COLPOCLEISIS
…..What is colpocleisis?
Colpocleisis is a procedure involving closure of the vagina. It is used to treat prolapse of
the vagina and pelvic organs in older women who are no longer sexually active. It may be
performed with or without presence of the uterus and cervix. It can be performed under general
or local anesthesia.
…..Why is it done?
Colpocleisis is performed for relief of symptomatic vaginal prolapse. It is indicated for
women who fail conservative therapy with a pessary or who do not wish to wear a pessary. It is
an option for patients that are not good candidates for/who do not wish to have extensive
reconstructive procedures. This procedure is only reserved for those who are not sexually active
and do not plan future coital activity.
…...What are the advantages and disadvantages?
Advantages to a colpocleisis include decreased morbidity, a shorter operative time, less
pain postoperatively, decreased blood loss, and a high success rate (95%). Studies indicate a
high satisfaction level in relief of bowel, bladder, and prolapse symptoms.
Disadvantages include the inability to engage in sexual intercourse. The surgery also
precludes the ability of the provider to evaluate the cervix or uterus for abnormalities. Previous
pap smears and cervical biopsies must be reviewed and history of abnormal uterine bleeding
must be evaluated prior to this procedure.
WHAT OTHER TREATMENTS ARE AVAILABLE TO TREAT PELVIC ORGAN PROLAPSE?
Surgery: There are several surgical procedures to treat prolapse, including hysterectomy
(complete removal of the uterus), sacralcolpopexy (lifting the vagina to the sacrum), and
anterior/posterior repairs of the vaginal walls. However, not all women are good candidates for
these or want to have these procedures.
Pessary: A vaginal pessary is a removable device made of rubber, plastic, or a silicone-based
material. It is placed into the vagina to support areas of pelvic organ prolapse. There are a
variety of shapes and sizes available. A physician or nurse practitioner chooses the best shape
and size of the pessary after taking measurements of the vagina. It must be removed for
cleaning periodically. If the patient is unable to remove the pessary on her own, visits are
required about every 3 months for removal and cleaning by the doctor or nurse practitioner.
PREPARATION FOR THE PROCEDURE
Before Surgery
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For surgery scheduled at St. Luke’s Hospital, pre-admission testing will be scheduled for you. Your
tests may include blood work, a urinalysis, chest x-ray, electrocardiogram and a pregnancy test.
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If MRSA positive, please refer to the MRSA protocol below to obtain appropriate pre-operative
therapies to use before your surgery.
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The anesthesiologist will talk with you at the time of your testing regarding the specific type of
anesthesia that will be administered. Inform the anesthesiologist if you wear dentures, or have a
family history of anesthetic complications. He/she or one of the personnel in the out-patient testing
will tell you what time to report to the out-patient admitting office the day of your scheduled
surgery.
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Do not bring jewelry or valuables with you to the hospital.
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Stopping smoking before surgery if strongly encouraged.
One Day Prior to Surgery
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Please refer to the bowel prep protocols attached. Please Follow a Clear Liquid Diet beginning at
4:00 PM the day before surgery. You may have Jello, broth, coffee, popsicles, tea, soda, Kool-Aid
and juices (except orange). ABSOLUTELY NO FOOD, LIQUID OR MEDICATION SHOULD BE TAKEN BY
MOUTH AFTER MIDNIGHT OF THE DAY PRIOR TO SURGERY. Please let Dr. Croak and the
anesthesiologist know if you take any medicines daily, or have a chronic illness.
After Surgery
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For procedures requiring an overnight stay, the length of your hospital stay can vary, but is typically
is 1-3 days. Please understand that with healthcare reform, Medicare and many private insurers will
now only allow a one night in the hospital for most surgical procedures.
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Perform breathing exercises every hour while awake in the hospital to keep lungs clear of excess
fluid; walking with assistance later in the day of surgery can help prevent blood clot formation
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If necessary, perform the catheterization plan specific to you surgery.
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Normal activities, including sex, can be resumed in 6 weeks in most cases; meanwhile, do not place
anything in the vagina
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Resume physical activities slowly; take showers instead of baths for 6 weeks
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To avoid constipation eat fruits, vegetables & whole-grain foods. Drink 8 glasses of fluid daily.
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You can drive after 1-2 weeks if you feel up to it, have discontinued narcotic pain meds, and can
press on the brake quickly without pain
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Do not lift more than 15 lbs until after your 6-week appointment; when you can return to work
depends on your responsibilities
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You will be seen in the office at 1 & 6 weeks postoperatively, and as needed
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Please call the office with any questions or concerns at 419.893.7134
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Notify your Dr. if you notice fever or chills, heavy vaginal bleeding or foul vaginal discharge,
redness, bleeding or discharge at the incision site, pain or swelling in your legs, shortness of
breath or chest pain, severe abdominal or pelvic pain
Taken from www.fda.gov Medical Devices Safety Alerts & Notices (07/13/2011)
Information on Surgical Mesh for Pelvic Organ Prolapse and Stress Urinary Incontinence: FDA wants to inform
you about the complications that can occur when surgical mesh is used to treat Pelvic Organ Prolapse (POP) and
Stress Urinary Incontinence (SUI), and provide you with questions to ask your surgeon before having these
procedures. This is part of our commitment to keep healthcare professionals and the public informed about the
medical products we regulate.
FDA has received reports of complications associated with the placement of mesh through an incision made in the
wall of the vagina. Although rare, these complications can have serious consequences. The reports have not been
linked to a single brand or model of mesh.
The most frequent complications included erosion through the vagina, infection, pain, urinary problems and
recurrence of the prolapse and/or incontinence.
In some cases, erosion of the mesh and scarring of the vagina led to discomfort and pain, including pain during
sexual intercourse. Some patients needed additional surgery to remove the mesh that had eroded into the vagina.
Other complications included injuries to nearby organs such as the bowel and bladder, or blood vessels.
Background: A pelvic organ prolapse (POP) occurs when a pelvic organ, such as your bladder, drops (“prolapses”)
from its normal position and pushes against the walls of your vagina. This can happen if the muscles that hold your
pelvic organs in place become weak or stretched from childbirth or surgery. More than one pelvic organ can drop at
the same time. Organs that can be involved in a pelvic organ prolapse include the bladder, the uterus, the bowel and
the rectum. Pelvic organ prolapse can cause pain or problems with bowel and bladder functions or interfere with
sexual activity. Stress urinary incontinence (SUI) is a type of incontinence caused by leakage of urine during
moments of physical stress.
Talking to your doctor: Before having an operation for POP or SUI, be sure to let your surgeon know if you’ve had
a past reaction to mesh materials such as polypropylene. Questions you should ask the surgeon before you agree to
surgery in which mesh will be used:
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What are the pros and cons of using surgical mesh in my particular case? Can my repair be successfully
performed without using mesh?
If a mesh is to be used, what’s been your experience with implanting this particular product? What
experience have your other patients had with this product?
What’s been your experience in dealing with the complications that might occur?
What can I expect to feel after surgery and for how long?
Are there any specific side effects I should let you know about after the surgery?
What if the mesh doesn’t correct my problem?
If I have a complication related to the mesh, can the mesh be removed and what could the consequences
be?
If a mesh is to be used, is there patient information that comes with the product, and can I have a copy?
Reporting complications to the FDA: In order to help FDA learn more about possible problems with surgical mesh,
it is important that both physicians and patients report complications that may be associated with this product.
You can report any problems to the FDA's MedWatch Adverse Event Reporting program either online, by mail or
FAX.
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Online : MedWatch Online Voluntary Reporting Form (3500)5
Mail : use postage-paid FDA form 3500 available at: MedWatch Forms6
Mail to MedWatch 5600 Fishers Lane, Rockville, MD 20852-9787
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FAX: 1-800-FDA-0178
Related Links
FDA Public Health Notification: Serious Complications Associated with Transvaginal Placement of Surgical Mesh in Repair of
Pelvic Organ Prolapse and Stress Urinary Incontinence
MRSA SCREEN PROTOCOL
(For patients with a positive result only)
IF you have tested positive for Methicillin Resistant Staph Aureus (MRSA), the
following protocol will be used to decrease the amount of bacteria present and help
prevent an infection with surgery.
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Bactroban ointment in both nostrils, twice a day for 10 days before surgery
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Cipro 500 mg by mouth twice daily for 2 days before surgery
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Povidone/Iodine douche 1-3 days before surgery (available at Buderer’s Pharmacy in
Perrysburg)
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Chlorhexadine (or similar) shampoo/wash the day before surgery (available at Buderer’s
Pharmacy in Perrysburg)
PRE-SURGERY BOWEL PREP INSTRUCTIONS
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May have regular diet up until 4:00 PM day before surgery
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At 4:00 PM, begin a clear liquids diet AND take one (1) Ducolax laxative tablet
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At 6:00 PM, use one (1) Fleets enemas according to instructions
Examples of Clear Liquids: Water, clear fruit juices (apple or white grape), chicken/beef
bouillon cubes, jello (NO RED OR PURPLE), popsicles ( NO RED OR PURPLE), Gatorade
(Light color only), clear soft drinks (7-UP, Sprite, Vernors), coffee/tea without cream (sugar is
Ok). No milk, milk products or orange juice.
*** ABSOLUTELY NOTHING BY MOUTH AFTER MIDNIGHT ***
STOP Plavix/Aspirin, Aspirin by-products 1 week prior to your surgery.
STOP Coumadin 5 days prior to your surgery.
PLEASE CONSULT the physician who ordered the Plavix and Coumadin before you stop
taking.
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NEWER ANTICOAGULANTS (I.E. PRADAXA, EFFIENT) MAY REQUIRE A LONGER
DISCONTINUANCE RATE PRIOR TO SURGERY DUE TO HEAVY BLEEDING RISK