Frailty and pelvic organ prolapse: Colpocleisis with or without hysterectomy as a treatment modality in elderly patients

The rising prevalence of pelvic organ prolapse (POP) in the aging population underscores the need to reevaluate treatment options. This study examines obliterative procedures, specifically colpocleisis performed with (CH) and without (C) concomitant vaginal hysterectomy, as management strategies for frail, non-sexually active elderly patients with advanced prolapse. This retrospective study analyzed data from patients who underwent either colpocleisis with concomitant vaginal hysterectomy (CH) or colpocleisis alone (C) at our institution between 2006 and 2020. Data were extracted from medical records to compare perioperative and postoperative outcomes. In addition, Visual Analog Scale (VAS), and analgesic consumption during hospitalization were documented. A total of 120 patients were included, with 48 undergoing CH and 72 undergoing C. The mean age was 74.5 ± 6.3 years. Patients in the C group were significantly older than those in the CH group (76.65 ± 6 vs. 71.3 ± 5.3 years, respectively; p < 0.0001). Ischemic heart disease (IHD) was significantly more prevalent in the C group (54.2 %) compared to the CH group (16.7 %, p < 0.0001). Postoperative hospital stay was significantly shorter in the C group (3.4 ± 1.1 vs. 4.07 ± 2 days, respectively; p = 0.001). Perioperative complications were infrequent and not significantly different between the two groups. Pain VAS scores on postoperative day 1 were significantly higher in the CH group (5.0 ± 1.5 vs. 3.0 ± 1.2, p < 0.0001), as was total postoperative analgesic use (p < 0.0001). Both CH and C are well-tolerated for managing advanced POP in the elderly. However, the addition of vaginal hysterectomy is associated with increased pain, greater analgesic consumption, and longer hospital stay. These findings suggest that colpocleisis may be preferable for select frail elderly patients to minimize postoperative discomfort and recovery time.