Research Fellow INOVA Health System, Urogynecology Division Falls church, Virginia, United States
Objectives: Colpocleisis provides efficient treatment for women with severe pelvic organ prolapse (POP) who do not desire to have sexual intercourse. Presently, there are no established methods for predicting new-onset postoperative urinary incontinence will occur after pelvic reconstruction. However, several women with severe POP additionally have urinary retention, so the surgeon is always balancing the risk that a patient will experience stress incontinence after colpocleisis, with the risk that any concomitant incontinence surgery might deteriorate urinary retention. This study aimed to evaluate complications of concomitant incontinence surgery with colpocleisis including its effect on postoperative voiding, bladder and urethral injury and new onset SUI.
Methods: We performed a retrospective chart review of all women who underwent colpocleisis with and without incontinence surgery. We reviewed Baseline demographics, urodynamic parameters, perioperative data, and postoperative data.
Results: A total of 167 patients were included in this study. The average age of the patients was 70.25 ± 7.86 (years). Ant stage (3.11 ± 0.69), post stage (2.57 ± 0.91), apical stage (2.99 ± 0.91). Preoperatively, 53 (31.7%) complained of stress urinary incontinence (SUI) symptoms, and an additional 33 (19%) were diagnosed with occult SUI and 32( 19%). Forty-seven (29.1%) patients underwent concurrent incontinence surgery. Concomitant sling placement resulted in voiding dysfunction in 2 patients, bladder and urethral injury in one patient and erosion of mesh in 1 patient. When complications of colpocleisis concomitant SUI versus colpocleisis were evaluated, no significant differences were found (p = 0.1).
Conclusions: Colpocleisis with concomitant incontinence surgery, in selective patients who have SUI symptoms and or urodynamic findings suggestive of SUI, alleviates urinary symptoms with minimal risk of peri and postoperative complication. This combined approach may be suggested to elderly women with SUI who are undergoing colpocleisis regardless of preoperative PVR.
