Obstetrics & Gynecology>>>>>Pelvic Relaxation and Urogynecology
Question 6#

You are discussing surgical options with the family of an elderly patient with symptomatic pelvic organ prolapse. Le Fort colpocleisis may be more appropriate than vaginal hysterectomy and A&P repair for patients in which of the following circumstances?

A. The patient is debilitated and in a nursing home
B. The patient has had postmenopausal bleeding
C. The patient has had endometrial hyperplasia
D. The patient has had cervical dysplasia that requires colposcopic evaluation
E. The patient has a history of urinary incontinence

Correct Answer is A

Comment:

Partial colpocleisis by the Le Fort procedure is reasonable for elderly patients who are not good candidates for surgery as treatment for uterine prolapse. The technique is appropriate for women who have a uterus in situ, and involves partial denudation of opposing surfaces of the vaginal mucosa followed by surgical apposition, thereby resulting in partial obliteration of the vagina. Small strips of vaginal epithelium are left laterally, to allow an outlet for drainage or bleeding. Patients who are candidates for this procedure must have no evidence of cervical dysplasia or endometrial hyperplasia, and must have an atrophic endometrium. This type of obliterative procedure is ideal for women who cannot tolerate a more extensive surgery and who no longer plan to have vaginal intercourse. A similar obliterative procedure may be performed in women who have already undergone hysterectomy, as treatment for vaginal prolapse. Urinary incontinence can be a side effect of these procedures, so many surgeons perform a concomitant incontinence procedure at the same time. An A&P repair essentially involves excision of redundant mucosa along the A&P walls of the vagina, at the same time strengthening the vaginal walls by suturing the lateral paravaginal fascia together in the midline.