Factors associated with recurrence after colpocleisis for pelvic organ prolapse in elderly women

Accepted Manuscript Factors associated with recurrence after colpocleisis for pelvic organ prolapse in elderly women Moon Kyoung Cho, Jong Ho Moon, Chul Hong Kim PII:

S1743-9191(17)30580-0

DOI:

10.1016/j.ijsu.2017.06.086

Reference:

IJSU 3983

To appear in:

International Journal of Surgery

Received Date: 14 June 2017 Revised Date:

1743-9191 1743-9191

Accepted Date: 28 June 2017

Please cite this article as: Cho MK, Moon JH, Kim CH, Factors associated with recurrence after colpocleisis for pelvic organ prolapse in elderly women, International Journal of Surgery (2017), doi: 10.1016/j.ijsu.2017.06.086. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Factors associated with recurrence after colpocleisis for pelvic organ

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prolapse in elderly women

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Moon Kyoung Cho, M.D., Ph.D., Jong Ho Moon, M.D., Chul Hong Kim, M.D., Ph.D.

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Department of Obstetrics and Gynecology, Chonnam National University Medical School,

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Gwangju, Korea

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MK Cho: Manuscript writing/editing

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JH Moon: Manuscript writing/editing

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CH Kim: Project development, Data Collection, Manuscript editing

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*Corresponding author: Chul Hong Kim, M.D., Ph.D.

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Department of Obstetrics and Gynecology, Chonnam National University Medical School, 8

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Hakdong, Dong-gu, Gwangju, Republic of Korea

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E-mail: [email protected]

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Tel: +82-62-220-6227; Fax: +82-62-227-1637

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*Word count: Abstract 114 Manuscript 1,952

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*Conflicts of interest: None.

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ACCEPTED MANUSCRIPT Ethical Approval

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The study was approved by the Institutional Review Board of Human Research of Chonnam

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National University Hospital.

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ACCEPTED MANUSCRIPT 1

Factors associated with recurrence after colpocleisis for pelvic organ

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prolapse in elderly women

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Factors associated with recurrence after colpocleisis for pelvic organ

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prolapse in elderly women

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ABSTRACT

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Introduction: The aim of this study was to evaluate the factors associated with recurrence

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after colpocleisis for pelvic organ prolapse in elderly women.

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Methods: This was a retrospective cohort study of patients who underwent colpocleisis for

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stage 3 or 4 pelvic organ prolapse at a single tertiary center from January 2007 to December

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2015.

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Results: A total of 107 patients who underwent colpocleisis were reviewed. Duration from

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prolapse occurrence to surgery was significantly longer (24.6 ± 22.8 years vs 8.0 ± 12.9 years,

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p=0.021) in patients who had recurrence after colpocleisis than in those without recurrence.

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Conclusion: Duration of prolapse was longer in patients with recurrence than in those who

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had a successful outcome.

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Keywords: Colpocleisis; Recurrence; Pelvic organ prolapse

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Introduction Pelvic organ prolapse (POP) is downward descent of female pelvic organs, including the

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bladder, bowel, uterus, or post-hysterectomy vaginal cuff, resulting in protrusion of the

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vagina, uterus, or both [1]. Despite the lack of studies assessing the prevalence of POP,

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currently, it is known that the overall prevalence ranges from 3-50% [2]. As life expectancy

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increases, disorders associated with aging, including POP, are becoming more prevalent.

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Demand for care for POP is expected to increase by 35% between 2010 and 2030 [3].

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The management of POP includes non-surgical and surgical management. For severe POP,

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most pelvic surgeons prefer surgical treatment. The surgical management is classified as

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restorative surgery using the patient’s endogenous supportive tissue, compensatory surgery

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using synthetic or biological material, and obliterative surgery which closes the vagina [4].

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However, pelvic reconstructive surgery in elderly women can be associated with significant

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morbidity. Obliterative surgery, such as colpocleisis, is associated with less morbidity

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compared with reconstructive surgery [5]. For elderly patients with significant medical

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comorbidity who do not desire preservation of the vaginal anatomy for sexual function,

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obliterative surgery may be an appropriate choice [6]. Because most of the candidates for

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colpocleisis have a significant medical comorbidity, failure of surgery is stressful for both the

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patient and the surgeon. The purpose of this study was to evaluate the risk factors for

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recurrence after colpocleisis.

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Materials and methods In this retrospective cohort study, we reviewed the risk factors and outcomes of women with

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primary or recurrent POP who underwent colpocleisis at this Hospital from January 2007 to

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December 2015. Women with stage III or IV POP with a significant medical and surgical risk

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for reconstructive pelvic surgery were included. All women did not wish to preserve coital

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function. Women with post-menopausal bleeding, pelvic malignancy, or desire to preserve

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sexual function were excluded from the study.

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All of the patients underwent a complete preoperative evaluation that included history,

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physical examination, and urinalysis. All of the patients were examined vaginally in the

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supine position with a Sims speculum during a Valsalva maneuver, and the prolapse severity

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was measured with the Pelvic Organ Prolapse Quantification system (POP-Q, International

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Continence Society) [7]. Gynecologic transvaginal ultrasonography was performed to rule

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out uterine and adnexal diseases in all of the patients. A complete multichannel urodynamic

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study (UDS) was also performed after uterus reduction using ring forceps. The UDS included

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free uroflowmetry, filling cystometry with a stress test, voiding cystometry, and urethral

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pressure profilometry. The diagnosis of occult urodynamic stress incontinence was made if

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urinary leakage occurred during the POP reduction. Prior to surgery, all of the patients

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received vaginal estrogen therapy for at least 1 month. All patients complete the short form of

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the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire

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(PFIQ-7).

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Colpocleisis was performed in the following manner: Traction was placed on the cervix with

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a tenaculum. Areas to be denuded anteriorly and posteriorly were marked with a sterile

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marking pen. The rectangular piece of the anterior vaginal wall was extended from 2 cm

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proximal to the tip of the cervix to approximately 5 cm below the external urethral meatus.

ACCEPTED MANUSCRIPT Vaginal epithelium was infiltrated with vasopressin diluted with 0.9% saline (1:50). Sharp

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and blunt dissection was used to remove the vaginal epithelium. Sufficient vagina was left

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bilaterally to form canals for draining cervical secretions or blood. The cut edge of the

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anterior vaginal wall was sewn to the cut edge of the posterior vaginal wall with interrupted

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1.0 Vicryl sutures to gradually push the uterus and the vaginal apex inward. After the entire

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vagina had been inverted, the superior and inferior margins over the rectangle were sutured

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horizontally. Perineorrhaphy and distal levatorplasty were performed to increase posterior

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pelvic muscle support and to narrow the introitus. A concomitant midurethral sling operation,

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tension free vaginal tape–obturator (TVT-O; Gynecare, TVT-Obturator System, Ethicon, Inc.),

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was performed in women with known or occult urodynamic stress incontinence.

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All of the surgeries were performed by a single surgeon. All of the patients were

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administered first-generation cephalosporin intravenously 1 hour before surgery and they

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underwent a prophylactic antiseptic vaginal wash with iodine-containing soap before the

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surgery. The mode of anesthesia was dependent on the patient’s condition and preferences.

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Postoperative follow-up was scheduled at 1 and 3 months, and 1 year, and every 6 months

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thereafter. At each visit, all of the POP-Q points were measured by the same individual.

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Recurrence was defined as a POP-Q stage greater than II, on the basis of the most dependent

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point and whether it occurred at the primary site or at a new location.

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The procedure was approved by the Institutional Review Board and an informed consent was obtained.

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Statistical analysis was performed with SPSS 20.0 for Windows (SPSS, Inc., Chicago, IL).

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Student's t-test was used for comparison of quantitative variables between groups. Fisher’s

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exact test was used to compare qualitative variables. A p value of less than 0.05 was

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considered statistically significant.

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Results A total of 107 patients underwent colpocleisis. Mean age at operation was 75.5 ± 5.8 years

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(range, 60-90 years), mean body mass index was 23.6 ± 3.2 kg/m2, and mean follow-up

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duration was 7.2 ± 9.4 months (range, 1-51 months). Mean parity was 4.7 ± 1.7 (range, 1-10).

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Among these 107 patients, 91 (85.0%) women had at least one medical comorbidity. Also, 28

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(26.2%) women and 23 (21.5%) women had undergone previous hysterectomy and previous

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POP surgery, respectively. Mean duration from occurrence of POP to surgery was 9.1 years

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(range, 0-53 years). The clinical characteristics of women who underwent colpocleisis are

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shown in Table 1. Patient symptom and physical examination are presented in Table 2.

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All patients underwent perineorrhaphy and distal levatorplasty, and 9 (8.4%) patients

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underwent TVT-O for stress urinary incontinence. Mean operation time in 107 patients was

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57.7 ± 17.5 minutes (range, 35-185 minutes). Mean hospital stay was 6.3 ± 3.6 days (range,

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4-34 days), and mean postoperative hospital stay was 4.2 ± 2.7 days (range, 2-26 days). Mean

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length of time from operation to recurrence was 3.3 ± 2.9 months (range, 1-9 months).

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Postoperative 3 month and 6 month follow-up rates were 71.0% (76/107) and 43.0% (46/107),

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respectively. Seven women were recurred after colpocleisis; three women underwent

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colposacropexy, two underwent colpocleisis, and two patient follow-up without surgery.

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Comparison of operation outcome between the recurrent group and the successful group is

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presented in Table 3. There were no difference between the recurrent and successful groups in

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operation time, hospital stay, postoperative hospital stay, and accompanied TVT-O operation.

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Postoperative complications were not significantly different depending on recurrence.

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We evaluated the risk factors for recurrence after colpocleisis. In univariate analysis,

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duration from prolapse occurrence to surgery was significantly longer (24.6 ± 22.8 years vs

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8.0 ± 12.9 years, p=0.021) in patients who had recurrence after colpocleisis than in those with

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a successful outcome. Other parameters were not associated with recurrence (Table 4).

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ACCEPTED MANUSCRIPT Discussion

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Because of medical comorbidity and anesthetic risk, surgical management of POP in elderly

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women with poor functional status is burdensome. For this reason, colpocleisis may be an

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ideal surgical option in elderly patients with significant comorbidity. However, recurrence of

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prolapse after colpocleisis is very troublesome for both the patient and the surgeon. The

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purpose of this study was to evaluate the risk factors for recurrence after colpocleisis.

In this study, the success rate of colpocleisis was 93.5%. Results of previous reports

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assessing the success rate were similar to those in this study [8-12].

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comparable improvements in quality of life and postoperative patient satisfaction in women

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who underwent either reconstructive or obliterative surgery [8]. In a study of 87 patients, it

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was observed that colpocleisis improves body image and pelvic floor symptoms [9].

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Krissi et al. reported that the risk factors for recurrence after colpocleisis were greater

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postoperative total vaginal length and wider genital hiatus [12]. In this study, patients who

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were recurred showed greater postoperative total vaginal length and wider genital hiatus, but

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not statistically significant.

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Parameter that was significantly associated with recurrence was duration between POP

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occurrence and colpocleisis. Our result shows that women with recurrence had a longer (24.6

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± 22.8 years vs 8.0 ± 12.9 years) duration between POP occurrence and surgery than women

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with a successful outcome. In a study of 47 patients, there was no significant difference in

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prolapse duration [12]. In this study, 107 women showed a longer (9.1 ± 14.2 years vs 61.9 ±

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50.1 months) mean duration of prolapse than that in the report by Krissi et al. This large

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difference may have originated from the unique Korean culture. The expression and

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discussion of sexuality is usually very conservative in Korea, as in other Asian countries [13].

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ACCEPTED MANUSCRIPT Adults in Korea regard sexuality as an important part of life, but only 2% of men and women

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have discussed sexual dysfunction with a medical doctor [14]. Due to conservative cultural

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characteristics, unfortunately many patients, especially elderly patients, feel embarrassed to

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visit an urogynecologist for POP and are not willing to seek medical treatment.

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Reasons for the association of duration of prolapse with increasing rate of recurrence after

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colpocleisis are unclear. On the other hand, there are few reports that evaluated the role of

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preoperative vaginal estrogen application in women with POP who underwent surgical

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management [15]. Rahn et al. reported that preoperative local estrogen application increased

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synthesis of mature collagen, decreased degradative enzyme activity, and increased thickness

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of the vaginal wall, suggesting that this intervention improves both the substrate for suture

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placement and maintenance of connective tissue integrity [16]. Thus, our finding may suggest

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that patients with prolonged duration of prolapse need proper preoperative vaginal estrogen

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application to improve the substrate for suture placement.

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Candidates for colpocleisis usually have poor health status with significant comorbidity, and

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many patients need preoperative management, e.g. blood pressure monitoring in patients with

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hypertension, blood glucose monitoring in women with diabetes mellitus. For this reason, we

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analyzed not only the mean hospital stay but also the postoperative hospital stay. Mean

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hospital stay was 6.3 ± 3.6 days (range, 4-34 days) and mean postoperative hospital stay was

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4.2 ± 2.7 days (range, 2-26 days) in all 107 patients.

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There were no serious postoperative complications. There were few minor postoperative

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complications, e.g. urinary tract infection, fecal incontinence, and vulvar edema. The total

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complication rate was 16.8% (18/107) in this study. Two patients received packed red blood

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cell transfusion. Zebede et al. reported that the total complication rate of colpocleisis was

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15.2% (47/310), and there was a need to perform an additional procedure during colpocleisis

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[11]. Catanzarite et al. reported that the complication rate was 8.1 % (23/283) during 30 days

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after colpocleisis [17]. The limitations of this study are its retrospective study design, a relatively small sample size,

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and lack of information on the quality of life. Another limitation is that the date of POP

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occurrence was obtained based on the patient’s memory which is not accurate especially in

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elderly patients and there was a long prolapse duration. The strength of this study is that all

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surgeries and follow-ups were performed by the same individual. Because of the Asian

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cultural characteristics, we unintentionally evaluated the association between prolapse

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duration and recurrence.

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ACCEPTED MANUSCRIPT Conclusion

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Duration from POP occurrence to surgery were the only parameters that were significantly

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associated with recurrence after colpocleisis. Therefore, women with a very long duration of

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prolapse should be counseled about possible recurrence of disease.

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Funding: none Conflict of interest: None

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References

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[1] Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet 2007;369:1027-1038.

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[2] Barber, M.D. & Maher, C. Epidemiology and outcome assessment of pelvic organ

188 189

190 191

192 193

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of pelvic floor disorders in the United States. Am J Obstet Gynecol 2013;209:584.e1-5

SC

187

[3] Kirby AC, Luber KM, Menefee SA. An update on the current and future demand for care

[4] Choi KH, Hong JY. Management of Pelvic Organ Prolapse. Korean J Urol. 2014 Nov;55(11):693-702.

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prolapse. Int Urogynecol J 2013;24:1783.

[5] Erekson EA, Yip SO, Ciarleglio MM, Fried TR. Postoperative complications after gynaecologic surgery. Obstet Gynecol 2011;118(4):785–793.

[6] Fitzgerald MP, Richter HE, Siddique S, et al. Colpocleisis: a review. Int Urogynecol J. 2006;17(30):261–271.

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185

[7] Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The

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standardization of terminology of female pelvic organ prolapse and pelvic floor

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dysfunction. Am J Obstet Gynecol. 1996;175:10–17.

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EP

194

197

[8] Murphy M, Sternschuss G, Haff R, van Raalte H, Saltz S, Lucente V. Quality of life and

198

surgical satisfaction after vaginal reconstructive vs obliterative surgery for the treatment of

199

advanced pelvic organ prolapse. Am J Obstet Gynecol. 2008;198(5):573.

200

[9] Crisp CC, Book NM, Smith AL, Cunkelman JA, Mishan V, Treszezamsky AD, Adams SR,

201

Apostolis C, Lowenstein L, Pauls RN; Fellows' Pelvic Research Network, Society of

202

Gynecologic Surgeons. Body image, regret, and satisfaction following colpocleisis. Am J

203

Obstet Gynecol. 2013;209(5):473.

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Fine P, Weber AM; Pelvic Floor Disorders Network. Pelvic support, pelvic symptoms, and

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patient satisfaction after colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct.

207

2008;19(12):1603-9.

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204

[11] Zebede S, Smith AL, Plowright LN, Hegde A, Aguilar VC, Davila GW. Obliterative

209

LeFort colpocleisis in a large group of elderly women. Obstet Gynecol. 2013;121(2 Pt

210

1):279-84.

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208

[12] Krissi H, Aviram A, Eitan R, From A, Wiznitzer A, Peled Y Risk factors for recurrence

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after Le Fort colpocleisis for severe pelvic organ prolapse in elderly women. Int J Surg.

213

2015;20:75-9.

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[13] Lee ZN. Korean culture and sense of shame. Transcult Psychiatry 1999; 36: 181-94.

215

[14] Moreira ED Jr, Kim SC, Glasser D, Gingell C. Sexual activity, prevalence of sexual

216

problems, and associated help-seeking patterns in men and women aged 40-80 years in

217

Korea: data from the Global Study of Sexual Attitudes and Behaviors (GSSAB). J Sex

218

Med 2006; 3: 201-11.

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[15] Rachaneni S, Latthe P. Role of perioperative low dose vaginal oestrogens in improving

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the outcomes of pelvic organ prolapse surgery. Med Hypotheses. 2013;81(6):1015-6.

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[16] Rahn DD, Good MM, Roshanravan SM, Shi H, Schaffer JI, Singh RJ, Word RA. Effects

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of preoperative local estrogen in postmenopausal women with prolapse: a randomized trial.

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J Clin Endocrinol Metab. 2014;99(10):3728-36.

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[17] Catanzarite T, Rambachan A, Mueller MG, Pilecki MA, Kim JY, Kenton K. Risk factors

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for 30-day perioperative complications after Le Fort colpocleisis. J Urol. 2014;192(3):788-

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Table 1. Characteristics of 107 women who underwent colpocleisis Parameter

No (%)

Mean ± SD

Range

75.5 ± 5.8

60-90

Body mass index (kg/m2)

23.6 ± 3.2

16-37

4.6 ± 1.7

1-10

49.3 ± 4.6

37-65

26.2 ± 7.4

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Age at operation (years)

Number of vaginal deliveries Age at menopause (years)

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Duration of menopause (years) Duration of prolapse sensation (years)

Hypertension

1-51

34 (31.8)

IHD

13 (12.1) 12 (11.2)

Respiratory illness*

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Parkinson’s disease

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History of CVA

CKD

7.2 ± 9.4

69 (64.5)

Diabetes mellitus

Cancer

0-53

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Comorbidity

9.1 ± 14.2

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Past heart operation

7 (6.5) 7 (6.5) 8 (7.5) 2 (1.9) 2 (1.9)

Past hysterectomy

28 (26.2)

Past POP operation

23 (21.5)

Duration of follow-up (months)

IHD=ischemic heart disease, CVA=cerebrovascular accident, CKD=chronic kidney disease, POP=pelvic organ prolapse *

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Asthma, chronic bronchitis or chronic obstructive pulmonary disease.

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Table 2. Physical examination and urinary symptom who underwent colpocleisis. Recurrence

Successful

(n=7)

(n=100)

P value

Preoperative physical examination, mean ± SD 4.9 ± 1.4

PB (cm)

2.6 ± 1.0

TVL (cm)

6.7 ± 1.2

Postoperative physical examination, mean ± SD

0.359

6.8 ± 0.6

0.678

0.092

3.0 ± 0.6

3.2 ± 0.8

0.275

5.2 ± 1.0

4.8 ± 0.7

0.083

4 (57.1)

54 (54.0)

0.472

4 (57.1)

71 (71.0)

0.722

Urge urinary incontinence

1 (14.3)

17 (17.0)

0.853

Stress urinary incontinence

0 (0.0)

6 (6.0)

0.505

Incomplete bladder emptying

5 (71.4)

65 (65.0)

0.667

Urge urinary incontinence

1 (14.3)

17 (17.0)

0.853

TVL (cm) Urinary symptoms, n (%)

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Urgency

GH=genital hiatus, PB=perineal body, TVL=total vaginal length

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2.9 ± 0.8

3.1 ± 0.7

PB (cm)

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0.406

4.3 ± 1.2

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4.6 ± 0.9

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GH (cm)

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Table 3. Comparison of operation outcome between the recurrent group and the non-recurrent

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group. Recurrence

Successful

(n=7)

(n=100)

63.6 ± 21.4

53.4 ± 17.3

0.347

Hospital stay (days)

5.3 ± 1.6

6.4 ± 3.7

0.325

Postoperative hospital stay (days)

3.6 ± 1.1

4.2 ± 2.7

0.370

P value

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Operation time (minutes)

Accompanied TOT

0 (0.0)

9 (9.0)

0.531

0 (0.0)

6 (6.0)

0.660

0 (0.0)

5 (5.0)

0.708

0 (0.0)

2 (2.0)

0.873

0 (0.0)

2 (2.0)

0.873

0 (0.0)

3 (3.0)

0.815

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Complication UTI Postoperative bleeding Fecal incontinence

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Vulvar edema Blood transfusion

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Parameter

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Successful

(n=7)

(n=100)

Age at operation (years)

73.9 ± 2.1

75.6 ± 6.0

0.318

Body mass index (kg/m2)

24.0 ±3.0

23.5 ± 3.2

0.641

No. of vaginal deliveries

4.0 ± 1.5

4.7 ± 1.8

0.257

Age at menopause (years)

50.7 ± 4.6

49.3 ± 4.6

0.299

Duration of menopause (years)

23.1 ± 5.7

26.4 ± 7.5

0.136

Duration of prolapse (years)

24.6 ± 22.8

8.0 ± 12.9

0.021

64 (64.0)

5 (71.4)

0.519

32 (32.0)

2 (28.6)

0.608

13 (13.0)

0 (0.0)

0.594

11 (11.0)

1 (14.3)

0.576

7 (7.0)

0 (0.0)

0.614

6 (6.0)

1 (14.3)

0.386

8 (8.0)

0 (0.0)

0.571

2 (2.0)

0 (0.0)

0.873

2 (2.0)

0 (0.0)

0.873

Past hysterectomy

26 (26.0)

2 (28.6)

0.590

Past POP operation

21 (21.0)

2 (28.6)

0.468

Duration of follow-up (months)

11.7 ± 7.9

6.8 ± 9.4

0.022

P value

Hypertension Diabetes mellitus

History of CVA Respiratory illness*

Cancer CKD

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Parkinson’s disease

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IHD

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Comorbidity

Past heart operation

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Parameter

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IHD=ischemic heart disease, CVA=cerebrovascular accident, CKD=chronic kidney disease, POP=pelvic organ prolapse

ACCEPTED MANUSCRIPT * Asthma, chronic bronchitis or chronic obstructive pulmonary disease.

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ACCEPTED MANUSCRIPT 1

Factors associated with recurrence after colpocleisis for pelvic organ

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prolapse in elderly women

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Highlights

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5

This study evaluated the risk factors associated with recurrence after colpocleisis.

7

For elderly patients with significant medical comorbidity who do not desire

8

preservation of the vaginal anatomy for sexual function, colpocleisis may be an

9

appropriate choice

M AN U

6

Duration from pelvic organ prolapse occurrence to surgery were the only parameters

11

that were significantly associated with recurrence after colpocleisis.

12

Women with a very long duration of prolapse should be counseled about possible

13

recurrence of disease.

AC C

EP

TE D

10