Does Colpocleisis Still Hold Value? The Evolution of Apical Prolapse Surgery: A Comparative National Database Study

<b>Background/Objectives:</b> Pelvic organ prolapse (POP) is a common condition that significantly affects quality of life. Obliterative surgery, such as colpocleisis, represents an alternative to reconstructive surgery with a historically established background. The trends in apical prolapse surgery have undergone substantial changes following FDA warnings. This study aims to analyze the trend of obliterative surgery within the context of apical POP surgery in the German healthcare system, considering global shifts, particularly following FDA warnings. <b>Methods</b>: A comprehensive analysis of in-patient data from the German Federal Statistical Office was carried out for the period between 2005 and 2021. The study included a total of 530,107 procedures, each classified by specific codes. Linear regression analysis was applied to identify and characterize trends in surgical patterns. <b>Results</b>: The trends in obliterative surgery showed a significant decline over the years (<i>p</i> < 0.001), particularly notable in older women. In contrast, a significant increasing trend was observed in the proportion of abdominal surgeries relative to the total number of procedures over time (<i>p</i> < 0.001), especially in the younger age group. <b>Conclusions</b>: Surgical trends over the specified timeframe highlight the notable evolution of POP management. Despite observed global fluctuations, obliterative surgery in Germany appeared to follow a declining trend in the changing mesh era, shaped by varying perspectives on the matter. The shifting global trend should be closely monitored and considered in urogynecological training.