Pelvic organ prolapse in women: Obliterative procedures (colpocleisis)
- Kimberly Kenton, MD, MS, FACOG, FACS
Kimberly Kenton, MD, MS, FACOG, FACS
- Professor, Obstetrics & Gynecology
- Chief, Female Pelvic Medicine & Reconstructive Surgery
- Northwestern University, Feinberg School of Medicine
- Chicago, IL
Pelvic organ prolapse (POP) affects millions of women; approximately 200,000 inpatient surgical procedures for prolapse are performed annually in the United States [1,2]. One in nine women will undergo surgery for prolapse or incontinence by age 80 years, and 30 percent of these women will require an additional prolapse surgery .
Reconstructive surgery corrects the prolapsed vagina and aims to restore normal anatomy, while obliterative surgery corrects prolapse by removing and/or closing off all or a portion of the vaginal canal (colpocleisis) to reduce the viscera back into the pelvis. Most women with symptomatic POP are treated with a reconstructive procedure. However, obliterative procedures are an effective option for women who cannot tolerate more extensive surgery and who are not planning future vaginal intercourse. In addition, obliterative procedures are consistently associated with high rates of satisfaction .
Obliterative procedures for POP are reviewed here. Evaluation of women with POP, conservative management, and choosing a primary surgical procedure are discussed separately. (See "Pelvic organ prolapse in women: Epidemiology, risk factors, clinical manifestations, and management" and "Vaginal pessary treatment of prolapse and incontinence" and "Pelvic organ prolapse in women: Choosing a primary surgical procedure".)
CANDIDATES FOR SURGERY
Indications for obliterative prolapse repair are generally the same as for other POP repair procedures, ie, symptomatic prolapse in women who decline or fail conservative therapy. However, obliterative procedures are less invasive and better tolerated by frail, older women than reconstructive procedures. (See "Pelvic organ prolapse in women: Choosing a primary surgical procedure", section on 'Candidates for surgical treatment'.)
Obliterative procedures are reserved for women who are not candidates for more extensive surgery or do not plan future vaginal intercourse. A study that surveyed older adults on their sexuality reported that the prevalence of sexual activity decreased with aging . Sexual activity amongst women ages 57 to 64 was 62 percent and decreased to 17 percent in women ages 75 to 85.
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- CANDIDATES FOR SURGERY
- PREOPERATIVE EVALUATION AND PREPARATION
- Informed consent and patient goals
- Physical examination
- Evaluation of urinary dysfunction
- - Urinary incontinence
- - Urinary retention
- SURGICAL PLANNING
- Choosing a type of obliterative procedure
- Concomitant hysterectomy
- Concomitant stress urinary incontinence surgery
- Routine postoperative care
- Sexual function
- SUMMARY AND RECOMMENDATIONS