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Surgical Procedures for Pelvic Organ Prolapse
Obliterative Surgery correcting POP.
One recent prospective study of carefully selected women
Obliterative surgery, such as total colpocleisis or the LeFort partial colpocleisis, with stage III or IV POP who received obliterative vaginal surgery
corrects POP by reducing the pelvic viscera back into the pelvis and closing off demonstrated a significant improvement in health-related quality of life
the vaginal canal either in part or in whole.
Obliterative procedures are less without an alteration in body image.
Since one of the major reasons to
commonly performed in Europe, Asia, and Australia compared with the US, perform obliterative surgeries is to avoid peri-operative complications, it is
and are usually reserved for women who have concomitant medical issues important to understand the risks of obliterative surgery in elderly women. In
and do not plan to be sexually active after surgery. Obliterative procedures are women over 75 years of age who received a full range of surgeries, including
increasing in popularity due to women living into the eighth and ninth colpocleisis, most complications included cystitis, blood transfusion, and
decades of life. The purported advantages of obliterative surgery are cardiovascular or respiratory comorbidities.
decreased operative time, decreased peri-operative morbidity, and an appears to contribute to the increased need for transfusion.
De novo rectal
extremely low prolapse recurrence risk. A recent systematic review of prolapse is another potential risk and patients undergoing obliterative surgery
colpocleisis noted that colpocleisis appears to be nearly 100% effective for should be warned about possible future development of this disorder.
1. Brown JS, Waetjen LE, Subak LL, Thom DH, et al., Pelvic organ suspensions: Analysis of complications using permanent mesh, Am functional outcome of vaginal paravaginal repair in the correction
prolapse surgery in the United States, 1997, Am J Obstet Gynecol, J Obstet Gynecol, 2005;193(6):2094–8. of anterior vaginal wall prolapse, Int Urogynecol J Pelvic Floor
2002;186(4):712–16. 18. Brizzolara S, Pillai, Allen A, Risk of mesh erosion with sacral Dysfunct, 2001;12(2):83–8.
2. Subak LL, Waetjen LE, van den Eeden S, et al., Cost of pelvic colpopexy and concurrent hysterectomy, Obstet Gynecol, 36. Young SB, Daman JJ, Bony LG, Vaginal paravaginal repair: One-
organ prolapse surgery in the United States, Obstet Gynecol, 2003;102(2):306–10. year outcomes, Am J Obstet Gynecol, 2001;185(6):1360–66.
2001;98(4):646–51. 19. Wu JM, Wells EC, Hundley AF, et al., Mesh erosion in abdominal 37. Kahn MA, Posterior colporrhaphy: Its effects on bowel and sexual
3. Kesharvarz H, Hillis SD, Kieke BA, Marchbank PA, Hysterectomy sacral colpopexy with and without concomitant hysterectomy, Am function, Br J Obstet Gynaecol, 1997;104:82–6.
surveillance—United States 1994–1999, MMWR, J Obstet Gynecol, 2006;194(5):1418–22. 38. Abramov Y, Gandhi S, Goldberg RP, et al., Site-specific rectocele
2002;51(SS05):1–8. 20. Nygaard IE, McCreery R, Brubaker L, et al., Abdominal repair compared with standard posterior colporrhaphy, Obstet
4. Wu JM, Wechter ME, Geller EJ, et al., Hysterectomy rates in the sacrocolpopexy: A comprehensive review, Obstet Gynecol, Gynecol, 2005;105(2):314–18.
United States, 2003, Obstet Gynecol, 2007;110(5):1091–5. 2004;104(4):805–23. 39. Cundiff GW, Fenner D, Evaluation and treatment of women with
5. Boyles SH, Weber AM, Meyn L, Procedures for pelvic organ 21. Krause HG, Goh JT, Sloane K, et al., Laparoscopic sacral suture rectocele: Focus on associated defecatory and sexual dysfunction,
prolapse in the United States, 1979–1997, Am J Obstet Gynecol, hysteropexy for uterine prolapse, Int Urogynecol J Pelvic Floor Obstet Gynecol, 2004;104(6):1403–21.
2003;188(1):108–15. Dysfunct, 2006;17(4):378–81. 40. Mellgren A, Anzen B, Nilsson BY, et al., Results of rectocele repair.
6. Olsen AL, Smith VJ, Bergstrom JO, et al., Epidemiology of surgically 22. Maher CF, Carey MP, Murray CJ, Laparoscopic suture hysteropexy A prospective study, Dis Col Rect, 1995;38(1):7–13.
managed pelvic organ prolapse and urinary incontinence, Obstet for uterine prolapse, Obstet Gynecol, 2001;97(6):1010–14. 41. Paraiso MFR, Barber MD, Muir TW, Walters MD, Rectocele repair: A
Gynecol, 1997;89(4):501–6. 23. Van Brummen HJ, Van de Pol G, Aalders CI, et al., Sacrospinous randomized trial of three surgical techniques including graft
7. Maher C, Baessler K, Glazener CM, et al., Surgical management of hysteropexy compared to vaginal hysterectomy as primary surgical augmentation, Am J Obstet Gynecol, 2006;195(6):1762–71.
pelvic organ prolapse in women: A short version Cochrane review, treatment for a descensus uteri: Effects on urinary symptoms, Int 42. Sung VW, Rogers RG, Schaffer JI, et al., Graft use in transvaginal
Neurourol Urodyn, 2008;27(1):3–12. Urogynecol J Pelvic Floor Dysfunct, 2003;14(5):350–55, discussion pelvic organ prolapse repair: A systematic review, Obstet Gynecol,
8. Colombo M, Maggioni A, Scalambrino S, et al., Surgery for 355. 2008;112(5):1131–42.
genitourinary prolapse and stress incontinence: A randomized trial 24. Miyazaki FS, Miya hook ligature carrier for sacrospinous ligament 43. Hiltunen R, Nieminen K, Takala T, et al., Low-weight polypropylene
of posterior pubourethral ligament plication and Pereyra suspension, Obstet Gynecol, 1987;70(2):286–8. mesh for anterior vaginal wall prolapse: A randomized controlled
suspension, Am J Obstet Gynecol, 1997;176(2):337–43. 25. Inmon WB, Pelvic relaxation and repair including prolapse of trial, Obstet Gynecol, 2007;110(2 Pt 2):455–62.
9. Colombo M, Vitobello D, Proietti F, Milani R, Randomised vagina following hysterectomy, South Med J, 1963;56:577–82. 44. Diwadkar GB, Barber MB, Feiner B, et al., Complication and
comparison of Burch colposuspension versus anterior 26. Shull BL, Bachofen C, Coates KW, Kuehl TJ, A transvaginal reoperation rates following surgical repair for apical vaginal
colporrhaphy in women with stress urinary incontinence and approach to repair of apical and other associated sites of pelvic prolapse: A meta-analysis, Obstet Gynecol, 2008; in press.
anterior vaginal wall prolapse, BJOG, 2000;107(4):544–51. organ prolapse with uterosacral ligaments, Am J Obstet Gynecol, 45. FDA public health notification: Serious complications associated
10. Lo TS, Wang AC, Abdominal colposacropexy and sacrospinous 2000;183(6):1365–73. with transvaginal placement of surgical mesh in repair of pelvic
ligament suspension for severe uterovaginal prolapse; A 27. Colombo M, Milani R, Sacrospinous ligament fixation and organ prolapse and stress urinary incontinence.
comparison, J Gynecol Surg, 1998;14(2):59–64. modified McCall culdoplasty during vaginal hysterectomy for 46. Ridgeway B, Walters MD, R Paraiso MF, et al., Early experience
11. Hunskaar S, Burgio K, Clark A, et al., Epidemiology of urinary and advanced uterovaginal prolapse, Am J Obstet Gynecol, with mesh excision for adverse outcomes after transvaginal mesh
fecal incontinence and pelvic organ prolapse. In: Abrams P, 1998;179(1):13–20. placement using prolapse kits, Am J Obstet Gynecol, 2008 Oct 7.
Cordozo L, Koury S, Wein A (eds), 3rd International Consultation on 28. Silva WA, Pauls RN, Segal JL, et al., Uterosacral ligament vault 47. Denehy TR, Choe JY, Gregori CA, Breen JL, Modified le fort partial
Incontinence. 1st ed. Paris: Health Publication Ltd, 2005. suspension: Five-year outcomes, Obstet Gynecol, colpocleisis with Kelly urethral plication and posterior
12. Abrams P, Cardozo L, Fall M, Griffiths D, et al., The standardisation 2006;108(2):255–63. colpoperineoplasty in the medically compromised elderly: A
of terminology of lower urinary tract function: Report from the 29. Gustilo-Ashby AM, Jelovsek JE, Barber MD, et al., The incidence of comparison with vaginal hysterectomy, anterior colporrhaphy, and
standardisation sub-committee of the international continence ureteral obstruction and the value of intraoperative cystoscopy posterior colpoperineoplasty, Am J Obstet Gynecol,
society, Am J Obstet Gynecol, 2002;187(1):116–26. during vaginal surgery for pelvic organ prolapse, Am J Obstet 1995;173(6):1697–1701, discussion 1701–2.
13. Benson JT, Lucente V, McClellan E, Vaginal versus abdominal Gynecol, 2006;194(5):1478–85. 48. FitzGerald MP, Richter HE, Siddique S, et al., Ann Weber for the
reconstructive surgery for the treatment of pelvic support defects: 30. Macer GA, Transabdominal repair of cystocele, a 20 year Pelvic Floor Disorders Network. Colpocleisis: A review, Int
A prospective randomized study with long-term outcome experience, compared with the traditional vaginal approach, Am J Urogynecol J Pelvic Floor Dysfunct, 2006;17(3):261–71.
evaluation, Am J Obstet Gynecol, 1996;175(6):1418–21, Obstet Gynecol, 1978;131(2):203–7. 49. Barber MD, Amundsen CL, Paraiso MF, et al., Quality of life after
discussion 1421–2. 31. Walter S, Olesen KP, Hald T, Jensen HK, Pedersen PH, Urodynamic surgery for genital prolapse in elderly women: Obliterative and
14. Maher CF, Qatawneh AM, Dwyer PL, et al., Abdominal sacral evaluation after vaginal repair and colposuspension, BJU, reconstructive surgery, Int Urogynecol J Pelvic Floor Dysfunct,
colpopexy or vaginal sacrospinous colpopexy for vaginal vault 1982;54(4):377–80. 2007;18(7):799–806.
prolapse: A prospective randomized study, Am J Obstet Gynecol, 32. Weber AM, Walters MD, Piedmonte MR, Ballard LA, Anterior 50. Stepp KJ, Barber MD, Yoo EH, et al., Incidence of perioperative
2004;190(1):20–26. colporrhaphy: A randomized trial of three surgical techniques, complications of urogynecologic surgery in elderly women, Am J
15. Maher C, Baessler K, Glazener CM, et al., Surgical management of Obstet Gynecol, 2001;185(6):1299–1304. Obstet Gynecol, 2005;192(5):1630–36.
pelvic organ prolapse in women, Cochrane Database Syst Rev, 33. Sand PK, Koduri S, Lobel RW, et al., Prospective randomized trial 51. Von Pechmann WS, Mutone M, Fyffe J, Hale DS, Total colpocleisis
2004;(4):CD004014. of polyglactin 910 mesh to prevent recurrence of cystoceles and with high levator plication for the treatment of advanced pelvic
16. Paraiso MF, Walters MD, Rackley RR, et al., Laparoscopic and rectoceles, Am J Obstet Gynecol, 2001;184(7):1357–62. organ prolapse, Am J Obstet Gynecol, 2003;189(1):121–6.
abdominal sacral colpopexies: A comparative cohort study, Am J 34. White GR, An anatomic operation for the cure of cystocele, Am J 52. Collins SA, Jelovsek JE, Chen CC, et al., De novo rectal prolapse
Obstet Gynecol, 2005;192(5):1752–8. Obstet Dis Women Children, 1912;65:286–90. after obliterative and reconstructive vaginal surgery for urogenital
17. Bensinger G, Lind L, Lesser M, et al., Abdominal sacral 35. Mallipeddi PK, Steele AC, Kohli N, Karram MM, Anatomic and prolapse, Am J Obstet Gynecol, 2007;197(1):84e1-e3.
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