Colpocleisis (Le Fort and Total)
Colpocleisis treats symptomatic advanced pelvic organ prolapse by reducing the prolapse and closing most of the vaginal canal. It is an option for a patient who accepts permanent loss of penetrative vaginal intercourse, particularly when frailty or other medical conditions increase the burden of reconstructive surgery. Many patients obtain substantial symptom relief, but recurrence, urinary symptoms and complications remain possible.[1][2][3]
For treatment selection, see Prolapse Repair. Concurrent stress-incontinence procedures are covered in the Female Stress Incontinence Database.
Choosing an Obliterative Repair
Discuss observation, pessary treatment and reconstructive surgery alongside colpocleisis. NICE recommends considering colpocleisis for uterine or vault prolapse when the patient does not intend penetrative vaginal sex and has a physical condition that increases operative or postoperative risk. Age alone does not determine suitability.[1]
| Decision | Practical discussion |
|---|---|
| Symptoms and goals | Establish which bulge, pressure, emptying or activity limitations the patient wants improved. Anatomic prolapse without bothersome symptoms does not itself require surgery. |
| Vaginal intercourse | Obtain the patient's informed agreement to permanent vaginal closure. Discuss possible future changes in relationships or sexual goals. Nonpenetrative sexual activity and clitoral stimulation remain possible. Partner involvement is optional and depends on the patient's wishes. |
| Medical and functional reserve | Assess frailty, comorbidities, mobility, cognition, anesthetic risk and recovery support. The operation still carries medical and surgical risks. |
| Uterine preservation | Clarify whether the uterus and cervix are present, whether there is concerning bleeding or pathology, and the implications of limiting future vaginal access. |
| Urinary and bowel symptoms | Separate prolapse symptoms from stress leakage, urgency, retention and defecatory complaints. Prolapse repair may improve some symptoms without curing every pelvic-floor problem. |
These discussions should precede the choice of technique; published series largely involve selected older women and cannot establish a universally superior operation for every patient.[1][2][3]
Variants and Anatomy
| Variant | Key distinction |
|---|---|
| Le Fort / partial colpocleisis | Anterior and posterior denuded surfaces are approximated to form a central septum, retaining lateral epithelial channels. When the uterus remains, the channels permit drainage from the cervix. Partial techniques can also be used after hysterectomy. |
| Total colpocleisis / colpectomy | More extensive epithelial removal and obliteration are performed for vault prolapse, usually after a previous hysterectomy. Published techniques use layered approximation or serial purse-string reduction. |
| Colpocleisis with concomitant hysterectomy | Hysterectomy and obliterative closure are combined when the individualized plan includes uterine removal. Hysterectomy is an additional decision, not a prerequisite for colpocleisis. |
Terminology and accompanying repairs vary among studies. Preserve enough distal anterior vaginal tissue to avoid compromising the urethra and bladder outlet. Perineorrhaphy or levator plication may accompany the repair, but neither a mandatory levator repair nor a fixed final vaginal depth and width is established for all patients.[2][3][7]
Preoperative Assessment
- Examine and document prolapse: record the compartments, POP-Q findings, genital hiatus, tissue quality, ulceration, prior operations and any concerning vaginal or cervical lesion. Confirm whether a uterus or cervical stump is present.[1][2]
- Assess bladder function: document stress and urgency symptoms, voiding difficulty and postvoid residual when indicated. A prolapse-reduction cough stress test can reveal otherwise masked stress leakage and inform counseling; a positive test does not automatically mandate a sling.[1][2][3]
- Use urodynamics for a specific decision: testing is not a universal prerequisite for every colpocleisis. NICE recommends multichannel filling and voiding cystometry before stress-incontinence surgery when anterior/apical prolapse, voiding dysfunction, unclear incontinence type or urge-predominant mixed incontinence, or previous SUI surgery complicates assessment.[1]
- Evaluate bleeding and retained organs: investigate postmenopausal bleeding, abnormal examination findings and relevant cervical/endometrial risk before closure. Confirm that cervical screening is appropriate for the patient's age and history. Routine cytology, HPV testing and endometrial biopsy for every asymptomatic low-risk patient are not an established universal package. Select ultrasound or sampling according to the clinical indication.[2]
- Explain future access: uterine and cervical evaluation becomes more difficult after closure. Drainage channels do not provide normal examination access or eliminate future cancer risk. Persistent or new bleeding and discharge still require evaluation.[2][6]
Operative Principles
The following describes the shared sequence. Exact dissection, suture configuration and additional repairs depend on the variant, anatomy and surgeon's training; small technique reports do not establish one mandatory recipe.[2][3][7]
Le Fort / partial colpocleisis
- Plan the epithelial excision. Identify the cervix or vault, urethral region and the anterior and posterior areas to be approximated. Preserve the lateral epithelial strips needed for channels and the distal anterior tissue protecting the bladder outlet.
- Develop the dissection carefully. Remove the planned epithelium while preserving supportive tissue and protecting the underlying bladder and rectum. Maintain visualization and hemostasis; hydrodissection is an adjunct, with agent and dose selected for the patient and local protocol.
- Reduce the proximal prolapse. Approximate the proximal margins, reducing the cervix or vault, and construct the lateral channels. Confirm that drainage channels have not been closed by the sutures.
- Approximate the supporting surfaces. Use successive layers of sutures to bring the denuded anterior and posterior tissues together, reduce the prolapse and close potential spaces without distorting the outlet.
- Complete the distal closure and any planned perineal repair. Reassess hemostasis, channel patency and the relationship of the closure to the urethra. Tailor narrowing to the anatomy rather than an arbitrary dimension.
Lateral channels are a core feature of a uterine-preserving Le Fort repair. A channel “wide enough for one finger” was described in one modified technique case; it should not be treated as a validated universal endpoint.[2][3][7]
Total colpocleisis
After identifying the vault and protecting the bladder, urethral region and rectum, remove the planned vaginal epithelium proximal to the preserved distal anterior segment. Reduce the vault and approximate the supporting tissue with layered sutures or serial purse strings, achieving hemostasis and avoiding residual spaces. Close the remaining epithelium and perform any individually planned perineal repair. Total and partial repairs differ in extent; observational comparisons do not prove identical outcomes.[2][3]
Concomitant Procedures
Hysterectomy
Hysterectomy is not routinely required. Discuss symptoms, suspected pathology, future evaluation, the patient's preferences and the added operative burden. Suspicion of malignancy requires an appropriate diagnostic and oncologic plan before an obliterative operation.[2]
The evidence is observational. A US inpatient study of 7,431 colpocleisis admissions found higher adjusted odds of an in-hospital complication with concomitant hysterectomy (OR 1.93, 95% CI 1.45–2.57); it could not measure complications after discharge or establish causation. A 2025 meta-analysis abstract, combining four retrospective studies and 1,423 patients, reported longer operations and greater blood loss with hysterectomy, without a statistically significant difference in overall complications. Different populations and definitions limit comparison; nonsignificance does not establish equal safety.[4][5]
Stress-incontinence surgery
For bothersome SUI, discuss concomitant treatment versus a staged procedure after prolapse repair. Include the possibility of persistent or newly apparent stress leakage, urgency, catheterization or voiding difficulty, sling-specific complications and a later operation. NICE recommends considering concurrent SUI surgery in women with SUI and anterior/apical prolapse, with explicit discussion of the uncertainty of longer-term benefit and the risks of combined versus sequential surgery.[1]
A prolapse-reduction test helps estimate risk; it does not establish that all patients with occult leakage benefit from the same procedure. In patients without incontinence, NICE advises against routinely adding surgery solely to prevent it. Suburethral plication should not be presented as an evidence-equivalent substitute for a contemporary sling.[1][3]
The colpocleisis-specific literature contains selected cohorts with different sling materials and indications. In the 2022 review, the often-quoted 14% revision for retention came from an autologous fascial sling series, not a synthetic midurethral-sling series; it is not an appropriate synthetic-sling counseling estimate.[2]
Outcomes: Keep the Endpoint and Follow-up Together
| Evidence | What was measured | Interpretation |
|---|---|---|
| Multicenter prospective cohort, 152 women | At 12 months, 75/103 examined women had POP-Q stage ≤1 and 96/103 had stage ≤2. Of 132 respondents, 125 were satisfied or very satisfied with their decision to undergo vaginal closure. | Symptom relief and satisfaction can remain high despite a less stringent anatomic outcome. Only 103/152 had the one-year examination. Stage ≤2 is not equivalent to no prolapse beyond the hymen. |
| Review of 49 studies, search through June 2020 | Reported anatomic results depended on definition: 62.5–100% for POP-Q stage ≤1, versus 87.5–100% for no prolapse beyond the hymen. | Heterogeneous, mostly observational series; these are study ranges, not a pooled patient-specific probability. |
| Danish nationwide cohort, 2,228 women; published abstract | Median follow-up 5.6 years; cumulative repeat-prolapse-surgery incidence 6.5% at two years and 8.2% at ten years. | Reoperation is a different endpoint from recurrent prolapse on examination. The decades-long cohort does not support a universal “0–1.8% lifetime reoperation” claim. |
Sources: prospective cohort,[3] narrative review,[2] Danish cohort abstract.[6]
Urinary and bowel symptom scores generally improve, but persistent symptoms are clinically important. In the prospective cohort, bothersome SUI was reported by 18/130 and bothersome urgency/UUI symptoms by 20/131 at one year. Concomitant incontinence treatment was chosen clinically and varied in type, so these data cannot establish the benefit of routinely adding a sling.[3]
Body image may improve: 80/131 respondents in that cohort reported that their body looked better, 49 the same and two worse. Regret is often uncommon in selected cohorts, but estimates depend on the question, responders and follow-up. Discuss loss of vaginal intercourse separately from dissatisfaction caused by recurrence, urinary symptoms or other complications.[2][3]
Complications and Follow-up
Counsel about bleeding, infection, urinary retention, persistent or new urinary symptoms, bladder/ureteral/rectal injury, recurrent prolapse and medical complications including thromboembolism. Risk depends on frailty, concurrent procedures and how long outcomes are observed. UTI rates are especially sensitive to whether infection was culture-confirmed and whether the observation window was an admission, 30 days or a year; do not combine those percentages into one personal risk estimate.[2][3][4]
Document the postoperative voiding assessment and arrange a catheter/removal plan if emptying is inadequate. Review wound healing, bleeding or discharge, bladder and bowel symptoms and any recurrent bulge. NICE recommends a postoperative review at six months including vaginal examination and ongoing access to review for recurrent symptoms or suspected complications. New postmenopausal bleeding after uterine-preserving closure still needs evaluation.[1][2][3]
Videos
References
1. NICE. Urinary incontinence and pelvic organ prolapse in women: management (NG123). Recommendations 1.3.15–1.3.16, 1.8 and 1.9. Recommendations.
2. Grzybowska ME, Futyma K, Kusiak A, Wydra DG. Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review. Int Urogynecol J. 2022;33(1):31-46. doi:10.1007/s00192-021-04907-7.
3. FitzGerald MP, Richter HE, Bradley CS, et al; Pelvic Floor Disorders Network. Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1603-1609. doi:10.1007/s00192-008-0696-6.
4. Raina J, Bastrash MP, Suarthana E, Larouche M. Perioperative complication rates of colpocleisis performed with or without concomitant hysterectomy: a large population-based study. Int Urogynecol J. 2023;34(5):1111-1118. doi:10.1007/s00192-023-05457-w.
5. Zacharakis D, Prodromidou A, Kathopoulis N, et al. Colpocleisis with or without hysterectomy: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2025;313:114583. doi:10.1016/j.ejogrb.2025.114583. Abstract reviewed.
6. Hammerbak-Andersen M, Klarskov N, Husby KR. Colpocleisis: reoperation risk and risk of uterine and vaginal cancer: a nationwide cohort study. Int Urogynecol J. 2023;34(10):2495-2500. doi:10.1007/s00192-023-05566-6. Abstract reviewed.
7. Lv H, Rong F. Modified LeFort partial colpocleisis. Int Urogynecol J. 2021;32(4):1043-1045. doi:10.1007/s00192-020-04545-5. Funding-number correction: doi:10.1007/s00192-021-04707-z.