Excision of elongated cervix during reconstructive surgery in patients with pelvic organ prolapse – pro et contra

Abstract

Aim. To determine whether the cervical elongation affects long-term outcomes of reconstructive surgery of pelvic organ prolapse.Materials and Methods. We consecutively enrolled 99 patients with grade 2-3 pelvic organ prolapse (Pelvic Organ Prolapse Quantification System) who underwent vaginal mesh surgery. Volume and length of the cervix were measured using vaginal ultrasonography immediately before the surgery. Cervical elongation was defined as cervix > 6 cm in length (n = 55). Upon 1 year of follow-up, we evaluated the primary outcome (pelvic organ prolapse) and secondary outcomes (cervical length and volume).Results. After 1 year of follow-up, cervical elongation was still detected in 18.1% of patients with cervical elongation before the surgery but not in those without (p = 0.008). Dyspareunia was documented in 14.5% and 2.2% of women with and without cervical elongation, respectively (p = 0.034). In patients with cervical elongation, the length of the cervix before the surgery and after 1 year of follow-up was 7.6 (7; 7.9) cm and 8.4 (7.9; 8.9) cm, respectively (p = 0.001); the respective values of cervical volume were 23.7 (23.4; 24.4) cm3 and 26.9 (25.7; 31.9) cm3 , respectively (p = 0.001); however, these differences were insignificant in patients without cervical elongation.Conclusion. Cervical excision may be recommended for the patients with pelvic organ prolapse and concurrent cervical elongation (length of the cervix > 6 cm). Cervical preservation in such patients may lead to progression of the elongation even after the correction of pelvic organ prolapse.