Body image, regret, and satisfaction following colpocleisis

Twelve Month Outcomes of Pelvic Organ Prolapse Surgery in Patients With Uterovaginal or Posthysterectomy Vaginal Prolapse Enrolled in the Multicenter Pelvic Floor Disorders Registry

OBJECTIVE

The aim of the study was to compare 12-month subjective and objective outcomes between 3 approaches to apical pelvic organ prolapse (POP) surgery in patients presenting with uterovaginal or posthysterectomy vaginal prolapse enrolled in the Pelvic Floor Disorders Registry for Research.

STUDY DESIGN

This was an analysis of a multicenter, prospective registry that collected both patient- and physician-reported data for up to 3 years after conservative (pessary) and surgical treatment for POP. Twelve-month subjective and anatomic outcomes for patients who underwent surgical treatment were extracted from the registry for analysis. Pelvic organ prolapse recurrence was defined as a composite outcome and compared between the 3 apical surgery groups (native tissue repair, sacrocolpopexy, colpocleisis) as well as the 2 reconstructive surgery groups (native tissue repair and sacrocolpopexy).

RESULTS

A total of 1,153 women were enrolled in the registry and 777 (67%) opted for surgical treatment, of whom 641 underwent apical repair and were included in this analysis (404 native tissue repair, 187 sacrocolpopexy, and 50 colpocleisis). The overall incidence of recurrence was as follows: subjective 6.5%, anatomic 4.7%, retreatment 7.2%, and composite 13.6%. The incidence of recurrence was not different between the 3 surgical groups. When baseline patient characteristics were controlled for, composite POP recurrence between the native tissue and sacrocolpopexy groups remained statistically nonsignificant. Concurrent perineorrhaphy with any type of apical POP surgery was associated with a lower risk of recurrence (adjusted odds ratio, 0.43; 95% confidence interval, 0.25-0.74; P = 0.002) and prior hysterectomy was associated with a higher risk (adjusted odds ratio, 1.77, 95% confidence interval, 1.04-3.03; P = 0.036).

CONCLUSION

Pelvic Floor Disorders Registry for Research participants undergoing native tissue apical POP repair, sacrocolpopexy, and colpocleisis surgery had similar rates of POP recurrence 12 months after surgery.

Perception of Treatment Success and Impact on Function with Antibiotics or Appendectomy for Appendicitis: A Randomized Clinical Trial with an Observational Cohort

OBJECTIVE

To compare secondary patient reported outcomes of perceptions of treatment success and function for patients treated for appendicitis with appendectomy vs. antibiotics at 30 days.

SUMMARY BACKGROUND DATA

The Comparison of Outcomes of antibiotic Drugs and Appendectomy trial found antibiotics noninferior to appendectomy based on 30-day health status. To address questions about outcomes among participants with lower socioeconomic status, we explored the relationship of sociodemographic and clinical factors and outcomes.

METHODS

We focused on 4 patient reported outcomes at 30 days: high decisional regret, dissatisfaction with treatment, problems performing usual activities, and missing >10 days of work. The randomized (RCT) and observational cohorts were pooled for exploration of baseline factors. The RCT cohort alone was used for comparison of treatments. Logistic regression was used to assess associations.

RESULTS

The pooled cohort contained 2062 participants; 1552 from the RCT. Overall, regret and dissatisfaction were low whereas problems with usual activities and prolonged missed work occurred more frequently. In the RCT, those assigned to antibiotics had more regret (Odd ratios (OR) 2.97, 95% Confidence intervals (CI) 2.05-4.31) and dissatisfaction (OR 1.98, 95%CI 1.25-3.12), and reported less missed work (OR 0.39, 95%CI 0.27-0.56). Factors associated with function outcomes included sociodemographic and clinical variables for both treatment arms. Fewer factors were associated with dissatisfaction and regret.

CONCLUSIONS

Overall, participants reported high satisfaction, low regret, and were frequently able to resume usual activities and return to work. When comparing treatments for appendicitis, no single measure defines success or failure for all people. The reported data may inform discussions regarding the most appropriate treatment for individuals.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT02800785.

Colpocleisis Techniques: An Open-and-shut Case for Advanced Pelvic Organ Prolapse

OBJECTIVE

To highlight several advanced surgical techniques for all types of colpocleisis. Pelvic organ prolapse is a common condition that affects up to 40% of the postmenopausal female population.1,2 Particularly for women with advanced pelvic organ prolapse who no longer desire penetrative vaginal intercourse and with multiple medical comorbidities, the obliterative approach is preferred due to decreased anesthetic needs, operative time, and perioperative morbidity.3 Additionally, colpocleisis is associated with a greater than 95% long-term efficacy with low patient regret, high satisfaction, and improved body image.4,5 MATERIALS AND METHODS: The umbrella term of "colpocleisis" encompasses a uterine-sparing procedure, the LeFort colpocleisis, colpocleisis with hysterectomy, and posthysterectomy vaginal vault colpocleisis. We demonstrate the surgical steps of performing each type of colpocleisis as well as levator myorrhaphy and perineorrhaphy, which are typically included to reinforce the repair.

RESULTS

To streamline the LeFort colpocleisis procedure, we demonstrate use of electrosurgery to mark out the epithelium and methods to create the lateral tunnels with LeFort colpocleisis with and without the use of a urinary catheter. We also present techniques that can be utilized across all types of colpocleisis including the push-spread technique for dissection, tissue retraction with Allis clamps and rubber bands on hemostat clamps to improve visualization, and approximation of the anterior and posterior vaginal muscularis to close existing space. Attention must be paid not to proceed past the level of the urethrovesical junction to avoid angulation of the urethra. We use an anatomic model to demonstrate appropriate suture placement during levator myorrhaphy to facilitate an adequate purchase of the levator ani muscles in order to adequately narrow the vaginal opening. Ultimately the goal of the colpocleisis procedure is a well-approximated, obliterated vagina, approximately 3 cm in depth and 1 cm in width.

CONCLUSION

The skills demonstrated enable the surgeon to maximize efficiency and surgical outcomes for an effective obliterative procedure for advanced stage pelvic organ prolapse.

Comparison of long-term results of obliterative colpocleisis and reconstructive vaginal surgery including sacrospinous ligament fixation in patients with total genital prolapse

Background

Treatment of total genital prolapse in elderly patients is still controversial in terms of postoperative objective and subjective results.

Aim

The present study aimed to compare the long-term objective and subjective cure rates of sacrospinous ligament fixation and Le Fort operation for treatment of total genital prolapse.

Patients and Methods

Patients over the age of 60 with stage 3 or 4 pelvic organ prolapse that presented to the Obstetrics and Gynaecology Clinic of the Faculty of Medicine of *** University. The study sample consisted of 17 patients that underwent Le Fort operation and 29 patients that underwent sacrospinous ligament fixation. Data on duration of operation, intraoperative complications, duration of hospital stay, and differences between preoperative and postoperative estimated blood loss, postoperative complications, and relapse in the long term were obtained. Questionnaires exploring quality of life, incontinence, and pelvic floor disorders were applied to the patients.

Results

As subjective cure rates, postoperative patient satisfaction (P = 0.001), regret rate (P = 0.038) and recommendation rate (P = 0.044), as well as postoperative questionnaire results, Pelvic Floor Impact Questionnaire and SF36 were found to be significantly better in the Le Fort group (respectively P = 0.039 and 0.042). As objective cure rates, there was no difference between the two groups in terms of postoperative cystocele, rectocele, and cystorectocele (P = 0.955) and postoperative recurrence of prolapse beyond the hymen (P: 0.893). Duration of operation and duration of hospital stay were found to be significantly shorter in the Le Fort group (respectively P = 0.032 and 0.012).

Conclusion

Le Fort operation could be the intervention of choice in sexually inactive elderly patients with stage 3 or 4 pelvic organ prolapse.

How does colpocleisis for pelvic organ prolapse in older women affect quality of life, body image, and sexuality? A critical review of the literature

Colpocleisis is a surgical treatment for pelvic organ prolapse that results in vaginal obliteration. This review aims to systematically evaluate the quality of life, changes in body image, regret, and impact on sexual activity in women after colpocleisis. A review was conducted using the PubMed and Scopus databases with search criteria specifying pelvic organ prolapse, colpocleisis, quality of life, body image, regret, sexuality, and their synonyms. For the selection of the eligible articles, we used the PRISMA reporting system. A total of 1285 articles were found. After removing duplicates and applying the inclusion and exclusion criteria, 30 articles were reviewed in full length. Quality of life after colpocleisis was evaluated in 22 articles, and 20 authors used validated questionnaires. All concluded that quality of life improved after surgical treatment. Twenty-one articles studied regret after obliterative treatment for pelvic organ prolapse. Most of the patients reported no regret. Regret was often due to bowel and bladder symptoms. A few patients reported regret because of loss of coital function. Body image was highlighted in six studies. Three articles assessed body image using the modified Body Image scale. The body image scores demonstrated a significant improvement after surgery. Women tended to remain sexually active and some also regained sexual activities after surgery. Colpocleisis remains a viable option for pelvic organ prolapse, without compromising quality of life, body image, or sexuality, but diligent patient selection is needed. Particular concern should be given to bladder and bowel symptoms since these are the main reason for dissatisfaction after colpocleisis.

Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

Introduction and hypothesis

The aims were to review the literature from the last two decades and analyze treatment efficacy and findings of the studies on colpocleisis.

Methods

A systematic search was conducted within the MEDLINE/PubMed and ClinicalTrials.gov databases, using the following keywords: pelvic organ prolapse (POP), colpocleisis, obliterative, and LeFort. All English full-text prospective and retrospective observational and interventional studies were included. Anatomical and subjective success, surgical techniques, concomitant procedures, complication rates, anesthesia methods, and decision regret were analyzed.

Results

A total of 237 papers were identified and 49 met the inclusion criteria. Mean patient age was 69.0 ± 8.0 to 84 ± 3.1. Over 90.2% of patients undergoing colpocleisis were diagnosed with POP stage ≥ 3. The follow-up ranged from 30 days to a median of 5 years. Anatomical success, defined as POP-Q stage ≤ 1 and no prolapse beyond the hymen, was achieved in 62.5 to 100% and 87.5 to 100% of all patients respectively. Subjective success ranged from 88% to 100%. Regret over the loss of coital ability ranged from 0% in many studies to 12.9%, general decision regret from 0% to 13.8%. After concomitant midurethral sling surgery, 86.8% to 94% of all patients were continent, with a 0–14% sling revision rate due to urinary retention. Urinary tract infection was the most common postoperative complication (4.3 to 9% confirmed with urine culture, 34.7% based on symptom definition). Bowel (0 to 2.7%) and urinary tract (0 to 9.1%) injuries were the consequences of concomitant procedures. The mortality rates were up to 1.3%.

Conclusions

Colpocleisis is a heterogeneous procedure, characterized by high subjective and objective success, low coital ability regret, and a low risk of complications.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00192-021-04907-7

Surgical and quality of life outcomes after pelvic organ prolapse surgery in older postmenopausal women

Introduction

To evaluate the surgical outcome, and quality of life (QoL) 12-months after Le Fort colpocleisis (LFC), and sacrospinous fixation (SSF) in older postmenopausal women.

Material and methods

Eighty-six (86) post-menopausal women were included in this study (38 in the LFC group and 48 in the SSF group). Pelvic organ prolapse quantification (POP-Q) was used to evaluate the participants’ pelvic organ prolapse (POP) pre-operatively and post-operatively (PO). The Arabic version of the WHOQoL-BREF Inventory was used to evaluate the participants’ QoL preoperatively and post-operatively. The surgical outcome and QoL 12-months after LFC and SSF were analysed to evaluate the surgical outcome, as well as QoL 12 months after LFC and SSF.

Results

The pre-operative Aa, Ba, D, Ap, and Bp values of POP-Q significantly improved 12 months PO in the LFC group (p1 = 0.004, 0.0006, 0.02, 0.004, and 0.0001; respectively), and in the SSF group (p1 = 0.003, 0.0003, 0.003, 0.0005, and 0.01, respectively). Eighty (93.02%) of the studied women had no prolapse at 12-month PO follow-up. The 12-month PO psychological and social health domains were significantly higher in the SSF group compared to the LFC group (p2 = 0.04, and 0.02, respectively). In addition, the 12-month PO general health satisfaction and total QoL scores were significantly higher in the SSF group compared to the LFC group (p2 = 0.03 and 0.01, respectively).

Conclusions

LFC can be considered a good surgical procedure with minimal or neglectable complications for POP in older postmenopausal women with multiple co-morbidities. The psychological and social health domains, general health satisfaction, and total QoL score were significantly higher in the SSF group compared to LFC group 12 months PO.

Conservative Management of Pelvic Organ Prolapse: Indian Contribution

Pelvic organ prolapse (POP) is a very common condition which can greatly impact a woman's quality of life. Treatment options are individualized and typically involve a combination of physiotherapy, pessary insertion and surgical treatments. It is well known that nulliparous prolapse in India constitutes 1.5-2% of genital prolapse, while the incidence is even higher (5-8%) for young women who have delivered one or two children, thus making it one of the highest rates in the world. This has necessitated the development of numerous conservative surgical treatment options for POP, which allows women to retain their sexual and reproductive function and therefore allows for subsequent pregnancies. With the controversy surrounding the use of mesh, a variety of surgical treatment options should be considered. Such alternative treatments include the use of surgical sling procedures, which have been used widely in Indian practice for the treatment of POP for over 60 years. This review outlines some of the well-established conservative treatment options for POP. It also highlights the unique contribution of Indian Obstetricians in the development of these conservative surgical treatment options, from prominent Indian Gynecologists including Dr VN Shirodkar, Dr BN Purandare, VN Purandare, RP Soonawala, Brigadier SD Khanna and Dr RM Nadkarni.

Satisfaction and Regret Following Uterosacral Ligament Suspension and Sacrocolpopexy: A Prospective Multicenter Analysis From the Fellows' Pelvic Research Network

OBJECTIVES

The primary objective was to compare levels of satisfaction, regret, and Patient Global Impression of Improvement (PGI-I) scores between women who underwent vaginal uterosacral ligament suspension (USLS) and minimally invasive sacrocolpopexy (SCP). Secondary objectives were to identify which preoperative counseling resources were most useful.

METHODS

This was a multicenter, retrospective cohort study through the Fellows' Pelvic Research Network that included women who underwent a USLS or SCP between January 2013 and January 2016 with 1-year follow-up. Women completed the Decision Regret Scale for Pelvic Floor Disorders, Satisfaction with Decision Scale for Pelvic Floor Disorders, and PGI-I. Data were also collected on usefulness of various educational preoperative resources.

RESULTS

A total of 175/367 (47.6%) women participated; 45 (25.7%) and 130 (74.3%) in the USLS and SCP groups, respectively. Mean Decision Scale for Pelvic Floor Disorders scores were 4.6 ± 0.8 and 4.5 ± 0.7 (P = 0.30) in the USLS and SCP groups, respectively, indicating a high level of satisfaction with surgical decision. The mean Decision Regret Scale for Pelvic Floor Disorders score was 1.5 ± 0.8 in USLS and 1.6 ± 0.8 in SCP (P = 0.53). The SCP group had higher PGI-I scores (1.7 ± 1.4 vs 2.0 ± 1.3, P = 0.02), indicating lower perceived postoperative improvement. Most women (151 [86.3%] of 175) reported that verbal counseling was sufficient and would not have found additional resources helpful.

CONCLUSIONS

Women have high satisfaction and low regret with their decision to pursue surgical correction with USLS or SCP. Most are satisfied with only verbal preoperative counseling.

Technical considerations and mid-term follow-up after vaginal hysterocolpectomy with colpocleisis for pelvic organ prolapse

OBJECTIVES

At the time of controversies on surgical treatment of pelvic organ prolapse, our aim was to describe an effective technique of hysterocolpectomy with colpocleisis for elderly patients not wishing to maintain vaginal sexual activity and present mid-term results including pelvic floor symptoms and quality of life, patient satisfaction and surgical complications using validated scores.

STUDY DESIGN

We conducted a retrospective study of all patients having undergone this surgery between June 2006 and June 2016. Women were examined using POP-Q classification and completed validated questionnaires concerning symptoms and quality of life before and after the surgery. Patient satisfaction was assessed using the PGI-I. Complications were described according to the Clavien-Dindo classification.

RESULTS

During the 10-year period, 37 women underwent the surgery with a mean age at surgery of 81.2 years (range: 61-93 years). One per-operative complication occurred (a rectal wound that was sutured) and five Clavien-Dindo grade 3b postoperative complications. Three repeat operations were necessary within 15 days; one suburethral sling had to be lowered because of urinary retention; one tension-free vaginal tape had to be unilaterally sectioned for acute urinary retention; and one woman presented a pararectal abscess requiring surgical drainage. The mean duration of hospitalization was 5.5 (+/-4.2) days. The mean follow-up time was 44.1 (±30.1) months. All symptoms and quality of life scores decreased significantly after the surgery and patient satisfaction was good (PGI-I score = 1.55 +/-0.8).

CONCLUSIONS

Hysterocolpectomy with colpocleisis appears to be an effective treatment with a high level of patient satisfaction among the elderly.

Razor-type dermatomes enable quick and thin vaginal dissection with less bleeding in colpocleisis

INTRODUCTION AND HYPOTHESIS

Although colpocleisis is a low-invasive surgical option to treat pelvic organ prolapse, it sometimes involves a long operative time with substantial bleeding. To streamline the vaginal dissection process in colpoclesis, we introduced the usage of dermatomes.

METHODS

All patients were sexually inactive women with post-hysterectomy prolapse. Data of the dermatome group were retrospectively compared with those of the historical control group based on operative features, perioperative complications and pathology of dissected tissue. In the dermatome group, 34 women underwent total colpocleisis with vaginal dissection using dermatomes; 4 were done mainly with electric dermatomes, and 30 were done with razor-type dermatomes. In the control group, 20 women underwent total colpocleisis with vaginal dissection using Metzenbaum scissors.

RESULTS

Using dermatomes in vaginal dissection was helpful to shorten total operative time (including perineoplasty) by one third from 76 to 51 min, to shorten the time of colpocleisis by half, from 62 to 32 min, and to reduce intraoperative bleeding by 76%, from 62 to 15 ml. In addition, none in the dermatome group and 2/20 patients in the control group had unintended peritoneal opening. Dissection with scissors removed not only the epithelium and submucosal layer but also the muscle layer. This was minimized with razor-type dermatomes and never occurred with electric dermatomes. Whereas electric dermatomes are difficult to get accustomed to and are expensive, razor-type dermatomes enable thinner dissection compared with scissors, are easy to handle and are inexpensive.

CONCLUSIONS

Razor-type dermatomes enable quick and thin vaginal dissection with less bleeding. Therefore, they can be recommended as a practical tool for colpocleisis, a prolapse operation mainly for frail elderly patients.

A qualitative study of women's values and decision-making surrounding LeFort colpocleisis

INTRODUCTION AND HYPOTHESIS

LeFort colpocleisis for uterovaginal prolapse can be appealing to elderly non-sexually active patients given the durability and low risk, particularly when the alternative procedure is more invasive and includes a hysterectomy. We used qualitative methods to explore women's decision-making and feelings after this procedure.

METHODS

We interviewed ten women after a LeFort colpocleisis (with or without mid-urethral sling) for uterovaginal prolapse. We conducted semi-structured interviews that were recorded and transcribed and then analyzed using grounded theory. The main themes were: the process of decision-making about whether to have an obliterative procedure, adequacy of preoperative counseling, and comparison against an alternative, more invasive surgical procedure with a hysterectomy. We also used the Decision Regret Scale and the Satisfaction with Decision Scale for Pelvic Floor Disorders.

RESULTS

Women made the decision to pursue LeFort colpocleisis mainly by themselves. They felt positive about the ability to control their body and their life through their own decision. None of the women regretted the procedure on the basis of the inability to have penetrative intercourse and did not feel it affected their sexual function in a negative way. Women felt adequately counseled regarding other options and the surgical procedure. Many patients wished they had pursued surgery earlier because they were very satisfied with the results.

CONCLUSIONS

Women who underwent LeFort colpocleisis were very happy with their decision. They primarily made the decision to have surgery autonomously. None of them regretted having an obliterative procedure for pelvic organ prolapse for reasons of sexual function.

Le Fort partial colpocleisis as an effective treatment option for advanced apical prolapse in elderly women

OBJECTIVE

The aim of this study was to evaluate the outcomes of women with advanced apical prolapse who were treated with the obliterative LeFort partial colpocleisis (LFC) procedure.

MATERIALS AND METHODS

We reviewed the medical records of patients who underwent LFC for advanced apical prolapse. We collected data for baseline patient characteristics, co-morbidities, severity of prolapse, operating time, intraoperative injuries, and postoperative complications. Subjective postoperative outcomes and patient satisfaction levels were also assessed.

RESULTS

Ninety-five patients underwent LFC during the study period. Median age of patients at operation was 76.0years. Mean operation time was 121.5 ± 31.9 min. Mean postoperative hospital stay was 3.5 ± 1.6 days. Postoperative complications, which were virtually all urinary symptoms, were present in 29.8% of patients, and 89.3% of patients have been in spontaneous remission. There was one case with perineal wound infection, one case of prolapse recurrence, and one case of de novo rectal prolapse after LFC. The objective success rate of the LFC procedure for all patients was 98.9% (94/95). Most (96%) patients were satisfied with the LFC results and pleased with the improvement in body image.

CONCLUSION

The obliterative LFC procedure had a high success rate and was associated with minimal adverse events for the elderly patients with advanced apical prolapse. This procedure should be considered as a treatment option for the advanced apical prolapse in selected elderly women who do not want to conserve vaginal intercourse, as it offers improvement in quality of life and is associated with a low regret rate.

Effect of pelvic floor dysfunction on sexual function and quality of life in Chinese women of different ages: An observational study

AIM

The aim of the present study was to investigate the effect of female pelvic floor dysfunction on sexual function and quality of life among different age groups.

METHODS

An observational study was carried out on 648 patients with pelvic organ prolapse (POP) or/and stress urinary incontinence. We assessed female sexual function and quality of life through the Prolapse/Urinary Incontinence Sexual Questionnaire Short Form and Incontinence Quality of Life Scale before surgeries, respectively. Patients were assigned into different age groups.

RESULTS

The mean age of all patients was 62.04 ± 9.39 years. A total of 436 patients had POP, 120 patients had stress urinary incontinence and the remaining patients had both. Although sexual frequency decreased with increasing age, 517 patients still remained sexually active. A total of 10.83% of the patients aged ≥70 years were still sexually active, and 8.51% of them had sex less than one time per month. The Prolapse/Urinary Incontinence Sexual Questionnaire Short Form score and sexual frequency decreased with increasing age. However, the Incontinence Quality of Life Scale score increased with increasing age. Patients with only POP and aged ≥70 years showed a higher Incontinence Quality of Life Scale score (P < 0.001).

CONCLUSIONS

The present study showed that POP and stress urinary incontinence are common among older Chinese women, and re associated with decreased sexual satisfaction and quality of life in China. It suggests that the existing sexual requirement of these patients should also be reconsidered before surgical assessment. Doctors should take sexual satisfaction into consideration when choosing a personalized type of surgery to improve the patients' quality of life physiologically and psychologically. Geriatr Gerontol Int 2019; 19: 299-304.

Clinical application and mid-term results of modified vaginal closure: pelvic symptoms, quality of life, satisfaction, and regret rate

OBJECTIVE

To evaluate the safety and efficacy of a modified vaginal closure in older women with severe pelvic organ prolapse (POP) with respect to symptoms, quality of life, postoperative satisfaction, regret rate, and complications METHODS:: From March, 2014 to December, 2016, in all, 32 women were enrolled in the study. All the participants underwent a modified vaginal closure. Records were reviewed to collect demographic characteristics and perioperative parameters. The Pelvic Floor Distress Inventory-short form 20 (PFDI-20) and the Short Form 36 Health Survey Profile (SF-36) were used to evaluate pelvic symptoms and self-perceived quality of life, respectively, 6 months postoperatively and at the latest follow-up. The Patient Global Impression of Change (PGI-C) was used to estimate the satisfaction. The satisfaction and regret rates were assessed at the latest follow-up.

RESULTS

After an average follow-up period of 23 months (range 8-41 months), none of the 32 women experienced recurrence of prolapse that required reoperation. During follow-up, significant improvements were observed in the Pelvic Organ Prolapse Distress Inventory (POPDI-6), Urinary Distress Inventory (UDI-6), and SF-36 results (P < 0.001). However, the Colorectal-Anal Distress Inventory (CRADI-8) results did not improve significantly (P = 0.074). None of the participants regretted undergoing this procedure, and the PGI-C indicated a satisfaction rate of 93.8%.

CONCLUSIONS

The modified vaginal closure showed a positive impact on POP and urinary symptoms, and consequently improved quality of life of the 32 participants. This procedure achieved a relatively high satisfaction rate and a low regret rate.

Colpocleisis: A Survey of Current Practice Patterns

BACKGROUND

Currently, there are no standard treatment guidelines for colpocleisis. Clinical practice varies widely for this safe and effective procedure.

OBJECTIVE

The aim of this study was to evaluate the current practice patterns in the United States among surgeons who perform colpocleisis.

METHODS

A 27-item anonymous Web-based survey was sent to all practicing physicians affiliated with the American Urogynecologic Society. It consisted of questions regarding the demographic background of the physicians and their current practice as it relates to colpocleisis.

RESULTS

Of the 1422 physicians contacted, 322 responded (23%) to the questionnaire. Slightly more than half were female with an average time of 15 years in practice. The majority of respondents (79%) were urogynecologists. Most surgeons chose colpocleisis for its high success rate, short operating time, and low risk of complications. Approximately half of the providers performed both LeFort and total colpocleisis. Only 18% performed a routine hysterectomy at the time of surgery. Routine preoperative endometrial evaluation was preferred by 68% of the respondents, with 81% utilizing a transvaginal ultrasound first. Almost all providers would perform concomitant incontinence procedures, with 54% requiring a positive cough stress test and normal postvoid residual.

CONCLUSIONS

There is variation in the current practice of colpocleisis in the United States. LeFort colpocleisis is most commonly performed, and routine hysterectomy is uncommon. Two thirds of surgeons evaluate the endometrium prior to surgery. Concomitant anti-incontinence procedures appear to be standard.

A Scoping Study of Psychosocial Factors in Women Diagnosed With and/or Treated for Pelvic Organ Prolapse

OBJECTIVE

Pelvic organ prolapse (POP) is prevalent and can impact women's physical and psychosocial health. To develop interventions that support this population, an understanding of the state of research on psychosocial factors related to POP is essential. We conducted a scoping study focused on the psychosocial experience of women with POP. The purpose of this review was to (1) inventory and describe the current state of knowledge of the psychosocial experience of women with POP, (2) identify gaps in knowledge, and (3) identify targets for future research.

METHOD

Electronic databases PsycINFO, PubMed, EMBASE, and CINAHL were searched through November 1, 2017.

RESULTS

Of 524 titles reviewed, 103 articles met all inclusion criteria. Articles were grouped by the disease period (ie, prediagnosis, diagnosis/preintervention, intervention, follow-up, and mixed) and psychosocial factors. Most articles (n = 73) focused on women undergoing intervention. Articles focusing on the preintervention period was the next largest category (n = 14). Follow-up after intervention (n = 8) and samples of mixed disease periods (n = 7) were less common. One article focused on women before diagnosis. Articles focused on quality of life (QOL; n = 79), sexual function (n = 51), satisfaction (n = 16), body image (n = 13), psychological distress (n = 4), and knowledge (n = 3).

CONCLUSIONS

Research on the psychosocial experience of POP has largely focused on changes in QOL and sexual function. Future research should target emotional experience of women with POP; relationships among QOL, psychological distress, body image, and sexual function; and psychosocial factors related to treatment outcomes.

Quality of life following vaginal reconstructive versus obliterative surgery for treating advanced pelvic organ prolapse

INTRODUCTION AND HYPOTHESIS

Although colpocleisis is effective in selected women, the low-morbidity obliterative procedure for treating pelvic organ prolapse (POP) and its impact on postoperative quality of life (QOL) have rarely been studied. Our aim was to assess QOL in women after colpocleisis and compare it with that of women after reconstructive vaginal surgery.

METHODS

This retrospective cohort study included women (aged 35-85 years) with POP who underwent obliterative or reconstructive surgical correction during 2009-2015. Patients who met the inclusion criteria underwent telephone interviews that included the validated Prolapse QOL questionnaire (P-QOL Thai).

RESULTS

Of 295 potential participants, 197 (67%) completed the questionnaire: 93 (47%) with obliterative and 104 (53%) with reconstructive surgery. Most were Thai (95.4%), multiparous (87%), and sexually inactive (76%). Their histories included hysterectomy (12%), incontinence or prolapse surgery (11%), and POP stage 3/4 (77%). Patients undergoing obliterative surgery were significantly older than those undergoing a reconstructive procedure (69 vs 58 years, P < 0.05). The obliterative group had more children, less education, and more advanced POP. There were no significant differences in operative parameters or complications. The obliterative surgery group had a significantly shorter hospital stay: median 2 (range 1-17) days vs 3 (1-20) days (P = 0.016). P-QOL scale revealed significantly less postoperative impairment in the obliterative surgery group (1.75 vs 5.26, P = 0.023). There were no significant differences in other P-QOL domains.

CONCLUSIONS

Colpocleisis improves condition-specific QOL in selected patients with advanced POP and remains an option for this group. Surgeons should consider counseling elderly women with advanced POP about obliterative vaginal surgery.

Body Image, Regret, and Satisfaction 24 Weeks After Colpocleisis: A Multicenter Study

OBJECTIVE

To evaluate the impact of colpocleisis on body image, regret, satisfaction, and pelvic floor symptoms 24 weeks after surgery.

METHODS

This was a prospective multicenter study conducted through the Society of Gynecologic Surgeons' Fellows' Pelvic Research Network with 7 sites across the United States. Women undergoing colpocleisis were enrolled. Outcomes assessed at 24 weeks included body image, regret, satisfaction, and pelvic floor symptoms. The Pelvic Floor Impact Questionnaire, Pelvic Floor Distress Inventory, the modified Body Image Scale, the Decision Regret Scale, and the Satisfaction with Decision Scale were administered. A sample size of 88 subjects was calculated for a significant change in the Body Image Scale.

RESULTS

Ninety subjects were enrolled. Two did not undergo surgery, and 7 were deceased at the time of 24-week follow-up. Significant improvements in all pelvic floor symptoms were noted 6 weeks postoperatively, and 24-week data showed sustained improvement. In addition, mean and total body image scores showed lasting significant improvement when compared with preoperative scores (P < 0.001 and P < 0.001, respectively). Finally, patients continued to be satisfied with their decision to undergo surgery (mean [SD] 4.6, [0.6]) and had a very low level of regret regarding this decision (mean [SD], 1.5 [0.7]).

CONCLUSIONS

Colpocleisis is a highly effective surgical treatment option for pelvic organ prolapse with improvements in both pelvic floor symptoms and body image. Furthermore, high satisfaction and low regret seen 24 weeks after surgery provide reassurance that colpocleisis is an excellent option for appropriate patients.

Factors associated with recurrence after colpocleisis for pelvic organ prolapse in elderly women

INTRODUCTION

The aim of this study was to evaluate the factors associated with recurrence after colpocleisis for pelvic organ prolapse in elderly women.

METHODS

This was a retrospective cohort study of patients who underwent colpocleisis for stage 3 or 4 pelvic organ prolapse at a single tertiary center from January 2007 to December 2015.

RESULTS

A total of 107 patients who underwent colpocleisis were reviewed. Duration from prolapse occurrence to surgery was significantly longer (24.6 ± 22.8 years vs 8.0 ± 12.9 years, p = 0.021) in patients who had recurrence after colpocleisis than in those without recurrence.

CONCLUSION

Duration of prolapse was longer in patients with recurrence than in those who had a successful outcome.

Pelvic Symptoms, Body Image, and Regret after LeFort Colpocleisis: A Long-Term Follow-Up

STUDY OBJECTIVE

To evaluate the impact of LeFort colpocleisis on body image, regret, and pelvic floor symptoms long-term after surgery.

DESIGN

Retrospective study (Canadian Task Force classification II-2).

SETTING

Tertiary university-affiliated hospital.

PATIENTS

Between April 2011 and April 2015, 334 patients underwent LeFort colpocleisis.

INTERVENTION

LeFort colpocleisis.

MEASUREMENT AND MAIN RESULTS

Patient characteristics (e.g., age, body mass index, parity, blood loss, and length of operation), comorbidities, and complications were obtained from medical records. The Chinese version of the Pelvic Floor Distress Inventory Questionnaire (PFDI-20) was used to evaluate self-perceived quality of life. A modified body image scale was used to assess self-image. Regret was assessed by the following question: "Do you regret choosing to undergo colpocleisis for pelvic organ prolapse (yes or no)?" In total, 278 women responded and were considered for statistical evaluation. Of these women, 234 (84%) had at least 1 comorbid condition. After a median 3-year follow-up (range, 1.5-4.5), only 1 woman had experienced recurrent prolapse and required a second surgery. The mean and total body image scores improved significantly from preoperation (p < .001). Approximately 97% of the patients were satisfied with their decision to undergo surgery, and none of the patients regretted their decision. Pelvic symptoms improved significantly from baseline (i.e., preoperation) to follow-up according to the following measures: PFDI-20, 67.5 ± 23.1 versus 23.8 ± 15.0 (p < .001); Pelvic Organ Prolapse Distress Inventory-6, 33.2 ± 19.6 versus 11.4 ± 10.6 (p < .001); Colorectal-Anal Distress Inventory-8, 10.8 ± 10.3 versus 3.6 ± 5.3 (p < .001); and Urinary Distress Inventory-6, 23.5 ± 18.5 versus 8.8 ± 9.7 (p < .001).

CONCLUSIONS

LeFort colpocleisis is a highly effective surgical treatment option for pelvic organ prolapse that improves both pelvic floor symptoms and body image. The high satisfaction and low regret in the long term after surgery indicate that LeFort colpocleisis is an excellent option for appropriate patients.

Patient satisfaction and regret with decision differ between outcomes in the composite definition of success after reconstructive surgery

INTRODUCTION AND HYPOTHESIS

To evaluate patient satisfaction and regret with their decision for reconstructive surgery, and determine if they valued each item equally in the composite definition of success after making the decision for surgery.

METHODS

A list was created including all patients who underwent laparoscopic sacral colpopexy or laparoscopic uterosacrocolpopexy. Patients were placed in mutually exclusive outcome categories (retreatment, symptomatic failure, anatomic failure, and surgical success). Retreatment included any postoperative treatment for urinary incontinence, pelvic organ prolapse including pessary use, or surgery for mesh complications. The validated modified Decision Regret Scale (DRS) and the Satisfaction Decision Scale (SDS) questionnaires were administered by telephone. Higher DRS scores indicate greater regret and higher SDS scores indicate greater satisfaction with the decision for surgery.

RESULTS

Of 715 patients, 197 were successfully contacted by telephone following reconstructive surgery and surveyed as study participants. Composite surgical outcomes were available for 150. Information on the need for retreatment was available for all the study participants. Surgery was successful in 101 (67.3 %) of the study participants. Anatomic failure occurred in 14, symptomatic failure occurred in 10, and retreatment was required in 25 of the study participants. Overall, the study participants were more satisfied than regretful with their decision for reconstructive surgery. Regret and satisfaction with their decision differed between outcomes in the composite definition of success after reconstructive surgery.

CONCLUSIONS

Surgeons and patients should focus on retreatment rates during preoperative outcome discussions because retreatment will result in the least satisfaction and greatest regret with the decision for reconstructive surgery.

Long-term quality of life, satisfaction, pelvic floor symptoms and regret after colpocleisis

PURPOSE

The aim of this study is to present long-term results including patients' satisfaction, pelvic floor symptoms, regret and change in body image in a long-term follow-up after colpocleisis.

METHODS

All women who underwent colpocleisis between September 2001 and February 2014 were identified from the hospital operating lists. These women were contacted for a telephone survey up to 13 years after surgery and asked to complete a structured questionnaire to assess patients' satisfaction, Quality of Life (QoL) and pelvic floor symptoms.

RESULTS

A total of 44 women underwent colpocleisis during the period from September 2001 to February 2014. Mean age was 78 years (range 65-91) years. Mean follow-up time was 41 months (range 10-120). Twenty women could be reached for the survey and were included in the analysis. 15 (75 %) reported a positive impact on QoL, 2 (10 %) a negative because of urinary problems, 2 (10 %) could not report any change in the QoL and 1 (5 %) could not answer this question. There was no recurrence of prolapse. The majority of patients (90 %) would undergo the same surgery again and no patient regretted the loss of her vaginal sexual function.

CONCLUSIONS

Colpocleisis seems to be an effective treatment for pelvic organ prolapse. In the long term, impact on quality of life is positive, whilst urinary tract symptoms seem to be the most bothersome factor.

Total colpocleisis: technical considerations

INTRODUCTION

We present a video describing the technical considerations for performing a total colpocleisis in the management of symptomatic post-hysterectomy pelvic organ prolapse.

METHODS

A 76-year old female presented with pelvic pressure and the presence of a palpable vaginal bulge. She had significant bother and had previously failed use of a pessary. She wasnot sexually active, with no plans for future sexual activity. Her medical history was significant for coronary artery disease with prior myocardial infarction. She had high-grade vaginal vault prolapse, without occult incontinence. After discussing observation, pessaries, restorative and obliterative procedures, she elected to undergo colpocleisis. Following hydrodissection with lidocaine with epinephrine, a quadrant-based dissection was performed to remove the vaginal epithelium circumferentially. Following this, serial purse string sutures were used to reduce the prolapse, with meticulous hemostasis. The vaginal epithelium was then closed transversely. Next, a perineorrhaphy was performed. The midline was plicated and the perineal body reconstructed.

RESULTS

The patient had an uncomplicated postoperative course. At six-week follow-up she had no evidence of recurrent prolapse and was voiding without difficulty.

CONCLUSIONS

Colpocleisis can provide excellent anatomic and subjective outcomes. Our goal is to highlight pertinent technical considerations in order to optimize patient outcomes.

Perioperative adverse events associated with colpocleisis for uterovaginal and posthysterectomy vaginal vault prolapse

BACKGROUND

Colpocleisis, a vaginal obliterative procedure, offers women with symptomatic pelvic organ prolapse an effective, durable anatomic repair and is associated with high patient satisfaction rates. Historically, colpocleisis was reserved for the medically frail or elderly with the goal of limiting anesthetic exposure, decreasing operative time, and minimizing adverse events. Several colpocleisis and colpectomy procedures exist and limited evaluation has been performed comparing these differences in regards to perioperative adverse events.

OBJECTIVE

The primary objective was to describe the overall rate of perioperative adverse events in patients undergoing colpocleisis. The secondary objective was to compare rates of adverse events between different colpocleisis procedures.

STUDY DESIGN

This is a retrospective chart review of patients who underwent colpocleisis at a tertiary care center from January 2003 through December 2013. Subjects were identified by their Current Procedural Terminology (CPT) codes and categorized into 3 groups: (1) partial or complete vaginectomy/colpectomy (CPT 57106, 57110); (2) vaginal hysterectomy with total or partial colpectomy (CPT 58275, 58280); and (3) Le Fort colpocleisis (CPT 57120). Baseline demographics, perioperative data, and postoperative data were collected. Analysis of variance was used to describe perioperative and postoperative adverse events in all subjects and to compare outcomes among the 3 groups.

RESULTS

In all, 245 subjects underwent colpocleisis during the study period. Mean age and body mass index were 78 (±7) years and 27.7 (±5.8) kg/m(2), respectively; 59.1% (140/245) of subjects had stage-4 prolapse. The most common adverse event was urinary tract infection occurring in 34.7% of subjects. Major adverse events were uncommon. There were no differences in event rates among the groups except for the following: patients undergoing concurrent vaginal hysterectomy had longer mean operative time (144 vs 108 vs 111 minutes, P = .0001), had higher estimated blood loss (253 vs 135 vs 146 mL, P = .0001), and were more likely to experience postoperative venous thromboembolism (4.6% vs 0% vs 0%, P = .01). After controlling for age, body mass index, medical comorbidities, estimated blood loss, and operative time, the risk of venous thromboembolism was no longer significant.

CONCLUSION

The overall rate of major perioperative and postoperative adverse events in women undergoing colpocleisis is low; however, concomitant hysterectomy is associated with longer operative times and higher blood loss.

Extent and Predictors of Decision Regret about Health Care Decisions: A Systematic Review

BACKGROUND

People often face difficult decisions about their health and may later regret the choice that they made. However, little is known about the extent of decision regret in health care or its predictors. We systematically reviewed evidence about the extent of decision regret and its risk factors among individuals making health decisions.

METHODS

The data sources were Medline, Embase, and reverse citation searches in Google Scholar and Web of Science. Studies using the Decision Regret Scale (DRS) to measure decision regret among individuals making nonhypothetical health decisions were included. There were no restrictions on study design, setting, or language. We extracted characteristics of included studies, measures of central tendency for DRS scores (0 = no regret, 100 = high regret), and all risk factors from published analyses. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. A narrative synthesis was performed owing to the heterogeneity of studies.

RESULTS

The initial search yielded 372 unique titles, and 59 studies were included. The overall mean DRS score across studies was 16.5, and the median of the mean scores was 14.3 (standard deviation range = 2.2-34.5) (n = 44 studies). The risk factors most frequently reported to be associated with decision regret in multivariate analyses included higher decisional conflict, lower satisfaction with the decision, adverse physical health outcomes, and greater anxiety levels.

CONCLUSIONS

The extent of decision regret as assessed with the DRS in nonhypothetical health decisions was often low but reached high levels for some decisions. Several risk factors related to the decision-making process significantly predicted decision regret. Additional research into the psychometrics of the DRS and the relevance of scores for clinicians and patients would increase the validity of decision regret as a patient-reported outcome.

Colpocleisis surgery in women over 80 years old with severe triple compartment pelvic organ prolapse

OBJECTIVE

To compare outcomes of Le Fort colpocleisis surgery, between women over 80 years old and younger women.

STUDY DESIGN

We searched the medical files for all consecutive women who underwent Le Fort colpocleisis as a primary or recurrent surgery for severe pelvic organ prolapse at our university-affiliated tertiary center between February 2007 and July 2013. Exclusion criteria for performance of the procedure were post-menopausal bleeding, pelvic malignancy, pelvic irradiation, and the desire to preserve coital function. The objective and subjective recurrence of prolapse, intraoperative and postoperative complications, and patient satisfaction were measured.

RESULTS

Forty-seven women underwent Le Fort colpocleisis. Of them, 23 were above 80 years, mean age 84.0±3.3, oldest: 91; and 24 were 80 years old and younger, mean age 70.8±6.1, youngest: 61. There were no intraoperative complications. Postoperative complications were recorded for 2 women with lower urinary tract infection and one woman had longer hospitalization time for warfarin treatment adjustment (9 days). Objective cure rates were 82.7% (19/23) and 83.3% (20/24), p=0.32, for women over 80, and women aged 80 and younger, respectively. The subjective cure rate was 86.7% (20/23) and 91.6% (22/24), respectively, p=0.28.

CONCLUSIONS

Objective and subjective cure rates of Le Fort colpocleisis in women over age 80 years were similar to those for younger women. The complications were mild and few, and unrelated to age. This procedure may be offered for women over 80 years old with severe symptomatic pelvic organ prolapse and medical comorbidities.

Apical prolapse repair: weighing the risks and benefits

PURPOSE OF REVIEW

This article reviews the current literature regarding surgical repair of vaginal apical prolapse and discusses the risks and benefits of various surgical approaches.

RECENT FINDINGS

Vaginal uterosacral ligament suspension has similar anatomic and subjective outcomes to sacrospinous ligament fixation at 1 year. Native tissue vaginal repairs offer decreased morbidity compared with mesh-augmented sacrocolpopexy; however, sacrocolpopexy has greater anatomic success. Minimally invasive sacrocolpopexy appears to be equivalent to open abdominal sacrocolpopexy. Native tissue repairs and transvaginal mesh kits support the vaginal apex with similar results; however, long-term follow-up is needed. Robotic and laparoscopic sacrocolpopexy are equally effective in restoring the vaginal apex.

SUMMARY

Surgical restoration of the vaginal apex can be accomplished via a variety of approaches and techniques. When deciding on the proper surgical intervention, the surgeon must carefully calculate the risks and benefits of each procedure while incorporating the patient's individual medical and surgical risk factors. Lastly, a discussion regarding the patient's overall goals of care is paramount to the decision-making process.

Risk factors for 30-day perioperative complications after Le Fort colpocleisis

PURPOSE

We identified rates of and risk factors for complications after colpocleisis using the American College of Surgeons NSQIP® database.

MATERIALS AND METHODS

Women treated with Le Fort colpocleisis from 2005 to 2011 were identified in the database. Primary outcomes were 30-day complication rates. Secondary outcomes were risk factors for complications and the impact of age and a concomitant sling on morbidity. Clinical and procedural characteristics were compared using the chi-square test and 1-way ANOVA.

RESULTS

We identified 283 women, of whom 23 (8.1%) experienced complications. The most common complication was urinary tract infection in 18 women (6.4%). There was 1 death for a 0.4% mortality rate. Increased complications were associated with age less than 75 years (p = 0.03), chronic obstructive pulmonary disease (p = 0.03), hemiplegia (p = 0.03), disseminated cancer (p = 0.03) and open wound infection (p = 0.02). Six patients (2.1%) required return to the operating room within 30 days. Complication rates did not differ based on operative time (p = 0.78), inpatient status (p = 0.24), resident involvement (p = 0.35), concomitant sling placement (p = 0.81) or anesthesia type (p = 0.27). Women undergoing colpocleisis without (191) and with (92) a sling had similar baseline characteristics. Colpocleisis without and with a sling had similar rates of complications (7.9% vs 8.7%, p = 0.81), urinary tract infection (5.8% vs 7.6%, p = 0.55), return to the operating room (2.1% vs 2.2%, p = 0.97) and mortality (0% vs 1.1%, p = 0.15).

CONCLUSIONS

Mortality and complication rates after colpocleisis are low with urinary tract infection being the most common postoperative complication. Concomitant sling placement does not increase 30-day complication rates.

Long-term follow-up after colpocleisis: regret, bowel, and bladder function

INTRODUCTION AND HYPOTHESIS

Colpocleisis is not a popular option amongst surgeons, possibly due to concern about long-term regret. This study assessed a cohort of women who underwent colpocleisis 2-5 years previously to determine the regret rate, the effect on quality of life (QOL) and bladder and bowel function.

METHODS

This was a longitudinal study of patients who underwent colpocleisis at least 2 years previously. Participants were asked to complete the Prolapse QOL (P-QOL), International Consultation on Incontinence-Urinary Incontinence (ICIQ-UI Short Form) and Colorectal Anal Distress Inventory questionnaires (CRADI). Two additional 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.)

RESULTS

Thirty-four women were identified. Six had died by the time of follow-up, and five declined to answer the questionnaires because of ill health. Twenty-three women responded (67 %). Mean age was 78.68 years. One woman regretted having had the surgery, as the colpocleisis had failed. Twenty-one women (91.3 %) would recommend this surgery; one would not (4.3 %), and another was not sure (4.5 %). Low P-QOL [8 (0-37) ± 9.41), ICIQ-UI (7 (0-17) ± 5.44) and CRADI (10; 0-28 ± 8.13] scores suggest a positive impact on QOL, bladder and bowel function.

CONCLUSION

In this cohort, colpocleisis produced a good outcome with low regret rate (4.3 %), good QOL and minimal effect on bladder and bowel function at 2-5 years.

Clinical challenges in the management of vaginal prolapse

Pelvic organ prolapse is highly prevalent, and negatively affects a woman’s quality of life. Women with bothersome prolapse may be offered pessary management or may choose to undergo corrective surgery. In choosing the most appropriate surgical procedure, there are many factors to consider. These may include the location(s) of anatomic defects, the severity of prolapse symptoms, the activity level of the woman, and concerns regarding the durability of the repair. In many instances, women and their surgeons are challenged to weigh the risks and benefits of native tissue versus mesh-augmented repairs. Though mesh-augmented repairs may offer better durability, they are also associated with unique complications, such as mesh erosion. Furthermore, newer surgical techniques of mesh placement via abdominal or vaginal routes may result in different outcomes compared to traditional techniques. Biologic grafts may also be considered to improve durability of a surgical repair, while avoiding potential complications of synthetic mesh. In this article, we review many of the clinical challenges that gynecologic surgeons face in the surgical management of vaginal prolapse. Furthermore, we review data that can help guide decision making when treating women with pelvic organ prolapse.