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Colpocleisis – Providing Closure for Advanced Pelvic Organ Prolapse

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Objectives: Colpocleisis remains a viable option for management of advanced pelvic organ prolapse (POP) with either primary or recurrent presentations. However, it is only indicated in women who are no longer sexually active and have no intention of future sexual intercourse. As colpocleisis can be performed either under regional or local anaesthesia, it is suitable even for those with severe co-morbidities that may preclude them from other types of surgery. This case series was done to assess our unit’s clinical outcome after colpocleisis by looking specifically at complication rates and incidence of POP recurrence.

 

Methods: This is a retrospective case series of 32 cases of colpocleisis done at University Malaya Medical Centre and University Malaya Specialist Centre from 1 January 2014 until 30 June 2018. Exclusion criteria are patients whose medical notes were unable to be obtained. Patients’ demographic data, symptoms of the prolapse, urinary and bowel systems as well as POP-Q assessments were evaluated pre-operatively. Intraoperative findings and any early or post-operative complications were noted. All patients were followed up at 6 weeks, 3 months and 6 months, then annually thereafter.

 

Results: In this case series, the median age of patients undergoing colpocleisis was 71 (range 57 – 87) years and the median parity was 4.28 (range 2 – 9). A quarter of the women presented with recurrent prolapse, with 60% having stage 4 pelvic organ prolapse. The average length of hospitalisation was 3.7 days (range 2 – 10), the longer durations were commonly due to preoperative optimisation of vaginal tissues and blood glucose levels. Concurrent perineorrhaphy was performed in 81.3%, with 34.3% undergoing concomitant vaginal hysterectomy. Overall, the surgery was well tolerated; the median estimate blood loss is 325 (range 100 – 800) millilitres and the commonest complication was postoperative wound infection 6.25%. Our centre has a procedure success rate of 96.8% at one year and 93.75% at two years of follow-up. However, the rate of attrition is high with 43% of patients defaulting follow-up at one year.

 

Conclusion: Women who have undergone colpocleisis are generally satisfied with the procedure and have good outcomes. Regular audit of any intervention should be performed to ensure that the care and treatment provided to patients are of a high standard.
 

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