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

• Published in: International Urogynecology Journal Vol. 29; no. 8; pp. 1141 - 1146
• Main Authors: Petcharopas, Alin, Wongtra-ngan, Supreeya, Chinthakanan, Orawee
• Format: Journal Article
• Language: English
• Published: London Springer London 01.08.2018; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Child; Colpotomy - adverse effects; Colpotomy - methods; Female; Gynecologic Surgical Procedures - methods; Gynecologic Surgical Procedures - psychology; Gynecology; Health risk assessment; Humans; Hysterectomy, Vaginal - methods; Hysterectomy, Vaginal - psychology; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pelvic organ prolapse; Pelvic Organ Prolapse - psychology; Pelvic Organ Prolapse - surgery; Postoperative Complications; Pregnancy; Quality of Life; Reconstructive surgery; Retrospective Studies; Surgery; Treatment Outcome; Urology; Vagina - surgery; Colpocleisis; Pelvic organ prolapse; Obliterative vaginal surgery; Elderly; Quality of life
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-018-3559-9

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.