To investigate the safety and efficacy of the modified total colpocleisis concomitant with hysterectomy in treatment of elderly women with severe pelvic organ prolapse (POP) with total pelvic floor defect.

From January 2017 to June 2020, a total of 24 elderly patients with total pelvic floor defect and POP were admitted to gynecologic department of Beijing Chaoyang Hospital, Capital Medical University, who no longer desired coital function. All patients underwent modified total colpocleisis and hysterectomy. The vagina was reconstructed into a vaginal remnant with a total length of 3 to 3.5 cm, a lower diameter of 2 to 2.5 cm, and a top mediastinum of 1 to 1.5 cm. TVT-O was performed simultaneously for stress urinary incontinence.

All 24 patients had severe defects of anterior, middle and posterior compartments of the pelvic floor, POP-Q stage Ⅲ-Ⅳ of POP, and age (76.5±6.2) years old. All patients had more than two kinds of complications, including hypertension (100%), diabetes (20.8%), coronary atherosclerosis with stenosis or myocardial infarction (41.6%), cerebral infarction with sequelae of limb dyskinesia (16.7%), bone and joint degeneration (16.7%), and 58.3% of cases had female stress urinary incontinence. The mean operative time was (201.4±44.7) minutes, estimated blood loss was (206.7±135.6) ml. Postoperative complications included lower limb intermuscular venous thrombosis (16.7%), pulmonary thrombosis (4.2%), and urinary retention (29.2%), and all were cured. 19 patients were followed up for 6 to 24 months postoperatively, and the vaginal remnant met the objective designed requirements. There was no recurrence. The overall efficacy was 100%. The subjective satisfaction was 100%.

This modified total colpocleisis concomitant hysterectomy for elderly women with severe total pelvic floor and POP is efficacy and safety. The vaginal remnant can obtain higher aesthetic appearance and the subjective satisfaction.