[Colpocleisis in elderly patients with severe pelvic organ prolapse].
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.
Lu
Yong-xian
YX
Department of Obstetrics and Gynecology, First Affiliated Hospital, General Hospital of People's Liberation Army, Beijing 100048, China. yongxianlu@sina.com
Hu
Man-luo
ML
Wang
Wen-ying
WY
Liu
Xin
X
Liu
Jing-xia
JX
Shen
Wen-jie
WJ
Ge
Jing
J
Zhang
Ying-hui
YH
Zhao
Ying
Y
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D014555:Urination Disorders / Q000209:etiology / Q000601:surgery; D014596:Uterine Prolapse / Q000601:surgery; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery*