Objective: To study the objective and subjective therapeutic effect of total and partial (LeFort) colpocleisis in treatment of severe pelvic organ prolapsed (POP) in selected elderly patients.
Methods: From Oct. 2005 to Feb. 2010, 63 severe POP patients [59-87 years, median age (75+/-6) years] with stage III and IV by POP-Q system underwent total and partial colpocleisis. The mean age was (75+/-6) years (59-87 years). Fifty-eight patients (58/63, 92%) present more than one kind of medical disease. There were 53 cases with uterus prolapse, 1 case with cervix prolapse and 9 cases with vaginal vault prolapse. Seven patients were recurrent POP from previous surgery. Twenty-three patients (36%) presented voiding difficulty. Seven patients (17%) presented obstructive bowel symptom. Three patients (5%) presented fecal incontinence, and 28 patients (44%) presented either had urinary incontinence or history of that. Among 63 patients, 48 patients (76%) underwent total colpoclesis, and 15 (24%) patients partial colpoclesis. Meanwhile, 58 (92%) patients underwent levator myorrhaphy plus perineorrhaphy and 20 (32%) patients underwent anti-urinary incontinence procedure (TVT-O), respectively. Patients were followed up to evaluate therapeutic effect at 2 months and 1 year after surgery. Objective evaluation included the POP-Q and the length of vagina, genital hiatus, perineal body. A nonvalidated Body Image and Satisfaction Questionnaire was completed for subjective evaluation.
Results: The mean operating time of 63 patients was (105+/-48) minutes, which was (128+/-58) in total and (82+/-26) minutes partial procedures, which exhibited significant difference (P<0.05). The mean blood loss was (187+/-128) ml (50-600 ml), total and partial procedures caused (232+/-159) and (101+/-54) ml, respectively, which also showed significant difference (P<0.05). No intraoperative injury or death occurred. The rate of postoperative complications was 5% (3/63). Mean follow-up time of 63 patients was 22.5 months (1-51 months). All patients had POP-Q staging score<or=I. No recurrent patient was observed. At 1 year after operation, the mean preoperative total vaginal length (TVL) and genital hiatus (GH) of (7.7+/-1.1) and (5.5+/-1.5) cm were decreased to (3.4+/-1.1) and (2.3+/-0.5) cm (P<0.01); and perineal body (PB) measurements was increased from (2.6+/-0.9) to (3.4+/-0.9) cm (P<0.01). Three (5%, 3/63) patients had mild urinary incontinence after the operation. Twenty-three patients with voiding difficulty presenting the mean postvoid residual volumes (110+/-38) ml (50-235 ml) were decreased to 12 ml after the operation. Obstructive bowel symptom was improved in 6 (54%, 6/11) patients, and fecal incontinence improved in 2 (2/3). One year after the operation, 52 (82%) patients completed the nonvalidated Body Image and Satisfaction Questionnaire. 49 (94%) patients said either 'very satisfied' or 'satisfied' with the outcome of their surgery, while 3 (6%) reported unsatisfied or not at all satisfied.
Conclusions: The objective and subjective curative rates of colpocleisis in treatment of severe POP are high with lower morbidity and recurrence. Colpocleisis is a safe and effective management in selected elderly patients with severe POP, who no longer desire to maintain vaginal coital function.