Colpocleisis is a well-established surgical intervention for advanced pelvic organ prolapse (POP), particularly benefiting older women who no longer engage in vaginal intercourse. This retrospective audit aimed to assess clinical outcomes and peri-operative complications following colpocleisis procedures conducted by the same surgical team over a ten-year period. The primary goal was to evaluate current practices, identify patterns in complications, and provide insights for service development.

This study reviewed all patients who underwent colpocleisis between 2015 and 2025. Data was gathered through electronic medical records and telephone follow-ups, utilizing the preformatted BSUG database for consistency. Key variables included demographic information, operative details, and post-operative outcomes. The study used validated questionnaires to gauge patient satisfaction and any regrets regarding the procedure. Primary endpoints included the recurrence of prolapse symptoms, urinary incontinence (pre-existing, new-onset, or recurrent), voiding dysfunction, urinary tract infections (UTIs), bowel symptoms, and complications related to mesh use. Descriptive statistics were employed to summarize key findings.

A total of 66 patients were included in the cohort, with a median age of 78 years (range: 65-91 years). Long-term follow-up data was available for 40 patients (60.61%) due to patient death (21) or loss to follow-up (5). Among those with long-term follow-up, only 27 patients agreed to participate in satisfaction surveys, with a median follow-up period of 12 weeks. Key results are as follows:

A. Peri-Operative Complications (N=66)  
- Intraoperative bleeding ≥ 500 ml: 3% (2 patients)  
- Postoperative self-limiting bleeding: 1.5% (1 patient)  
- Urinary tract infections (UTIs): 4.5% (3 patients)

B. Long-Term Follow-Up (N=40)  
- Recurrent urinary incontinence: 30% (12 patients), with no cases requiring surgical intervention  
- No new-onset urinary incontinence was observed  
- Voiding difficulties: 10% (4 patients)  
- Recurrent UTIs/Cystitis: 17.5% (7 patients)  
- Bowel-related issues (e.g., constipation, obstructive defecation): 10% (4 patients)  
- No cases of recurrent prolapse requiring further surgical intervention, although 7.5% (3 patients) experienced recurrent prolapse requiring conservative management

C. Long-Term Satisfaction and Regret (N=27)  
- Only 7.4% (2 patients) reported worsening symptoms after surgery  
- A mild degree of regret was expressed by 3.7% (1 patient)  
- High levels of satisfaction: 81.4% (22 patients) very satisfied, 7.4% (2 patients) satisfied, and 11.1% (3 patients) unsatisfied

These findings align with previous studies, which demonstrate that colpocleisis is associated with high rates of anatomical success and low reoperation rates.(1) However, the occurrence of new urinary symptoms following surgery underscores the importance of comprehensive preoperative counseling and consideration of continence procedures at the time of prolapse repair. (2) Additionally, while bowel symptoms are less frequently reported in the literature, their presence in this cohort indicates the need for heightened postoperative surveillance.(3)

Colpocleisis remains a highly effective and valuable treatment option for women with advanced POP who are no longer sexually active. This audit reinforces its efficacy and highlights the need for long-term surveillance of urinary and bowel symptoms. These findings emphasise the importance of tailored patient counseling and may inform improvements in perioperative care pathways, ultimately enhancing outcomes and patient satisfaction.

Zyczynski HM, et al. "Colpocleisis for advanced pelvic organ prolapse: outcomes and complications." *Am J Obstet Gynecol*. 2008.
Raker CA, et al. "Risk of stress urinary incontinence after obliterative prolapse repair." *Obstet Gynecol*. 2014.
Crisp CC, et al. "Outcomes of colpocleisis for pelvic organ prolapse." *Female Pelvic Med Reconstr Surg*. 2013.