Abstract
ObjectiveAs the population ages, obliterative procedures (OP) are expected to become an increasingly important treatment option. The primary aim of this study was to evaluate vaginal and urinary symptoms 3 months after OP and peri- and postoperative complications. The secondary aim was to investigate long-term outcomes, including patient satisfaction, regret rate and the rate of symptomatic recurrent prolapse after OP. Another secondary aim was to evaluate the feasibility of performing OP under local anesthesia (LA) as increasingly more operations are performed under LA. Study designRetrospective study of 43 women who underwent OP during a 10-year period. Patients completed three prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery, 3 months postoperatively and at long-term follow-up. Records were reviewed for complications, use of anesthetics, recurrences, patient satisfaction and regret. ResultsA Le Fort colpocleisis was performed in 31 (72 %) and a colpectomy in 12 (28 %) patients. At 3 months` follow-up, patients had a statistically significant improvement in vaginal symptoms. Twelve patients (46 %) became continent, compared with 14 (54 %) with remaining urinary incontinence (UI). There were no patients with de novo UI 3 months’ after surgery. Total complication rate was 4,6% (2/43). A symptomatic recurrent prolapse occurred in 4 patients (9.3 %). The satisfaction rate was 86 %. No patients reported regret choosing to have vaginal closure surgery. Twenty one (49 %) of the procedures were performed under local anesthesia with intravenous sedation. ConclusionObliterative procedures are good surgical options for elderly women with a positive impact on vaginal and urinary symptoms, low complication and recurrence rate. Patients report high satisfaction and no regret over loss of sexual ability at longterm follow-up. OP under LA with intravenous sedation is a feasible and safe option.
Highlights
Based on a Danish population- based registry study the lifetime risk of having pelvic organ prolapse (POP) surgery is 18.7 % for an 80-year-old woman and 21.5 % for women aged 85+ years [1].The surgical management of POP includes reconstructive and obliterative procedures (OP)
Glavind outcomes, including patient satisfaction, regret rate and the rate of symptomatic recurrent prolapse after vaginal OP. Another secondary aim was to evaluate the feasibility of performing OP under local anesthesia (LA) as increasingly more operations are performed under LA
Performing LeFort colpocleisis, rectangular portions of the anterior and posterior vaginal walls are demarcated within the same margins posteriorly and anteriorly, and the vaginal epithelium is dissected off the underlying fibromuscular layers with a sharp dissection
Summary
Based on a Danish population- based registry study the lifetime risk of having pelvic organ prolapse (POP) surgery is 18.7 % for an 80-year-old woman and 21.5 % for women aged 85+ years [1]. The surgical management of POP includes reconstructive and obliterative procedures (OP). Reconstructive surgery corrects the prolapsed vagina and aims to restore normal anatomy, while OP (colpectomy and Le Fort colpocleisis) are defined as operations. Obliterative procedures are highly effective surgical treatments for advanced apical prolapse with success rates between 91 % and 100 % [2] and recurrence rates as low as 4.2 % [3]. Outcomes, including patient satisfaction, regret rate and the rate of symptomatic recurrent prolapse after vaginal OP. Another secondary aim was to evaluate the feasibility of performing OP under local anesthesia (LA) as increasingly more operations are performed under LA
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