Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

Abstract

Introduction and hypothesis The aims were to review the literature from the last two decades and analyze treatment efficacy and findings of the studies on colpocleisis. Methods A systematic search was conducted within the MEDLINE/PubMed and ClinicalTrials.gov databases, using the following keywords: pelvic organ prolapse (POP), colpocleisis, obliterative, and LeFort. All English full-text prospective and retrospective observational and interventional studies were included. Anatomical and subjective success, surgical techniques, concomitant procedures, complication rates, anesthesia methods, and decision regret were analyzed. Results A total of 237 papers were identified and 49 met the inclusion criteria. Mean patient age was 69.0 ± 8.0 to 84 ± 3.1. Over 90.2% of patients undergoing colpocleisis were diagnosed with POP stage ≥ 3. The follow-up ranged from 30 days to a median of 5 years. Anatomical success, defined as POP-Q stage ≤ 1 and no prolapse beyond the hymen, was achieved in 62.5 to 100% and 87.5 to 100% of all patients respectively. Subjective success ranged from 88% to 100%. Regret over the loss of coital ability ranged from 0% in many studies to 12.9%, general decision regret from 0% to 13.8%. After concomitant midurethral sling surgery, 86.8% to 94% of all patients were continent, with a 0–14% sling revision rate due to urinary retention. Urinary tract infection was the most common postoperative complication (4.3 to 9% confirmed with urine culture, 34.7% based on symptom definition). Bowel (0 to 2.7%) and urinary tract (0 to 9.1%) injuries were the consequences of concomitant procedures. The mortality rates were up to 1.3%. Conclusions Colpocleisis is a heterogeneous procedure, characterized by high subjective and objective success, low coital ability regret, and a low risk of complications.

Colpocleisis in the surgical treatment of pelvic organ prolapse: clinical experience

“…The high success rate, patient satisfaction and low regret rate reported in the literature (1,(7)(8)(9) were supported by this study. With a mean follow-up of 49.6 months, there were two (2.2%) recurrent cases.…”

Evaluation of patients undergoing colpocleisis: A single-center experience

“…The study found that 48 female patients underwent colpocleisis due to POP. The mean age of these patients was 73.25±5.45 (60-80), gravidity was 4.58±2.38 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11), and parity was 4.08±1.45 (2)(3)(4)(5)(6)(7). Twenty-eight of the patients (58.3%) underwent partial colpocleisis (LeFort).…”

“…Protrusion of pelvic organs (uterus, rectum, bladder) toward or out of the vagina is called pelvic organ prolapse (POP). The main purpose of treatment POP is to improve symptoms, and reconstructive or obliterative surgical approaches are available (1,2). The treatment approach depends on the patient's expectations and preferences.…”

“…It can be performed by two methods: partial (LeFort) and complete (1). It can be recommended for older women who no longer want to use the vagina for sexual intercourse, for women who want to avoid hysterectomy, and for patients who prefer surgery with the lowest risk of complications and a short duration (2,3). The advantages of this surgery are its short duration, minimal blood loss, rapid discharge from the hospital, and the fact that only local anesthesia is required.…”

“…However, it also has disadvantages, such as the lack of sexual activity after the procedure, the development of de novo incontinence or urinary incontinence, and the impossibility of taking an endometrial biopsy because the cervical canal cannot be reached (4). Cervical lesions should be evaluated and treated as appropriate before prolapse repair (2). The procedure has a high success rate and long-term patient satisfaction (3).…”