Elsevier

Urology

Volume 80, Issue 3, September 2012, Pages 542-546
Urology

Female Urology
Colpocleisis for Advanced Pelvic Organ Prolapse

https://doi.org/10.1016/j.urology.2012.06.009Get rights and content

Objective

To characterize our experience with colpocleisis in a urologic setting because it has not been documented broadly in the urologic literature.

Methods

Retrospective review of demographics, urodynamics, presenting symptoms, complications, and outcomes for patients undergoing colpocleisis from 2001-2010 was performed. A questionnaire including the short forms of the Urinary Distress Inventory and Pelvic Organ Prolapse Distress Inventory (POPDI-6), and the Patient Global Impression of Improvement was sent to consenting patients.

Results

Fifty-three patients were identified. Examinations were all POP-Q stage 3 or greater or Baden Walker grade 3 or higher; 73.6% underwent total colpocleisis and 26.4% Le Fort; 60.4% underwent concomitant sling. Complications included 1 patient requiring transfusion, 1 with pulmonary embolus, 1 needing clot evacuation, and 1 requiring intraoperative cystotomy repair. There was no postoperative de novo urgency, no recurrence of prolapse, and no chronic urinary retention. In patients not undergoing urethral sling, stress urinary incontinence persisted in 4 patients and occurred de novo in 1. Mean follow-up was 9.3 months. Twenty-two surveys were returned: 90.9% described their condition as much or very much better on Patient Global Impression of Improvement. The average POPDI-6 score was 9.1. Frequency and urgency were the most common complaints leading to bother on the UDI-6 (33.3%). Most of these responders had a preoperative urge component.

Conclusion

In a selected patient population, colpocleisis is safe and efficacious. Persistent lower urinary tract symptoms comprise the highest frequency of complaints after colpocleisis, and this must be included in patient counseling. In an aging patient population with expected increase in demand for pelvic floor reconstruction, colpocleisis is a useful approach for the urologist.

Section snippets

Material and Methods

We performed an institutional review board–approved retrospective review of patients undergoing colpocleisis from 2001-2010. We documented patient demographics, presenting symptoms, preoperative urodynamic findings, concomitant procedures, complications, postoperative symptoms, and examination findings. Stress urinary incontinence (SUI) was objectively assessed at the surgeon's discretion by either urodynamics (UDS) or cough stress testing with the prolapse reduced.

Surgery was performed by 1 of

Results

Fifty-three patients were identified, with a mean office follow-up of 9.3 months (range 2-72). Demographics are listed in Table 1. All patients were POP-Q stage 3 or greater or Baden-Walker grade 3 or higher. No patients were sexually active. Of 19 patients with a recorded reason for sexual inactivity, 14 cited a deceased partner, 3 cited a partner with erectile dysfunction, and 2 cited strong religious beliefs.

Nine patients (17%) complained of urge urinary incontinence (UUI) preoperatively.

Comment

In our experience in a urologic setting, colpocleisis was safe and efficacious. Efficacy rates were high, with 91% reporting improvement on PGII, no recurrence of prolapse on examination, and no requirement of subsequent prolapse repairs. This is consistent with the prior literature,3, 4, 11 which reports success rates between 91% and 100% in follow-up periods of 2 weeks to 15 years. In our group, patients responding to the questionnaire reported a very low rate of prolapse symptoms on the

Conclusions

Colpocleisis is safe and efficacious. In our cohort there were few operative or postoperative complications. Patient satisfaction is high, with most patients reporting improved body appearance and sensation as well as improvement on PGII. Lower urinary tract symptomatology is frequently present in these patients and has significant risk of persistence after surgery. Lower urinary tract symptoms comprise the highest frequency of complaints after colpocleisis, and this must be included in patient

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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