Making What Is Old New Again: A Narrative Review Informing Expert Consensus on Obliterative Management of Primary Uterovaginal Prolapse.

Abstract

Introduction and hypothesis: Surgical management of uterovaginal prolapse using an obliterative vaginal approach is a safe and highly effective option for correction of pelvic organ prolapse. However, there is a lack of standardized procedural guidelines to optimize outcomes. As part of the Global Uterine Pelvic Organ Prolapse (U-POP) Consensus Conference held in Winston Salem, NC, USA, 20-21 April 2026, we aimed to compare specific techniques for colpocleisis in women undergoing surgery for primary uterovaginal prolapse.

Methods: A large database systematic review was conducted on publications 31 December 2020 through 4 November 2025. Studies that described specific colpocleisis techniques were included. Primary outcomes were anatomical success, subjective improvement in bulge symptoms, and perioperative complications. Evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Owing to the low quality of available evidence, a modified Delphi consensus process was used to develop consensus statements at the U-POP conference.

Results: Of the 587 studies identified, 24 cohort and case series met the inclusion criteria. All studies were of low quality according to GRADE criteria. Two consensus statements were successfully agreed upon through the modified Delphi process.

Conclusions: High-quality evidence supporting specific surgical techniques for obliterative repair of uterovaginal prolapse is limited, with most literature predating 2000. Significant variability exists in the operative techniques described, despite the established safety and efficacy of the procedure. Because meta-analysis was not possible owing to the absence of comparative trials, these consensus statements represent an important first step toward standardization. Further prospective and comparative research is needed to better define techniques and their impact on surgical outcomes in the modern age.