Obliterative Repair for Pelvic Organ Prolapse: Retrospective Cohort Comparing Three Techniques

Obliterative surgery is a well-established treatment for advanced pelvic organ prolapse (POP) in women who no longer desire vaginal intercourse. Comparative data between techniques remain limited; this study evaluated outcomes of three obliterative procedures in a tertiary centre.

This retrospective cohort included all women undergoing obliterative POP surgery between 2012 and 2024. Procedures were colpocleisis (vault), colpocleisis with vaginal hysterectomy, and Le Fort colpocleisis. Primary outcomes were objective cure (maintenance of vaginal closure without prolapse beyond the hymen), and subjective cure (absence of bulge symptoms). Secondary outcomes included length of hospitalization, recurrence, postoperative complications, and de novo or worsening urgency urinary incontinence. Group comparisons used ANOVA and chi-square tests (p < 0.05).

A total of 144 women were analysed (median age 76 years); 98% presented with Pelvic Organ Prolapse Quantification (POP-Q) stage III-IV. Colpocleisis (vault) was performed in 35%, colpocleisis with hysterectomy in 42%, and Le Fort in 23%. Objective cure rates were 92%, 89%, and 85% (p = 0.58), while subjective cure was achieved in 94%, 92%, and 91% (p = 0.70). Hospitalization was longer after colpocleisis with hysterectomy (p = 0.0016). Recurrence (6-12%, p = 0.61) and postoperative complications (0-7%, p = 0.38) were similarly low across groups.

All three obliterative techniques demonstrated excellent anatomical and symptomatic success with minimal morbidity. Differences were limited to length of hospitalization. These findings reinforce obliterative surgery as a simple, safe, and durable option for women with advanced POP who do not wish to preserve vaginal sexual function.