Risk factors for cervical stenosis after laser cone biopsy.
OBJECTIVE
To evaluate the incidence of cervical stenosis after laser cone biopsy and to identify risks factors for this adverse outcome.


METHODS
Prospective study evaluating all patients (n = 375) treated by laser cone biopsy for suspected cervical intraepithelial neoplasia between 1 January 1990 and 31 December 1996. Patients were contacted by mail for a clinical evaluation, 37 +/- 26 months after surgery. Two hundred and thirty-eight patients (63%) reply to this clinical follow-up examination including colposcopy, cervical smear and evaluation of cervical stenosis. Cervical stenosis was defined as cervical os narrowing preventing the insertion of a cotton swab.


RESULTS
Forty patients (16.8%) had cervical stenosis at follow-up. The risk of postoperative cervical stenosis increases when patients were older (mean age of women with stenosis 42 years versus 35 years; P < 0.0001), when the depth of surgical excision increases (mean surgical specimen height 18.2 mm in women with stenosis versus 15.9 mm; P < 0.01), when preoperative junction was endocervical (2.5; 95% confidence interval (CI) 1.4-4.7), when vaginal packing was necessary (2.4; 95% CI 1.4-4.2), and when continuous laser mode was used (2.1; 95% CI 1.2-3.7). Stenosis incidence was lower when human papilloma virus (HPV) was present on cervical biopsy (0.47; 95% CI 0.3-0.8), when women were smokers (0.48; 95% CI 0.3-0.9), and when a Surgicel compress was placed in the excision site (0,4; 95% CI 0.2-0.8). Patient age was the only significant independent predictor of stenosis identified by a multivariate analysis using logistic regression.


CONCLUSIONS
Patient with advanced age should be counselled regarding the risks for cervical stenosis after laser cone biopsy. Other surgical options may be considered when patient age exceeds 40 years.
Department of Obstetrics, Gynaecology Fetal Medicine and Human Reproduction, Bretonneau University Hospital, 2 boulevard Tonnelle, 37044 Tours, France.
Sandra
S
Houlard
Franck
F
Perrotin
Florence
F
Fourquet
Henri
H
Marret
Jacques
J
Lansac
Gilles
G
Body
D000328:Adult; D000367:Age Factors; D002584:Cervix Uteri / Q000821:virology; D003127:Colposcopy; D019092:Conization / Q000009:adverse effects* / Q000379:methods*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007834:Lasers; D016015:Logistic Models; D027383:Papillomaviridae / Q000302:isolation & purification; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking; D002577:Uterine Cervical Diseases / Q000209:etiology* / Q000473:pathology; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology