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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Jones KA, Shepherd JP, Oliphant SS, et al. Trends in inpatient prolapse procedures in the United States, 1979-2006. Am J Obstet Gynecol 2010; 202:501.e1.
- Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol 2003; 188:108.
- Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997; 89:501.
- Fitzgerald MP, Richter HE, Bradley CS, et al. Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19:1603.
- Lindau ST, Schumm LP, Laumann EO, et al. A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 357:762.
- Barber MD, Amundsen CL, Paraiso MF, et al. Quality of life after surgery for genital prolapse in elderly women: obliterative and reconstructive surgery. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:799.
- Abbasy S, Kenton K. Obliterative procedures for pelvic organ prolapse. Clin Obstet Gynecol 2010; 53:86.
- FitzGerald MP, Richter HE, Siddique S, et al. Colpocleisis: a review. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17:261.
- DeLancey JO, Morley GW. Total colpocleisis for vaginal eversion. Am J Obstet Gynecol 1997; 176:1228.
- FitzGerald MP, Brubaker L. Colpocleisis and urinary incontinence. Am J Obstet Gynecol 2003; 189:1241.
- Hanson GE, Keettel WC. The Neugebauer-Le Fort operation. A review of 288 colpocleises. Obstet Gynecol 1969; 34:352.
- Hoffman MS, Cardosi RJ, Lockhart J, et al. Vaginectomy with pelvic herniorrhaphy for prolapse. Am J Obstet Gynecol 2003; 189:364.
- Gutman RE, Bradley CS, Ye W, et al. Effects of colpocleisis on bowel symptoms among women with severe pelvic organ prolapse. Int Urogynecol J 2010; 21:461.
- Murphy M, Sternschuss G, Haff R, et al. Quality of life and surgical satisfaction after vaginal reconstructive vs obliterative surgery for the treatment of advanced pelvic organ prolapse. Am J Obstet Gynecol 2008; 198:573.e1.
- Elkadry EA, Kenton KS, FitzGerald MP, et al. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol 2003; 189:1551.
- Hullfish KL, Bovbjerg VE, Steers WD. Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up. Am J Obstet Gynecol 2004; 191:201.
- Mahajan ST, Elkadry EA, Kenton KS, et al. Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery. Am J Obstet Gynecol 2006; 194:722.
- Brubaker, L, Norton, P. Current Clinical Nomenclature for Description of Pelvic Organ Prolapse. Journal of Pelvic Surgery 1996; 2:257.
- Ellerkmann RM, Cundiff GW, Melick CF, et al. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 2001; 185:1332.
- Gutman RE, Ford DE, Quiroz LH, et al. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? Am J Obstet Gynecol 2008; 199:683.e1.
- Swift S, Woodman P, O'Boyle A, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005; 192:795.
- Mouritsen L, Larsen JP. Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:122.
- Abbasy S, Lowenstein L, Pham T, et al. Urinary retention is uncommon after colpocleisis with concomitant mid-urethral sling. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20:213.
- Moore RD, Miklos JR. Colpocleisis and tension-free vaginal tape sling for severe uterine and vaginal prolapse and stress urinary incontinence under local anesthesia. J Am Assoc Gynecol Laparosc 2003; 10:276.
- Visco AG, Brubaker L, Nygaard I, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19:607.
- Beverly CM, Walters MD, Weber AM, et al. Prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse. Obstet Gynecol 1997; 90:37.
- von Pechmann WS, Mutone M, Fyffe J, Hale DS. Total colpocleisis with high levator plication for the treatment of advanced pelvic organ prolapse. Am J Obstet Gynecol 2003; 189:121.
- Kohli N, Sze E, Karram M. Pyometra following Le Fort colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct 1996; 7:264.
- Shayya RF, Weinstein MM, Lukacz ES. Pyometra after Le Fort colpocleisis resolved with interventional radiology drainage. Obstet Gynecol 2009; 113:566.
- Toglia MR, Fagan MJ. Pyometra complicating a LeFort colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20:361.
- Carberry CL, Hampton BS, Aguilar VC. Pyometra necessitating hysterectomy after colpocleisis in an extremely elderly patient. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:1109.
- Roth TM. Pyometra and recurrent prolapse after Le Fort colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:687.
- Wei JT, Nygaard I, Richter HE, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med 2012; 366:2358.
- Catanzarite T, Rambachan A, Mueller MG, et al. Risk factors for 30-day perioperative complications after Le Fort colpocleisis. J Urol 2014; 192:788.
- Mueller MG, Ellimootil C, Abernethy MG, et al. Colpocleisis: a safe, minimally invasive option for pelvic organ prolapse. Female Pelvic Med Reconstr Surg 2015; 21:30.
- Stepp KJ, Barber MD, Yoo EH, et al. Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol 2005; 192:1630.
- Hill AJ, Walters MD, Unger CA. Perioperative adverse events associated with colpocleisis for uterovaginal and posthysterectomy vaginal vault prolapse. Am J Obstet Gynecol 2016; 214:501.e1.
- Misrai V, Gosseine PN, Costa P, et al. [Colpocleisis: indications, technique and results]. Prog Urol 2009; 19:1031.
- Zebede S, Smith AL, Plowright LN, et al. Obliterative LeFort colpocleisis in a large group of elderly women. Obstet Gynecol 2013; 121:279.
- Fitzgerald MP, Kulkarni N, Fenner D. Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse. Am J Obstet Gynecol 2000; 183:1361.
- Harmanli OH, Dandolu V, Chatwani AJ, Grody MT. Total colpocleisis for severe pelvic organ prolapse. J Reprod Med 2003; 48:703.
- Lu YX, Hu ML, Wang WY, et al. [Colpocleisis in elderly patients with severe pelvic organ prolapse]. Zhonghua Fu Chan Ke Za Zhi 2010; 45:331.
- Hullfish KL, Bovbjerg VE, Steers WD. Colpocleisis for pelvic organ prolapse: patient goals, quality of life, and satisfaction. Obstet Gynecol 2007; 110:341.
- Crisp CC, Book NM, Cunkelman JA, et al. Body Image, Regret, and Satisfaction 24 Weeks After Colpocleisis: A Multicenter Study. Female Pelvic Med Reconstr Surg 2016; 22:132.
- 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