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.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK, drmadhuck@gmail.com.
authors.forename: Chendrimada
authors.initials: C
authors.lastname: Madhu
authors.forename: Richard
authors.initials: R
authors.lastname: Foon
authors.forename: Wael
authors.initials: W
authors.lastname: Agur
authors.forename: Phillip
authors.initials: P
authors.lastname: Smith
mesh_terms: D000758:Anesthesia; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000175:diagnosis*; D011446:Prospective Studies; D014143:Traction