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Putting POP-Q to the test: does C − D = cervical length?

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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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References

  1. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  2. Rogers RM, Richardson AC. Clinical evaluation of pelvic support defects with anatomic correlations. In: Bent AE, Ostergard DR, Cundiff GW, Swift SE, editors. Ostergard's urogynecology and pelvic floor dysfunction. Philadelphia: Lippincott Williams & Wilkins; 2003.

    Google Scholar 

  3. Ibeanu OA, Chesson RR, Sandquist D, Perez J, Santiago K, Nolan TE. Hypertrophic cervical elongation: clinical and histological correlations. Int Urogynecol J. 2010;21:995–1000.

    Article  PubMed  Google Scholar 

  4. Berger MB, Rajeev R, Guire KE, Delancy JOL. Is cervical elongation associated with pelvic organ prolapse? Int Urogynecol J. 2012;23:1095–103.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dancz CE, Werth L, Sun V, Lee S, Walker D, Özel B. Comparison of the POP-Q examination, transvaginal ultrasound, and direct anatomic measurement of cervical length. Int Urogynecol J. 2014;25:457–64.

    Article  PubMed  Google Scholar 

  6. Geoffrion R, Louie K, Hyakutake MT, Koenig NA, Lee T, Filipenko JD. Study of prolapse-induced cervical elongation. J Obstet Gynaecol Can. 2016;38(3):265–9.

    Article  PubMed  Google Scholar 

  7. Persu C, Chapple CR, Cauni V, Gutue S, Geavlete P. Pelvic Organ Prolapse Quantification System (POP-Q) – a new era in pelvic prolapse staging. J Med Life. 2011;4(1):75–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Boonstra H, Oosterhuis JW, Oosterhuis AM, Fleuren GJ. Cervical tissue shrinkage by formaldehyde fixation, paraffin wax embedding, section cutting and mounting. Virchows Arch A Pathol Anat Histopathol. 1983;402(2):195–201.

    Article  CAS  PubMed  Google Scholar 

  9. Mothes AR, Mothes H, Frober R, Radosa MP, Runnebaum IB. Systematic classification of uterine cervical elongation in patients with pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol. 2016;200:40–4.

    Article  PubMed  Google Scholar 

  10. Vierhout ME, Stoutjesdijk J, Spruijt J. A comparison of preoperative and intraoperative evaluation of patients undergoing pelvic reconstructive surgery for pelvic organ prolapse using the pelvic organ prolapse quantification system. Int Urogynecol J. 2005;17:46–9.

    Article  Google Scholar 

  11. Teleman P, Laurikainen E, Kinne I, Pogosean R, Jakobsson U, Rudnicki M. Relationship between the Pelvic Organ Prolapse Quantification system (POP-Q), the Pelvic Floor Impact Questionnaire (PFIQ-7), and the Pelvic Floor Distress Inventory (PFDI-20) before and after anterior vaginal wall prolapse surgery. Int Urogynecol J. 2015;26:195–200.

    Article  CAS  PubMed  Google Scholar 

  12. Finamore PS, Goldstein HB, Vakili B. Comparison of estimated cervical length from the pelvic organ prolapse quantification exam and actual cervical length at hysterectomy: can we accurately determine cervical elongation? J Pelvic Med Surg. 2009;15:17–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwell Health at Hofstra North Shore-LIJ School of Medicine, Great Neck, NY, USA

    Kathryn S. Williams, Marjorie L. Pilkinton & Harvey A. Winkler

  2. Biostatistics, Feinstein Institute for Medical Research, Manhasset, NY, USA

    Lisa Rosen

  3. Department of Obstetrics and Gynecology, Northwell Health at Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA

    Laura Dhariwal

Authors
  1. Kathryn S. Williams
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  2. Lisa Rosen
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  3. Marjorie L. Pilkinton
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  4. Laura Dhariwal
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  5. Harvey A. Winkler
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Corresponding author

Correspondence to Kathryn S. Williams.

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Conflicts of interest

Harvey A. Winkler, MD, is a consultant for Kimberly Clarke and Boston Scientific and an expert witness for Johnson & Johnson. All other authors report no conflicts of interest.

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Williams, K.S., Rosen, L., Pilkinton, M.L. et al. Putting POP-Q to the test: does C − D = cervical length?. Int Urogynecol J 29, 881–885 (2018). https://doi.org/10.1007/s00192-017-3464-7

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  • DOI: https://doi.org/10.1007/s00192-017-3464-7

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