A Prospective Analysis of Total Colpocleisis for Severe Uterovaginal Prolapse
Drs. Ozgur H. Harmanli, M. H. T. Grody, Vani Dandolu, Ashwin Chatwani

OBJECTIVE: To assess the perioperative complications, and the anatomic and functional efficacy of total colpocleisis for severe uterovaginal prolapse.
MATERIALS AND METHODS : In this prospective descriptive study, we analyzed the perioperative complications and the efficacy of total colpocleisis for 41 consecutive women with severe pelvic prolapse who underwent this procedure at Temple University Hospital between November 1994 and June 2001.  All women underwent an objective assessment of site-specific defects using the Baden-Walker classification. Total vaginal obliteration was accomplished by total denudation of vaginal mucosa followed by row-by-row, front-to-back approximation of raw surfaces. The patients had the appropriate reconstructive procedure together with total colpocleisis. Vaginal hysterectomy was also performed in patients with a uterus. They were all followed by the same surgeon who performed the procedures. All of the patients were also contacted via telephone before submission of the study. 
RESULTS: Forty-one high-risk women with a mean age of 76.4 underwent total colpocleisis during the study period. The mean follow-up was 28.7 months (range 5-65 months).  Vaginal hysterectomy was performed in 12 patients.   All but 10 patients underwent concomitant modified paravaginal cystourethropexy. Modified perineorraphy was standard in every case. There were no perioperative complications. Cure rate for urinary incontinence was 53.1% in 32 patients with preoperative urinary incontinence. No recurrence of prolapse was noted.
CONCLUSION : Total colpocleisis combined with site-specific reconstructive surgery is a prudent and highly effective approach for high-risk elderly patients.