Long-Term Follow-Up After Colpocleisis

Abstract

Vaginal reconstructive surgery in women with pelvic organ prolapse has high rates of success but is associated with risks of complications that make it unsuitable for elderly women. Colpocleisis is an alternative surgical option in this population. It is a simple procedure with fewer complications than vaginal reconstruction. Mean blood loss is low, operating time is short, and anatomic and functional outcomes are good. However, colpoclesis is an obliterative procedure that closes the vaginal opening, preventing intercourse and any future sexual activity. Therefore, it is not an option for women who wish to preserve vaginal function. Some surgeons are concerned over long-term regret of patients after surgery. Although previous studies show high rates of satisfaction in elderly women with little regret (≤10%) and improvement in their quality of life (QOL), follow-up was short, ranging from 12 weeks to 1 year. Few studies have evaluated the impact of colpoclesis on bowel and bladder function. The aim of this retrospective longitudinal study was to assess the regret rate and the effect on QOL and bladder and bowel function in a cohort of women who had undergone colpocleisis 2 to 5 years previously. Participants completed 3 validated questionnaires to assess QOL and impact on bladder or bowel function: the Prolapse QOL, the International Consultation on Incontinence–Urinary Incontinence Short Form, and the Colorectal Anal Distress Inventory. The medium follow-up was 3 years (range, 2–5 years). In addition, the following 2 questions were asked: (1) Do you regret having vaginal closure surgery for prolapse? (never, sometimes, often, all the time) and (2) Would you recommend this surgery to a relative or friend who is not sexually active? (yes, no). Of the 34 women identified who underwent the procedure, 6 died by the time of follow-up, and 5 could not answer the questionnaires because of ill health. The remaining 23 women responded (67%) and were included in the analysis. The median age was 78.68 years. Colpocleisis failed in the only woman who regretted having had the surgery. Low scores on the Prolapse QOL (8 [0–37] ± 9.41), the International Consultation on Incontinence–Urinary Incontinence Short Form (7 [0–17] ± 5.44), and the Colorectal Anal Distress Inventory (10 [0–28] ± 8.13) indicated a positive impact on QOL and bladder and bowel function. These findings show an excellent outcome among women in this population 2 to 5 years after colpocleisis; there was low regret (4.3%) and good QOL, with minimal adverse effects on bladder and bowel function. Elderly women undergoing this procedure can be reassured that they are unlikely to regret having had the surgery and that long-term bowel and bladder problems should be low.