Obliterative versus Reconstructive Surgery for Advanced Pelvic Organ Prolapse in Older Women: A Systematic Review for Preference-Sensitive Surgical Decision-Making.

This systematic review asks whether obliterative surgery (e.g., colpocleisis) or reconstructive surgery is preferable for older women with advanced pelvic organ prolapse across safety, durability, urinary, bowel, and patient-reported outcomes. Across 29 reports, obliteration consistently shortened operative time and often reduced blood loss and recurrence-related reoperation, but global complications, anatomical superiority, and functional outcomes were not clearly different. The authors conclude that evidence is most reliable for lower procedural burden (low certainty), while other outcomes remain very low certainty, supporting preference-sensitive counseling.