RANCHO MIRAGE, CALIF. — Three of 32 women regretted undergoing partial colpocleisis a mean of 28 months after surgery, two because of recurrent prolapse and one due to continued stress incontinence, Thomas L. Wheeler II, M.D., reported.
In follow-up interviews, none cited loss of sexual function as a reason for regret. Overall, satisfaction rates were high, he said at the annual meeting of the Society of Gynecologic Surgeons.
The surgery significantly reduced patient distress over symptoms and the impact of incontinence on their lives, compared with baseline levels, assessed by the short-form Incontinence Impact Questionnaire (IIQ) and the short-form Urogenital Distress Inventory (UDI).
There have been no published reports comparing preoperative and postoperative quality of life scores using validated instruments such as these to assess results from colpocleisis, noted Dr. Wheeler of the University of Alabama, Birmingham.
The investigators obtained records on 54 patients who had undergone partial colpocleises during a 5-year period, but 19 patients were demented, lost to follow-up, or deceased. Three declined to participate in the study. The remaining 32 patients answered a question about regret, and 28 of them also answered a question about satisfaction with results of the surgery. The mean age of respondents was 81 years.
In the three patients (9%) who regretted the surgery, the two recurrent prolapses occurred at 5 and 7 months after the operation. The third patient had undergone a modified Pereyra procedure at the time of colpocleisis and reported continuing incontinence.
Sixteen of the 28 patients said they were completely satisfied with their progress since the surgery, 8 were somewhat satisfied, and 4 (14%) were not satisfied, he said.
The IIQ asked seven questions about whether and how severely urine leakage affected various functions in patients' lives, emotional health, and feelings of frustration, with higher scores representing a greater impact of incontinence. Mean scores improved significantly from 41 before surgery to 14 at the last interview.
The UDI contained six questions about whether and how much patients were bothered by symptoms such as frequent urination, leakage, difficulty emptying the bladder, and pain or discomfort, with higher scores indicating worse outcomes. Mean scores improved significantly from 63 before surgery to 24 at the last interview, Dr. Wheeler said.
In previous reports, regret rates ranged from 0% to 10% in four case series, one of partial colpocleisis and three of total colpocleisis. A previous report of patient satisfaction in a series of total colpocleisis procedures reported that 5% of patients were not satisfied with results.