Comparison of Clinical Results of Lefort and Total Colpocleisis Operations Performed in Patients with Uterovaginal Pelvic Prolapse

Abstract

Purpose: The aim of this study is to compare the clinical results and operation success of Lefort and Total Colpocleisis surgeries performed in patients with stage 2 and above pelvic organ prolapse (POP). Materials and Methods: This retrospective cohort study included 40 patients who underwent Lefort and Total Colpocleisis surgeries in our clinic between 2015-2022. Demographic and clinical results were obtained from the hospital database. Data on the presence of relapse and de novo incontinence symptoms, postoperative complications, and their management were obtained from individual postoperative examinations of the patients. Results: The mean age at operation was 75.7±6.7. The mean parity of the patients was four, and all had a normal vaginal delivery. It was observed that 67.5% of the subjects had at least one comorbidity. The anatomic success rate of Total colpocleisis at one-year follow-up was 95.4%, and Lefort colpocleisis was 94.4%. The incidence of de novo stress urinary incontinence at one-year follow-up was 10%. The subjects were treated with mini-sling operations. Conclusion: Colpoclesis can be safely applied in the elderly and sexually inactive population due to its low perioperative complications and recurrence rates compared to reconstructive surgeries. It should be kept in mind that de novo incontinence may occur after colpoclesis surgery.

Keywords

• Lefort Colpocleisis
• colpocleisis
• pelvic organ prolapse
• urinary incontinence

Uterovaginal Pelvik Prolapsuslu Hastalarda Uygulanan Lefort ve Total Kolpokleisis Ameliyatlarının Klinik Sonuçlarının Karşılaştırılması

Öz

Amaç: Bu çalışmanın amacı evre 2 ve üzeri pelvik organ prolapsusu (POP) olan hastalarda uygulanan Lefort ve Total Kolpokleisis ameliyatlarının klinik sonuçları ve ameliyat başarısının karşılaştırılmasıdır. Gereç ve yöntem: Bu retrospektif kohort çalışmasına 2015-2022 yılları arasında kliniğimizde Lefort ve Total Kolpokleisis cerrahisi uygulanan 40 hasta dahil edildi. Demografik ve klinik sonuçlar hastane veri tabanından elde edildi. Nüks ve de novo inkontinans semptomlarının varlığı, postoperatif komplikasyonlar ve yönetimi ile ilgili veriler hastaların ameliyat sonrası bireysel muayenelerinden elde edildi. Bulgular: Ortalama operasyon yaşı 75,7±6,7 idi. Hastaların ortalama paritesi dörttü ve hepsi normal vajinal doğum yaptı. Olguların %67,5'inde en az bir ek hastalık olduğu görüldü. Bir yıllık takipte Total colpocleisis anatomik başarı oranı %95.4 ve Lefort colpocleisis %94.4 idi. Bir yıllık takipte de novo stres üriner inkontinans insidansı %10 idi. Hastalar mini-sling operasyonları ile tedavi edildi. Sonuç: Kolpoklesis, rekonstrüktif cerrahilere göre düşük perioperatif komplikasyonları ve nüks oranları nedeniyle yaşlı ve cinsel olarak aktif olmayan popülasyonda güvenle uygulanabilir. Kolpoklesis ameliyatından sonra de novo inkontinansın oluşabileceği akılda tutulmalıdır.

Anahtar Kelimeler

• Kolpokleizis
• pelvik organ prolapsus
• üriner inkontinans

Kaynakça

1. 1. Nawrot J, Humaj-Grysztar M, Gniadek A, et al. Quality of life of women with postmenopausal pelvic organ prolapse. Pielegniarstwo XXI wieku / Nursing in the 21st Century. 2017;16:17-23.
2. 2. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. The Journal of the American Medical Association. 2008;300:1311–16.
3. 3. Demirci N, Ataman H, Aba A, et al. Pelvik organ prolapsusu/üriner inkontinans ile ilişkili şikayetlerin kadınların cinsel fonksiyonuna etkisi. Zeynep Kamil Tıp Bülteni. 2013;44:58–64.
4. 4. Abbasy S, Kenton K. Obliterative procedures for pelvic organ prolapse. Clin Obstet Gynecol. 2010;53:86-98.
5. 5. Güner H, Güler İ. Transvaginal approaches to uterın and vault prolapse. Turkiye Klinikleri J Surg Med Sci. 2007;3:70-6.
6. 6. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. American Journal of Obstetrics and Gynecology. 2001;184:1496-1501.
7. 7. Güngör UF, Alper N, Ayyıldız EH, et al. Pelvik Organ Prolapsus Cerrahisinde Lefort Kolpokleizis-İstanbul Tıp Fakültesi Deneyimi. J Clin Obstet Gynecol. 2013;23:76-9.
8. 8. FitzGerald MP, Richter HE, Siddique S, et al. Ann Weber for the pelvic floor disorders network, colpocleisis: a review. Int Urogynecol J. 2006;17:261–71.

9. 9. Tinelli A, Malvasi A, Rahimi S, et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause. 2010;17:204-12.
10. 10. Sung VW, Weitzen S, Sokol ER, et al. Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol. 2006;194:1411-17.
11. 11. Fitzgerald MP, Richter HE, Bradley CS, et al. Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1603-09.
12. 12. Hullfish KL, Bovbjerg VE, Steers WD. Colpocleisis for pelvic organ prolapse: patient goals, quality of life, and satisfaction. Obstet Gynecol. 2007;110:341-45.
13. 13. Zebede S, Smith AL, Plowright LN, et al. Obliterative LeFort colpocleisis in a large group of elderly women. Obstet Gynecol. 2013;121:279-84.
14. 14. Krissi H, Aviram A, Eitan R, et al. Risk factors for recurrence after Le Fort colpocleisis for severe pelvic organ prolapse in elderly women. Int J Surg. 2015;20:75-9.
15. 15. Park JY, Han SJ, Kim JH, et al. Le Fort partial colpocleisis as an effective treatment option for advanced apical prolapse in elderly women, Taiwan. J Obstet Gynecol. 2019;58:206–11.
16. 16. Olsen A, Smith V, Bergstrom J, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–06.
17. 17. Hoskey KA, Shippey SH, Handa VL. Surgical repair of recurrent prolapse after LeFort colpocleisis. Int Urogynecol J. 2012;23:371-73.
18. 18. Barber MD, Amundsen CL, Paraiso MFR, et al. Quality of life after surgery for genital prolapse in elderly women: obliterative and reconstructive surgery. Int Urogynecol J. 2007;18:799–806.
19. 19. Jelovsek J, Barber MD. Advanced pelvic organ prolapse decreases body image and quality of life. Am J Obstet Gynecol. 2006;194:1455–61.
20. 20. Kohli N, Sze E, Karram M. Pyometra following Le Fort colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7:264-66.
21. 21. Abbasy S, Lowenstein L, Pham T, et al. Urinary retention is uncommon after colpocleisis with concomitant mid-urethral sling. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:213-16.