Vaginal Obliterative Procedures for Pelvic Organ Prolapse: A Systematic Review.

IMPORTANCE: Pelvic organ prolapse is a common condition, the prevalence of which is likely to increase with the aging of our population. Also changing are parameters by which outcomes are assessed, shifting toward patient-centered care.

OBJECTIVE: To review vaginal obliterative procedures for surgical treatment of advanced pelvic organ prolapse historically and to discuss evidence on indications for colpocleisis, outcomes, and complications, as well as review pros and cons for concomitant vaginal hysterectomy and anti-incontinence procedures.

EVIDENCE ACQUISITION: Review predominantly of the English language literature on issues associated with obliterative vaginal surgery for advanced pelvic organ prolapse from LeFort's and Neugebauer's original description in the late 1800s to now.

RESULTS: LeFort and total colpocleisis are effective procedures for surgical treatment of advanced pelvic organ prolapse with relatively low complication rates. Patient satisfaction is high. Loss of coital function is rarely a reason for regret. Hysterectomy is not required in most patients with procidentia. Anti-incontinence procedures can be performed at time of colpocleisis for patients with coexisting stress incontinence. Evidence is conflicting with regard to occult stress urinary incontinence.

CONCLUSIONS AND RELEVANCE: Colpocleisis are valuable procedures for women with severe pelvic organ prolapse who do not wish to retain coital function. Results are maintained in women with recurrent prolapse after prior failed reconstructive surgery. Considering a patient's goals for surgery and comprehensive presurgical counseling are important determinants of patient satisfaction.

TARGET AUDIENCE: Obstetricians and gynecologists, family physicians.

LEARNING OBJECTIVES: After completing this activity, the learner should be better able to list indications and contraindications for vaginal obliterative procedures, discuss risks and benefits of sling placement at time of colpocleisis, list perioperative complications, and discuss perioperative workup for LeFort colpocleisis.