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Deldar Pesikhani M, Ghanbari Z, Eftekhar T, Kazemi M, Nassiri S, Sabzi Shahrbabaki F, Ghaemi M. Long-term outcomes and quality of life after Manchester procedure for pelvic reconstructive surgery in women with cervical elongation. Eur J Obstet Gynecol Reprod Biol 2023; 289:152-157. [PMID: 37678128 DOI: 10.1016/j.ejogrb.2023.08.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/03/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Native-tissue techniques for Pelvic Organ Prolapse (POP) repairs, such as the Manchester Procedure (MP), have recently been revitalized. However, there are conflicting opinions regarding correcting cervical elongation support by the MP, and the risk of possible poor outcomes and postoperative complications. Therefore, this study aimed to investigate anatomical and patient-reported outcomes during one year after MP. DESIGN Prospective cohort study. SETTING This study was conducted on women who underwent the MP for cervical elongation between 2010 and 2020. PATIENTS Women with apical compartment prolapse up to stage 3 due to cervical elongation. INTERVENTIONS Manchester Procedure. MEASUREMENTS Pre and postoperative evaluations by POP Quantification (POP-Q) system were performed, and patients filled out the quality-of-life questionnaires including Pelvic Floor Distress Inventory Short Form 20 (PFDI-20), and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and 12 months after the procedure. Anatomical outcomes were measured by POP-Q and the changes in POP-related symptoms were evaluated and reported. MAIN RESULTS 33 participants were recruited in the study. Significant anatomical improvements were obtained in all compartments after the surgery. After 12 months in POP-Q examination, the mean (±SD) of Ba was changed from +1.82 (±1.71) to -1.18 (±1.50), C was changed from -1.25 (±2.81) to -6 (±1.82), and D from -6.30 (±1.42) to -7.1 (±1.25) respectively (P < 0.001). POP-Q stage 0-1 was obtained inof7% in the apical compartment (C < -1), but only in 45.4% in the anterior compartment (Ba < -1). A significant reduction in symptom scores was obtained for PFDI-20 (P < 0.01) and PISQ-12 (P = 0.011). CONCLUSIONS Our findings suggest that the MP provides adequate apical support with improvement in anatomic and subjective findings for patients with cervical elongation.
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Affiliation(s)
- Maryam Deldar Pesikhani
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zinat Ghanbari
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Tahereh Eftekhar
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Kazemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saina Nassiri
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Sabzi Shahrbabaki
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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García-Mejido JA, Ramos Vega Z, Armijo Sánchez A, Fernández-Palacín A, Fernández CB, Sainz Bueno JA. Interobserver variability of ultrasound measurements for the differential diagnosis of uterine prolapse and cervical elongation without uterine prolapse. Int Urogynecol J 2021. [PMID: 34618192 DOI: 10.1007/s00192-021-04980-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/13/2021] [Indexed: 10/30/2022]
Abstract
OBJECTIVES Our study aims to determine the interobserver variability of different ultrasound measurements (pubis-cervix distance, pubis-uterine fundus distance, and pubis-Douglascul-de-sac distance) previously analyzed for the ultrasound differential diagnosis of uterine prolapse (UP) and cervical elongation CE without UP. MATERIALS AND METHODS We conducted a prospective observational study with 40 patients scheduled to undergo surgical correction of UP and CE without UP. All patients underwent pelvic floor ultrasound examination by an examiner (E1) who acquired ultrasound images. Using these images, E1 measured the distances for the ultrasound differential diagnosis of UP and CE without UP, and these distances were compared with those measured by the other examiner (E2). Values were analyzed by calculating ICCs with 95% CIs. RESULTS For UP, excellent reliability was obtained for all measurements except the pubis-Douglascul-de-sac measurement at rest, which was moderate (ICC 0.596; p = 0.028) and for the difference between the pubis-Douglascul-de-sac measurement at rest and during the Valsalva maneuver, which was good (ICC 0.691; p < 0.0005). For CE without UP, interobserver reliability was excellent for all measurements analyzed except the pubis-cervix measurement during the Valsalva maneuver, which was moderate (ICC 0.535; p = 0.052) and for the pubis-Douglascul-de-sac measurement at rest, which was good (ICC 0.768; p < 0.0005). CONCLUSIONS There is excellent interobserver reliability in measurements of the difference in the distance from the pubic symphysis to the uterine fundus at rest and during the Valsalva maneuver for both UP and CE without UP, which are used for the ultrasound differential diagnosis of UP and CE without UP.
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Seçkin KD, Kadiroğulları P, Kıyak H, Doğan AR, Tapısız ÖL. The manchester procedure combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling. J Turk Ger Gynecol Assoc 2021; 23:219-221. [PMID: 34109740 PMCID: PMC9450923 DOI: 10.4274/jtgga.galenos.2021.2021.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This video will demonstrate a minimally invasive technique, in which the Manchester procedure was combined with laparoscopic sacrohysteropexy by retroperitoneal tunneling in patients with uterine prolapse and cervical elongation who wished to preserve the uterus. The principle steps and techniques to complete the operation are dictated in the video. The prolapse surgery was performed uneventfully, and the uterus was restored to its anatomical position. During the two years of follow-up, there were no complications from the prolapse or mesh-related events. No prolapse recurrence was observed. This technique facilitates uterine-sparing surgery, results in less bleeding and shorter operative time, and we believe that it may reduce the recurrence of prolapse due to the elongation of the cervix.
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Affiliation(s)
- Kerem Doğa Seçkin
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Pınar Kadiroğulları
- Department of Obstetrics and Gynecology, Acıbadem Mehmet Ali Aydınlar University Atakent Hospital, İstanbul, Turkey
| | - Hüseyin Kıyak
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Ali Rıza Doğan
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Ömer Lütfi Tapısız
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Onigahara M, Yanazume S, Ushiwaka T, Togami S, Kamio M, Kobayashi H. Importance of Cervical Elongation Assessment for Laparoscopic Sacrocolpopexy. Gynecol Minim Invasive Ther 2021; 10:127-131. [PMID: 34040975 PMCID: PMC8140543 DOI: 10.4103/gmit.gmit_114_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 11/04/2022] Open
Abstract
Cervical elongation in patients with pelvic organ prolapse (POP), who previously underwent laparoscopic sacrocolpopexy (LSC), is not fully understood. We report a case of a second surgery for endometrial cancer complicated with POP recurrence, which seemed to be related to cervical elongation following LSC. A 65-year-old woman was referred for invasive treatment following LSC. Although preoperative endometrial cytology was negative, the resected uterine specimen revealed endometrioid carcinoma. The patient also had complications of cervical prolapse with cystocele Stage III. Repeat surgery was performed with a trachelectomy, anterior-posterior colporrhaphy, and vaginal apex suspension. Mesh had been adequately sutured to the upper cervix in the previous surgery, and the resected cervix was elongated up to 9 cm. Cervical elongation may be correlated with the inaccurate preoperative endometrial examination, and it may also promote POP recurrence leading to a poorly supported pelvic floor. We suggest that cervical elongation should be identified before POP surgery.
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Affiliation(s)
- Mikihisa Onigahara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Shintaro Yanazume
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Takashi Ushiwaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Masaki Kamio
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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Moegni F, Hakim S, Hidayah GN, Suskhan, Priyatini T, Meutia AP, Santoso BI. Cervical elongation caused by big cervical fibroid resembling malignant cervical prolapse? Management via vaginal surgery. Int J Surg Case Rep 2021; 82:105847. [PMID: 33838487 PMCID: PMC8045036 DOI: 10.1016/j.ijscr.2021.105847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cervical elongation could lead to cervical elongation thus worsen the descent of uterine prolapse. In certain cases, this hypertrophic and hyperplastic mass could have fragile surface with some bleeding and necrotic, resembling cervical cancer. As case of cervical elongation due to cervical fibroid is quite rare, such cases are valuable to be reported. We present two cases of cervical fibroid with cervical elongation resembling cervical malignancy. PRESENTATION OF CASE First case was A 59-year-old lady with intractable vaginal mass since one day before admission. Bleeding from the mass was positive. We found a bulky vaginal mass exceeding hymenal ring, 14 × 7 × 6 cm sized, with some necrotic and discharge, foul smelling, and some bleeding area. Ultrasound evaluation revealed a cervical fibroid with differential diagnosis cervical malignancy. The second case was Mrs 53-year-old with vaginal mass since last year. For the last 7 months the mass has been bigger and could not be inserted into vagina, with some bleeding. We found globular vaginal mass 12 × 9 × 6 cm exceeding hymenal ring, with some necrotic and reddish surface, foul smelling, discharge, and some blood. Ultrasound evaluation revealed cervical mass on anterior lip with elongated cervices. Both cases have been menopaused. As the clinical presentation resembling malignancy, we did biopsy. The biopsy results were no evidence of malignancy, then we did Manchester fothergill, and colporaphy as needed. DISCUSSION Length between internal to external cervical ostium ≥ 5 cm correlated to cervical elongation. Growing cervical mass could drag the cervix, predisposing to cervical elongation and prolapse. Cervical fibroids protruded through vagina was usually pedunculated. But in our cases, the fibroids were not pedunculated but manifested as a bulky mass on the cervical tissue with some bleeding and necrotics, mimicking cervical malignancy. The most important initial management besides ultrasound evaluation was mass biopsy. CONCLUSION In such cervical fibroids with cervical elongation resembling cervical malignancy, biopsy is compulsory to determine the diagnosis and to lead the management.
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Affiliation(s)
- Fernandi Moegni
- Urogynecology Division Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Surahman Hakim
- Urogynecology Division Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Gita Nurul Hidayah
- Urogynecology Division Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Suskhan
- Urogynecology Division Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tyas Priyatini
- Urogynecology Division Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Alfa Putri Meutia
- Urogynecology Division Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Budi Iman Santoso
- Urogynecology Division Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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García-Mejido JA, Ramos-Vega Z, Armijo-Sánchez A, Fernández-Palacín A, García-Jimenez R, Sainz JA. Differential diagnosis of middle compartment pelvic organ prolapse with transperineal ultrasound. Int Urogynecol J 2021; 32:2219-2225. [PMID: 33484288 DOI: 10.1007/s00192-020-04646-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to identify the best parameter (pubis-cervix measurement, pubis-uterine fundus measurement or pubis-pouch of Douglas measurement) on transperineal ultrasound, based on the difference between measurements taken at rest and with the Valsalva maneuver, for presurgical differential diagnosis between uterine prolapse (UP) and cervical elongation (CE) without UP. METHODS A prospective observational study of 60 consecutively recruited patients who underwent corrective surgery of the middle compartment (UP or CE without UP). A transperineal ultrasound was performed, and the descent of the pelvic organ was measured in relation to the posteroinferior margin of the pubis in the midsagittal plane, referencing the uterine fundus, pouch of Douglas and the cervix at rest and with the Valsalva test. RESULTS Receiver operating characteristic (ROC) curves were constructed for the three evaluated measures, based on the difference between rest and Valsalva, for the diagnosis of UP. For the pubis-cervix distance, an area under the curve (AUC) of 0.59 was obtained; for the pubis-uterine fundus distance, the AUC was 0.81; and for the pubis-pouch of Douglas distance, the AUC was 0.69. Based on the best AUC (the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver), a cut-off point of 15 mm was established for the diagnosis of UP (sensitivity: 75%; specificity: 95%; positive predictive value: 86%; and negative predictive value: 89%). CONCLUSION A difference of ≥15 mm in the pubis-uterine fundus distance at rest and with the Valsalva maneuver is useful for differentiating UP from CE without UP by ultrasound.
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Affiliation(s)
- José Antonio García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain.
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain.
| | - Zenaida Ramos-Vega
- Department of Obstetrics and Gynecology, Nuestra Señora de la Merced Hospital, Seville, Spain
| | | | - Ana Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - Rocío García-Jimenez
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
| | - José Antonio Sainz
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
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Alay I, Kaya C, Karaca I, Yildiz S, Cengiz H, Ekin M, Yasar L. Diagnostic value of preoperative ultrasonography, cervical length measurement, and POP-Q examination in cervical elongation estimation. Int Urogynecol J 2020; 31:2617-2623. [PMID: 32653969 DOI: 10.1007/s00192-020-04426-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/01/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Cervical elongation (CE) has not been clearly defined and has similar symptoms to pelvic organ prolapse. We aimed to evaluate the diagnostic value of preoperative POP-Q examinations, ultrasonographic measurements, and direct cervical length measurement with a Foley catheter in predicting CE on postoperative hysterectomy specimens. METHODS Fifty-six patients who underwent vaginal hysterectomy for apical pelvic organ prolapse were included. The patients were divided into two groups based on the hysterectomy specimens' corpus/cervix ratio (CCR) as follows: the non-CE group, CCR > 1; the CE group, CCR < 1. The preoperative direct cervical length measurement was performed using 10-French Foley catheters. The recommended cutoff values and sensitivity/specificity analysis of the cervical measurements with Foley, ultrasound, and C-D measurements according to POP-Q were determined by the receiver-operating characteristic analysis. RESULTS There were 13 patients (23%) in the non-CE group and 43 patients (76%) in the CE group. The mean cervical measurements with Foley catheter and ultrasound, C-D diameter, and postoperative cervix measurements were 49.4 ± 12.6 mm, 42.14 ± 9.4 mm, 41.4 ± 17.2 mm, and 49.5 ± 13 mm, respectively. Cervical measurement with a Foley catheter had 65% sensitivity and 62.5% specificity with a 47.5-mm cutoff value. Among these preoperative measurements, Foley catheter measurements were the most compatible with postoperative cervical measurements. There was no significant association between CE and age, body mass index, menopause duration, point C, and point D. CONCLUSION Cervical length measurement with a Foley catheter may be preferred for estimation of CE.
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Affiliation(s)
- Ismail Alay
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, Istanbul, Turkey.
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, Istanbul, Turkey
| | - Ibrahim Karaca
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sukru Yildiz
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, Istanbul, Turkey
| | - Huseyin Cengiz
- Department of Obstetrics and Gynecology, Istanbul Aydın University Faculty of Medicine, Istanbul, Turkey
| | - Murat Ekin
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, Istanbul, Turkey
| | - Levent Yasar
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Tevfik Saglam Street, No: 11, Zuhuratbaba, Bakirkoy, Istanbul, Turkey
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Nosti PA, Gutman RE, Iglesia CB, Park AJ, Tefera E, Sokol AI. Defining Cervical Elongation: A Prospective Observational Study. J Obstet Gynaecol Can 2019; 39:223-228. [PMID: 28413041 DOI: 10.1016/j.jogc.2016.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Our primary aim was to define cervical elongation (CE) using the following methods: (1) measurement of pathology specimen, (2) physician perception, (3) intraoperative estimate of anterior cervical length, and (4) office Pelvic Organ Prolapse Quantification (POP-Q) points C and D. Our secondary aim was to determine whether these definitions correlate with perioperative outcomes. METHODS Women undergoing vaginal hysterectomy and prolapse repair were enrolled. Office POP-Q measurements were collected. Estimates of cervical length were made based on points C minus D of the POP-Q and by manual exam using the surgeon's index and middle fingers. Cervical dimensions were measured from the pathology specimen at the end of the case. CE was defined as one standard deviation (SD) above the mean for each definition. Additional intraoperative data was collected to determine the surgeon perception of cervical anatomy. RESULTS A total of 90 patients were enrolled during the study period. Our definitions for CE were as follows: (1) 5 cm (70 without and 20 with CE), (2) physician perception (67 without and 23 with CE), (3) 3.4 cm (79 without and 11 with CE), and (4) 8.3 cm (77 without and 13 with CE). After controlling for uterine weight and the presence of fibroids, the operative time was the only outcome measure that remained elevated for patients with CE using our first definition (42.4 ± 20.1 without vs. 53.8 ± 19.2 with CE, P = 0.03). CONCLUSIONS CE using our first definition was associated with a statistically significant increase in operative time in women undergoing hysterectomy at the time of prolapse repair.
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Affiliation(s)
- Patrick A Nosti
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Women and Infants' Services, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC.
| | - Robert E Gutman
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Women and Infants' Services, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC
| | - Cheryl B Iglesia
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Women and Infants' Services, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC
| | - Amy J Park
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Women and Infants' Services, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC
| | - Eshetu Tefera
- Department of Biostatistics and Epidemiology, Medstar Health Research Institute, Hyattsville, MD
| | - Andrew I Sokol
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Women and Infants' Services, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC
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Wang H, Kira Y, Hamuro A, Takase A, Tachibana D, Koyama M. Differential gene expression of extracellular-matrix-related proteins in the vaginal apical compartment of women with pelvic organ prolapse. Int Urogynecol J 2018; 30:439-446. [PMID: 29600404 DOI: 10.1007/s00192-018-3637-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/08/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is a multifactorial disorder that impairs the quality of life (QoL) of older women in particular. The purpose of this study was to elucidate the pathogenesis of POP by focusing on the extracellular matrix (ECM). METHODS Patients were classified into two groups-with or without cervical elongation-using the POP quantification system. Specimens were obtained from 29 women with POP during hysterectomy. The expression of fibulin-5, elastin, integrin β1 (ITGβ1), lysyl oxidase-like protein-1 (LOXL1) and collagen in the vagina, uterosacral ligament, and uterine cervix was investigated by quantitative real-time polymerase chain reaction (RT-PCR) and correlation between gene levels and severity of POP examined. The location of proteins was analyzed using immunohistochemical staining and expression of fibulin-5 protein analyzed by Western blotting. RESULTS Fibulin-5 and elastin were mainly expressed in lamina propria and fibromuscular layers of the vagina and uterosacral ligament. Gene levels of fibulin-5 and ITGβ1 in uterosacral ligaments increased with severity of POP in women with cervical elongation, while no correlation was observed in women with a normal cervix. In women with uterine cervical elongation, each ECM-related gene significantly increased with POP staging. Furthermore, fibulin-5 protein also increased in the uterosacral ligament and uterine cervix. CONCLUSIONS The severity of POP and gene expression of ECM-related proteins were inversely correlated in vaginal tissue in a normal and elongated cervix. These results suggested that the differing progression of the two types of POP have a relationship with ECM-related protein.
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Affiliation(s)
- Haijiao Wang
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yukimi Kira
- Department of Research Support Platform, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihiro Hamuro
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Aki Takase
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Daisuke Tachibana
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masayasu Koyama
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
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Williams KS, Rosen L, Pilkinton ML, Dhariwal L, Winkler HA. Putting POP-Q to the test: does C - D = cervical length? Int Urogynecol J 2018; 29:881-5. [PMID: 28871354 DOI: 10.1007/s00192-017-3464-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/18/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We investigated the correlation between calculated cervical length (CCL) and gross specimen cervical length (GCL) after total vaginal hysterectomy (TVH) at the time of surgery for pelvic organ prolapse (POP). METHODS This was a retrospective chart review of patients who had undergone TVH with reconstructive surgery for POP between 2013 and 2015. Patients without an intact specimen or documented cervical length in the pathology report were excluded. CCL was defined as the absolute difference between Pelvic Organ Prolapse Quantification (POP-Q) points C and D. GCL was obtained from the pathology report as the distance from the external to the internal os. The Bland-Altman method was used to assess the accuracy of POP-Q measurements with a priori ranges. Symptom severity was evaluated using the PFDI-20 questionnaire. Analysis of variance was used to model both GCL and CCL as a function of prolapse stage and the leading compartment. RESULTS The final analysis included 202 subjects. Of the CCL measurements, 56.93% were within ±2 cm of GCL, while 36.14% were within ±1 cm. POP stage was significantly associated with GCL (P < 0.0024). CCL was significantly longer in patients with stage 4 POP (3.57 cm, 95% CI 3.13-4.00) than in those with stage 2 POP (P < 0.0017; mean 2.68 cm, 95% CI 2.45-2.92) and stage 3 POP (P < 0.0300; mean 2.94 cm, 95% CI 2.73-3.15). There were no significant correlations between PFDI scores and CCL or GCL. CONCLUSIONS The agreement between POP-Q CCL (|C - D|) and GCL decreases with increasing POP-Q stage. There was no correlation between POP symptom severity and GCL or CCL. GCL significantly increased with increasing POP stage.
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Geoffrion R, Louie K, Hyakutake MT, Koenig NA, Lee T, Filipenko JD. Study of Prolapse-Induced Cervical Elongation. J Obstet Gynaecol Can 2016; 38:265-9. [PMID: 27106197 DOI: 10.1016/j.jogc.2016.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The cervix often appears to be elongated in women with pelvic organ prolapse (POP). This can pose surgical challenges. MRI evidence has suggested that prolapsed cervices are significantly longer than those in normal controls. Our objective was to compare cervical length in surgical hysterectomy specimens from women with symptomatic POP with the length in specimens from women with other benign gynaecological conditions. METHODS In this pilot, prospective, case-control study, hysterectomy specimens were collected at St. Paul's Hospital, Vancouver, BC, between 2013 and 2015. Recorded patient demographics were age at the time of hysterectomy, any prior history of cervical dysplasia, and reason for hysterectomy. Specimens from women in whom the indication for hysterectomy was POP were compared with the specimens from women with other benign gynaecological conditions. Specimens were excluded if there was a history of cervical dysplasia because we could not verify whether women had undergone previous procedures resulting in cervical shortening. After bivalving each uterus, cervical and total uterine lengths were measured by staff pathologists, and the ratios of cervical length to total uterine length were calculated. Measurements in the two hysterectomy groups were compared using linear regression. RESULTS Seventy-seven specimens were collected, 52 from women with POP and 25 from women without POP. The most common indication for hysterectomy in women without POP was uterine fibroids. Women with POP were on average older than women without POP (mean 58.5 years vs. 47.8 years, P < 0.001). The ratio of cervical length to total uterine length in women with POP was 0.10 higher (95% CI 0.03, 0.16; P = 0.005) than in women without POP. CONCLUSION Women with symptomatic POP have significantly higher ratios of cervical length to total uterine length than women without POP.
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Affiliation(s)
| | | | | | | | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, Vancouver BC
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