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Obliterative Vaginal Surger y for Pelvic Organ Prolaps e Thomas L. Wheeler II, MD, MSPHa,*, Kimberly A. Gerten, Jeffrey B. Garris, MD, MSa MD b , KEYWORDS  Obliterative surgery  Colpocleisis  Older women  Management  Pelvic organ prolapse Estimates for surgeries performed for female pelvic organ prolapse in the United States exceed more than 500,000 surgical procedures per year.1 Considering that only 10% to 20% of women with prolapse are currently believed to seek medical attention and that the number of American women greater than age 50 is projected to increase by more than 70% over the next 30 years, the number of surgeries performed for prolapse is expected to dramatically increase.2–4 Although restorative reconstructive surgical procedures may be indicated for those patients with prolapse who desire to maintain sexual function, many other patients with prolapse may be medically compromised or have other reasons why postoperative coital function is not desired. For those patients, whether elderly or of younger age, with no desire to preserve postoperative coital function, an obliterative surgical procedure to repair pelvic organ prolapse has many advantages and should be considered. Typically, obliterative procedures are less invasive, require shorter operative times, and have less surgical risks over traditional vaginal reconstructive procedures.5,6 Various techniques have been described for performing obliterative surgery. These obliterative procedures can be generally divided into partial or total colpocleisis. Either procedure can be performed with or without levator myorrhaphy and high perineorrhaphy. When pelvic anatomy limits or prevents more traditional techniques of colpocleisis, a constricting anterior and posterior colporrhaphy with levator myorrhaphy and high perineorraphy is an option. The pelvic reconstructive surgeon who performs these procedures should have comfort in preoperative discussion with the patient of the risks and benefits associated with the procedure, the surgical skills needed to perform the procedure, and a Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, University of South Carolina, Greenville Campus, 480 West Faris Road, Greenville, SC 29608, USA b Park Nicollet Urogynecology and Reconstructive Pelvic Surgery, 6490 Excelsior Boulevard, Suite E111, St. Louis Park, MN 55426, USA * Corresponding author. E-mail address: (T.L. Wheeler II). Obstet Gynecol Clin N Am 36 (2009) 637–658 doi:10.1016/j.ogc.2009.08.003 0889-8545/09/$ – see front matter ª 2009 Elsevier Inc. All rights reserved.

Obliterative Vaginal Surgery for Pelvic Organ Prolapse

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