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

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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.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00192-021-04907-7

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Most cited references 53

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ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

Jonathan AC Sterne, Miguel A. Hernán, Barnaby Reeves … (2018)

Non-randomised studies of the effects of interventions are critical to many areas of healthcare evaluation, but their results may be biased. It is therefore important to understand and appraise their strengths and weaknesses. We developed ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”), a new tool for evaluating risk of bias in estimates of the comparative effectiveness (harm or benefit) of interventions from studies that did not use randomisation to allocate units (individuals or clusters of individuals) to comparison groups. The tool will be particularly useful to those undertaking systematic reviews that include non-randomised studies.

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Effect of patient age on increasing morbidity and mortality following urogynecologic surgery.

V Sung, Charles Rardin, Sherry Weitzen … (2006)

The purpose of this study was to estimate the effect of age on the risk of in-hospital mortality and morbidity following urogynecologic surgery and to compare risks associated with obliterative versus reconstructive procedures for prolapse in elderly women. We conducted a retrospective cohort study utilizing data from 1998 to 2002 from the Nationwide Inpatient Sample. Multivariable logistic regression was performed to obtain odds ratios estimating the effect of age on risk of death and complications, adjusting for comorbidities and demographic factors. There were 264,340 women in our study population. Increasing age was associated with higher mortality risks per 1000 women ( or = 80 years, 2.8; P or = 80 years, 200; P or = 80 years, OR 13.6 [95% CI 5.9-31.4]), compared with women < 60 years. The risk of peri-operative complications was also higher in elderly women 80 years of age and older (OR 1.4 [95% CI 1.3-1.5]) compared with younger women. Elderly women 80 years and over who underwent obliterative procedures had a lower risk of complication compared with those who underwent reconstructive procedures for prolapse (17.0% vs 24.7%, P < .01). Although the absolute risk of death is low, elderly women have a higher risk of mortality and morbidity following urogynecologic surgery.

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Quality of life after surgery for genital prolapse in elderly women: obliterative and reconstructive surgery.

Linda Barber, Marie Paraiso, Cindy Amundsen … (2007)

The objective of this study was to determine if obliterative and reconstructive vaginal surgery for advanced pelvic organ prolapse improve quality of life in elderly women. Women age 65 years or older with stage 3 or 4 pelvic organ prolapse who desired surgical correction were prospectively enrolled. The subjects underwent either obliterative or reconstructive vaginal surgery based on their personal preference and sexual expectations. The subjects received a pelvic organ prolapse quantitation examination and completed the pelvic floor distress inventory (PFDI), the pelvic floor impact questionnaire (PFIQ), the SF-36, and the Beck depression inventory preoperatively, 6 and 12 months after surgery. Seventy-nine subjects were enrolled, 70 of whom completed follow-up: 30 in the obliterative group and 40 in the reconstructive group. Both groups demonstrated significant improvements in the pelvic organ prolapse, urinary, and colorectal scales of the PFDI and PFIQ 6 and 12 months after surgery with no differences between the two treatment groups. In addition, there were significant and clinically important improvements noted in the bodily pain, vitality, social functioning, role-emotional, and mental health summary scales of the SF-36 in both groups after surgery, with no significant difference between groups. In appropriately selected elderly women, both obliterative and reconstructive vaginal surgery for advanced pelvic organ prolapse significantly improved health-related quality of life.

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Author and article information

Contributors

Magdalena Emilia Grzybowska:

ORCID: http://orcid.org/0000-0002-5311-3450

mgrzybowska@gumed.edu.pl , mlgrzybowska@wp.pl

Journal

Journal ID (nlm-ta): Int Urogynecol J

Journal ID (iso-abbrev): Int Urogynecol J

Title: International Urogynecology Journal

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0937-3462

ISSN (Electronic): 1433-3023

Publication date (Electronic): 18 August 2021

Publication date PMC-release: 18 August 2021

Publication date (Print): 2022

Volume: 33

Issue: 1

Pages: 31-46

Affiliations

[1 ]GRID grid.11451.30, ISNI 0000 0001 0531 3426, Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, , Medical University of Gdańsk, ; Smoluchowskiego 17, 80-214 Gdańsk, Poland

[2 ]GRID grid.411484.c, ISNI 0000 0001 1033 7158, 2nd Department of Gynecology, , Medical University of Lublin, ; Lublin, Poland

[3 ]GRID grid.11451.30, ISNI 0000 0001 0531 3426, Department of Periodontology and Oral Mucosa Diseases, , Medical University of Gdansk, ; Orzeszkowej 18, 80-204 Gdansk, Poland

Author information

Magdalena Emilia Grzybowska http://orcid.org/0000-0002-5311-3450

Article

Publisher ID: 4907

DOI: 10.1007/s00192-021-04907-7

PMC ID: 8739283

PubMed ID: 34406418

SO-VID: 01a348bb-de7b-4146-8a12-4b069f5951ae

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 1 March 2021

Date accepted : 6 June 2021

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: colpocleisis,complications,pelvic organ prolapse,regret,satisfaction,success

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: colpocleisis, complications, pelvic organ prolapse, regret, satisfaction, success

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

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Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Supplementary Information

Related collections

Bacterial vaginosis and biofilm

Most cited references 53

ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

Effect of patient age on increasing morbidity and mortality following urogynecologic surgery.

Quality of life after surgery for genital prolapse in elderly women: obliterative and reconstructive surgery.

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