ABSTRACT: Colpocleisis is an effective surgical treatment for advanced pelvic organ prolapse. The procedure has a high success rate (90%–100%) with low complication risks. A number of studies have shown that colpocleisis improves quality of life and pelvic floor symptoms in patients with advanced prolapse. However, this obliterative procedure alters normal female anatomy and is associated with future loss of vaginal intercourse.
Surgeons may be reluctant to offer colpocleisis due to concerns for patient regret or dissatisfaction secondary to the perception of impaired body image. The limited data available on its impact on body image, regret, or satisfaction are inconsistent and show wide variations. Moreover, many studies that evaluated colpocleisis did not use validated measures to assess regret or satisfaction.
The aim of this prospective multicenter study was to determine whether patients with pelvic organ prolapse undergoing colpocleisis have improved body image following surgery. The study was conducted through the Society of Gynecologic Surgeon’s Fellows’ Pelvic Research Network. Validated measures were used to document regret. All women enrolled in the study had elected colpocleisis for management of prolapse. Participants completed the following questionnaires preoperatively and 6 weeks postoperatively: the Pelvic Floor Distress Inventory, the Pelvic Floor Impact Questionnaire, and the modified Body Image Scale (BIS). At the 6-week postoperative visit, participants were also asked to complete the Decision Regret Scale and the Satisfaction with Decision Scale.
Evaluable data were available from 87 patients. Mean patient age was 79 (SD, 5.8) years with a mean body mass index of 27 (SD, 5.3) kg/m2. The majority (89.3%) was white; 90% had prolapsed stage 3 or less. Significant improvements occurred in all parameters at 6 weeks after surgery. Mean BIS scores were significantly decreased (from 4.8 to 1.2, P < 0.001), indicating improved body image. The number of subjects with BIS scores in the reference range doubled following surgery. Significant decreases were found in the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire scores (P < 0.001and P < 0.001), suggesting a positive impact on bowel and prolapse symptoms. The mean Decision Regret Scale score was low (1.32 [SD, 0.59]), which indicates very little regret; the mean score on the Satisfaction with Decision Scale–Pelvic Floor Dysfunction was 4.73 (SD, 0.62), suggesting high satisfaction.
Colpocleisis is an effective surgical option for the management of pelvic organ prolapse in elderly women and significantly improves perception of body image and associated pelvic floor symptoms while providing high satisfaction and low regret.
Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati (C.C.C., R.N.P.), and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus (N.M.B.), OH; Section of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Cleveland Clinic Florida, Westin, FL (A.L.S.); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Loyola University, Chicago, IL (J.A.C.); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Massachusetts Memorial Hospital, Worcester (V.M.), and Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge (S.R.A., A.C.), MA; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, NY (A.D.T.); and Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel (L.L.)