Hysterocolpectomy with colpocleisis for massive genital prolapse in women aged over 70 years

Abstract

Objectives We report long-term objective and subjective outcomes after hysterocolpectomy in elderly patients. Methods We conducted a retrospective study of colpocleisis procedures performed between January 1, 1989 and January 1, 1999 in patients over 70 years of age. Patient characteristics, operative data and objective outcome data were obtained from the patients’ records. Subjective outcome data were obtained by a standardized telephone interview. Results During the 10-year study period, 30 subjects aged between 70 and 89 years (78.1 ± 5.8, average ± S.D.) with complete uterovaginal prolapse were treated by colpocleisis, hysterocolpectomy, suburethral plication, anterior, posterior colporrhaphy and high levator plication. The median operating time and medin decrease in hemoglobin were, respectively, 79 min (range, 50–160 min) and 2.2 mg/dl (range, 0.2–3.6 mg/dl). No intraoperative complications occurred. The median hospital stay was 8 days (range, 4–20 days). Objective cure, defined as the absence of prolapse to the hymen, was achieved in all 30 patients. Median office follow-up time was 7.7 months (range, 1–21 months). Symptoms of stress incontinence persisted in four cases (13%) and appeared de novo in two cases (6.6%). Median telephone follow-up was 35 ± 48 months (range 13–161 months). Five of the 30 patients died during the follow-up period. Subjective cure, defined as a response of “satisfied” or “very satisfied”, was achieved in 25 patients (83%). Eighty-eight percent of patients reported being very satisfied or satisfied. Conclusion Colpocleisis with colpohysterectomy appears to be an effective treatment for massive uterogenital prolapse in elderly women.