Urinary outcomes following colpocleisis without concomitant anti-incontinence procedure: A retrospective...

Pelvic organ prolapses (POP), a common condition among elderly women, frequently coexists with urinary incontinence (UI). Although concomitant anti-incontinence procedures during POP surgery might reduce postoperative SUI, they also increase the risk of urinary retention, voiding dysfunction and long-term mesh complications. This study aims to evaluate the urinary outcomes in women with advanced POP who underwent colpocleisis alone, without anti-incontinence surgery.

This retrospective cohort study included all the consecutive patients who underwent colpocleisis between 2016 and 2023. Patients with concomitant anti-incontinence surgery or inability to follow up were excluded. Preoperative evaluation included demographics, medical history, pelvic ultrasound, POP quantification (POP-Q) staging, and ICIQ-UI-SF questionnaires. Total or partial colpocleisis was performed, and patients were reassessed using POP-Q and ICIQ-UI-SF, postoperatively.

A total of 90 patients were included in the analysis. The mean age was 69.2 ± 7.4 years and body mass index (BMI) 24.6 ± 3.5 kg/m². Parity ranged from 1 to 13. Advanced POP predominated (Stage III: 44.4%, Stage IV: 54.4%). Major complications occurred in four patients. Generally, preoperative and postoperative distribution of urinary incontinence varied significantly (P-value = 0.012). Postoperatively, 83.7% of preoperative SUI cases resolved, and de novo SUI developed in two patients (4.4%). Patients with persistent or de novo urge urinary incontinence after surgery reported improvement in postoperative symptoms with lifestyle modifications, bladder training, or medication.

Colpocleisis is a safe and effective surgical option for POP that is also able to significantly improve urinary incontinence when performed without a concomitant anti-incontinence procedure. The low incidence of new-onset urinary incontinence after surgery supports a staged rather than concomitant approach for prolapse and anti-incontinence procedures. Counseling patients regarding the potential persistence or development of urinary symptoms is essential. Based on these findings, preoperative urodynamic testing might not be necessary for many elderly patients. Further comparative studies are required to confirm these findings and refine the patient selection criteria.