[Surgical techniques] Recurrence after colpocleisis for pelvic organ prolapse and practical solutions to prevent the same

Abstract

The number of patients with pelvic organ prolapse (POP) who are indicated to undergo colpocleisis has been increasing in recent years. Two problems are likely to occur after this procedure. One is POP recurrence of the residual vagina. The other is development of stress urinary incontinence (SUI). Here, I am detailing the surgical procedures to prevent these two complications based on the cause of these complications.

1.Cause and treatment of POP recurrence after colpocleisis:

The possible causes of postoperative POP recurrence are (1) insufficient removal of the vaginal mucosa, (2) incomplete treatment of enterocele (hernia sac) or overlooking its presence, (3) insufficient approximation of the antero-posterior vaginal submucosal tissues, and (4) incomplete treatment of widely opened genital hiatus or insufficient perineoplasty. The essential points of the operative techniques used to eliminate these causes and to prevent bulge recurrence of the residual vagina after colpocleisis are illustrated here with figures.

2.Cause and treatment of SUI development after colpocleisis:

It is conceivable that urethra is pulled down posteriorly as a result of approximation of the anterior and posterior vaginal walls, thus the posterior-urethrovesical angle (P-UV angle) becomes blunt. This blunting of the P-UV angle is thought to be a cause of SUI. Kelly plication of the bladder neck may be effective in making this angle accurate. High perineorrhaphy may help to prevent the posterior movement of the urethra caused by the vaginal closure.

These procedures are also shown with illustrations.