Rouhier'colpocleisis with concomitant vaginal hysterectomy: an instructive video for Female Pelvic Surgeons
IUGA Academy. Constantin F. Jun 30, 2018; 213248; 264 Topic: Pelvic Organ Prolapse
Florin Constantin
Florin Constantin

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264

Rouhier’colpocleisis with concomitant vaginal hysterectomy: an instructive video for Female Pelvic Surgeons

constantin, F1; Dubuisson, J1; Veit-Rubin, N2

1: Department of Obstetrics and Gynecology, University Hospitals Geneva, Geneva, Switzerland; 2: Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria

Introduction: The treatment of pelvic organ prolapse (POP) in elderly women can be challenging. The vaginal operation known as colpocleisis, the total occlusion of the urogenital hiatus, was first performed by Neugebauer in 1867 but was only published in 1881. In France, the colpocleisis with concomitant hysterectomy was described by Rouhier. The Rouhier’s operation represents a safe, time-saving and reproducible procedure in case of POP associated with uterine pathology (benign or malignant) for elderly women without the desire for the preservation of coital function.

Objective: The objective of this video is to provide anatomic illustrations and a precise description of surgical steps necessary to achieve successful total colpocleisis with hysterectomy.

Methods: We present the case of a 62-year-old woman who was referred for hysterectomy in the context of metastatic endometrial cancer (pulmonary, bones and liver metastasis). She complained about vaginal bulge and was diagnosed with a POP-Q stage-4 genital prolapse on physical examination. Due to important comorbidities (arterial hypertension, obesity, metastatic endometrial cancer), we discussed surgical treatment including colpocleisis with concomitant vaginal hysterectomy to which the patient consented.

Results: This video illustrates the different surgical steps of a colpohysterectomy according to Rouhier. No intraoperative complications occurred and the postoperative follow-up was uneventful. The patient was fully satisfied and does not present a recurrence of POP after a 17 months follow-up. She continues to be treated with chemotherapy.

Conclusion: Indications for colpoclesis should be an exception but could be offered to sexually inactive women of advanced age after thoroughly discussion and patient consent. If a hysterectomy is necessary, Rouhier's operation offers a time-saving, reproducible and efficient option for women with symptomatic POP who do not desire future vaginal intercourse.

References:

  • Colpocleisis: a review. Int Urogynecol J Pelvic Floor Dysfunct 17(3):261–71.
  • An aging nation: the older population in the United States. U.S Department of Commerce Economics and Statistics Administration. census.gov/prod/2014pubs/p25-1140.pdf
  • Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol 2011; 205:230.e1–5.

Disclosure:

Work supported by industry: no.

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