COLPOCLEISIS - AN EFFECTIVE TREATMENT FOR ADVANCED GENITAL PROLAPSE

Babatunde Awolaja, Sara Nausheen

Macclesfield District General Hospital (MDGH), Macclesfield, United Kingdom

Colpocleisis is a minimally invasive surgical procedure suitable for advanced genital prolapse in the elderly and frail with good success rate.

OBJECTIVES: To assess the efficacy, complication rate, and evaluate compliance with BSUG (British Society of Urogynaecology) recommendations in terms of database entry and follow up.

DESIGN: A retrospective audit carried out at the gynaecology department at MDGH over a 5-year period (2017-2022).

METHOD: All women who underwent colpocleisis were included and data analysed from notes, electronic records and BSUG database

RESULTS: A total of n=16 women were included, with the mean age 79 years. Twelve women 12/16 had stage 4 vault prolapse, 3 had procidentia and 1 had stage 3 prolapse. Most of the women n=14/16 had co-morbidities. As for their presentation, 7/16 women had associated urinary symptoms, commonly urinary incontinence 5/16.

There was no intraoperative complication recorded, none of the patients was returned to theatre within the first 72 hours or readmitted within 30 days for procedure related events, and there was no long-term problem identified at follow-up.

A total of 5/16 women returned to hospital for procedure related events, majority 4/5 were for elective trial without a catheter  and one was an emergency attendance for infection.

All the women completed the pre and post operative symptom questionnaires, and more than 90% of the patients were followed up face to face within 6 months and one had a virtual follow-up.

A total of 12/16 women felt very much better in terms of their global impression of prolapse symptoms and 3/16 felt better and only one lady had a recurrence of the prolapse. Twelve women had BSUG database entry giving a compliance rate of 75%.

CONCLUSION: Our audit demonstrates the success of 93.8% in line with the reported literature and also its safety with no surgical complications and minimal post operative morbidity. Our BSUG data recording could be further improved.

Due to increase in ageing population in the UK, there is a need to impart knowledge and skill to ATSM (advanced training skills module) urogynaecology trainees to perform this relatively simple surgery in suitable women with advanced genital prolapse. Although the numbers of procedures may not be many, we recommend that this procedure can be safely undertaken in the district general hospitals and not necessarily  confined to tertiary centres.