UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

VAGINAL OBLITERATIVE PROCEDURES

Serdar Aykut

Mardin Training and Research Hospital, Department of Gynecology and Obstetrics, Mardin, Türkiye

Aykut S. Vaginal Obliterative Procedures. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.261-268.

ABSTRACT

Pelvic organ prolapse (POP) is one of the leading causes of urogynecological morbidity in women, with a markedly increased incidence particularly in the postmenopausal period. Its prevalence has been reported to reach 30–50% with advancing age, resulting in significant negative effects on quality of life. The etiology is multifactorial; advanced age, obesity, connective tissue weakness, history of vaginal delivery, multiparity, and conditions associated with chronic increases in intra-abdominal pressure (e.g., chronic cough, constipation) are considered major predisposing factors. Both conservative and surgical treatment options are available for POP; however, surgical intervention is usually preferred in advanced-stage cases. The choice of surgical procedure depends on several factors, including the patient’s age, systemic comorbidities, life expectancy, functional capacity, and, most importantly, sexual activity status. In this context, vaginal obliterative procedures represent a reliable and effective treatment modality, particularly in elderly, non–sexually active women with high comorbidity burdens. Obliterative surgeries are irreversible procedures based on partial or complete closure of the vaginal canal. The most frequently performed techniques are LeFort partial colpocleisis and posterior (total) colpocleisis, both of which are characterized by high anatomical and functional success rates, low surgical morbidity, minimal blood loss, short operative time, and rapid postoperative recovery. Moreover, because of their low mortality rates, these procedures can also be safely performed in elderly patients with elevated anesthetic risk and significant comorbidities. Although the permanent obliteration of the vaginal canal renders future sexual activity impossible—a major limitation—numerous studies have demonstrated that, with appropriate patient selection and indications, symptoms improve significantly, quality of life is substantially enhanced, and patient satisfaction remains high. Therefore, obliterative procedures are regarded as an effective and reliable surgical option in the management of POP, particularly among women who have completed their sexual life or have no future expectations of sexual activity.

Keywords: Pelvic organ prolapse; Colpocleisis; Urogenital surgical procedures

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