Outcome of obliterative versus reconstructive surgery for pelvic organ prolapse in women of advanced age − A propensity score analysis

Abstract

Objective

Le Fort colpocleisis and reconstructive pelvic organ prolapse (POP) surgery in women aged ≥ 75 were compared. Evaluated outcomes were objective POP cure and long-term complications.

Study Design

We retrospectively identified patients aged > 75 following POP surgery during 2008–2021. Data were retrieved from clinical files. Objective cure was defined as POP stage < 2. Propensity score (PS) matching was used to balance background variables for outcomes of interest.

Results

108 women were identified. The PS-matched cohort for objective cure included 65 women and resulted in comparable cure rates: 18 (78.3%) vs 27 (64.3%) women, respectively (p = 0.375). Survival analysis demonstrated decreased rate of objective failure following Le Fort colpocleisis (HR = 0.52, 95% CI of [0.2138, 1.309], p = 0.20).

In the initial cohort, obliterative surgery resulted in more postoperative constipation. A PS model matched for constipation included 55 women and resulted in a trend to more constipation following Le Fort colpocleisis: 9 (40.9%) women vs 4 (13.8%) women, respectively (p = 0.06, SMD = 0.639).

Conclusion

Reconstructive POP surgery and Le Fort colpocleisis are equally effective in women of advanced age. POP recurrence may appear earlier following reconstructive surgery. Obliterative surgery may be related to more postoperative constipation.