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International Urogynecology Journal

Published in:

01-09-2014 | Original Article

Does traction on the cervix under anaesthesia tell us when to perform a concomitant hysterectomy? A 2-year follow-up of a prospective cohort study

Authors: Chendrimada Madhu, Richard Foon, Wael Agur, Phillip Smith

Published in: International Urogynecology Journal | Issue 9/2014

Abstract

Introduction and hypothesis

Variations exist in urogynaecological practice to decide on hysterectomy in managing prolapse. This study evaluates the outcomes of uterine preservation during anterior colporrhaphy with apparent uterine descent with cervical traction under anaesthesia. We hypothesize that cervical traction should not be used to assess uterine prolapse.

Methods

Thirty-five women opting for surgery for symptomatic anterior prolapse (≥ stage 2) with no uterine prolapse (point C at −3 or above) were recruited. “Validated cervical traction” was applied under anaesthesia. Only an anterior repair was performed. Incontinence Modular Questionnaire Vaginal Symptoms (ICIQ-VS) questionnaires were used for follow-up. Wilcoxon test was used for statistical analysis.

Results

Stage 2 uterine prolapse (POPQ) was demonstrated in all women with traction under anaesthesia. Follow-up was possible in 29 women, 5 did not respond and 1 needed a hysterectomy at 6 months (2.86 %, 95 % CI 0.07–14.91 %). The mean follow-up time was 23 months (range: 13–34 months). There was a significant reduction in the ICIQ-VS scores from 22.7 (pre-operative) to 7.97 at 23 months (p < 0.001) and a significant improvement in the quality of life scores (4.3 to 1.86; p < 0.0001). There was also a significant reduction in the complaint of a bulge in the vagina (question 5a—ICIQ-VS; 2.91 to 0.89; p < 0.0001).

Conclusions

The “cervical traction” test seems unnecessary, and the decision for a hysterectomy should be based on examination findings in the clinic. Larger RCTs are needed to evaluate cervical traction in the assessment of prolapse.

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Title: Does traction on the cervix under anaesthesia tell us when to perform a concomitant hysterectomy? A 2-year follow-up of a prospective cohort study
Authors: Chendrimada Madhu
Richard Foon
Wael Agur
Phillip Smith
Publication date: 01-09-2014
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 9/2014
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-014-2361-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Does traction on the cervix under anaesthesia tell us when to perform a concomitant hysterectomy? A 2-year follow-up of a prospective cohort study

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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