V2-10: SURGICAL TECHNIQUE: TOTAL COLPOCLEISIS
Total colpocleisis is an excellent treatment option utilizing native tissue for complete vault eversion in older women not interested in coital function. This video illustrates our surgical technique for total colpocleisis.
An 88 year-old female presented with pelvic organ prolapse (POP) after failing conservative management. She complained of concomitant storage and voiding lower urinary tract symptoms (LUTS), particularly stress urinary incontinence (SUI) with a pessary in place. Examination revealed complete procidentia and SUI with POP reduction. She elected to undergo total colpocleisis, and transobturator midurethral sling placement.
The procedure began by marking of four quadrants, from the apex to bladder neck, posterior and lateral vaginal walls. Lidocaine with epinephrine was used for hydrodissection and hemostasis. The vaginal epithelium was dissected and excised in each quadrant. Purse string sutures were placed sequentially at 2-3 cm from each other until the entire prolapse was reduced. Cystoscopy was performed to ensure patency of the ureters. The anti-incontinence procedure (not shown) was performed. The anterior vaginal wall was closed, followed by posterior vaginal wall closure including a tight perineorrhaphy.
On examination at 6 months, no recurrence of her prolapse was noted. Further, the patient reported that her SUI and LUTS had resolved. Colpocleisis remains an effective and minimally invasive option for women with severe POP who are not interested in maintaining sexual function.