, she developed an enterocele, which was initially managed conservatively with a pessary. However, at 16 months postoperatively, vaginal cuff dehiscence was observed, necessitating emergency laparoscopic repair with suturing of the dehisced vaginal cuff. Despite this, the enterocele recurred at 22 months postoperatively. A multidisciplinary team reviewed the case and determined that a definitive surgical approach was required. The patient underwent laparoscopic pelvic floor mesh fixation combined with gracilis muscle flap reconstruction. The procedure was completed without intraoperative or postoperative complications, and no recurrence has been observed at six months postoperatively.

The management of vaginal cuff complications after RARC should be individualized based on each case. Although laparoscopic pelvic floor mesh fixation combined with gracilis muscle flap reconstruction is an invasive procedure, it appears to be the most definitive surgical treatment option for recurrent cases.