title: Does the uterine cervix become abnormally reinnervated after subtotal hysterectomy and what is the association with future trachelectomy?
abstract: OBJECTIVE
  To compare nerve fiber density in the cervices removed by trachelectomy from women with pelvic pain with those cervices removed for nonpain indications.
  
  
  METHODS
  Retrospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  Two university hospitals.
  
  
  METHODS
  Subjects who underwent trachelectomy during a 10-year time frame were identified.
  
  
  METHODS
  Two tissue sections were obtained from each preserved cervix specimen and stained for S100 antibody. The numbers of S100-immunoreactive peripheral nerve fibers were assessed in 6 high-powered fields (HPFs) per tissue section (12 total HPFs per patient). Information collected included patient characteristics and surgical findings. We excluded any patients with dysplasia/cancer and those without an available adequate specimen.
  
  
  RESULTS
  We evaluated the cervix specimens from 35 patients who underwent trachelectomy for pain (n = 25, group 1) and nonpain (n = 10, group 2) indications in addition to control cervices (n = 15, group 3) from benign hysterectomies performed for nonpain indications. There were increased numbers of nerve fibers in trachelectomy patients with pain versus those without pain (group 1 vs group 2, p = .02). There were also increased numbers of nerve fibers in both trachelectomy groups compared with the control group (group 1 vs group 3, p < .01; group 2 vs group 3, p = .04). Adjusted average cervical nerve counts/HPF were 17.8 (95% confidence interval [CI], 13.2-22.3) for pain-indicated trachelectomies, 11.5 (95% CI, 4.8-18.2) for nonpain, and 6.3 (95% CI, 0.8-11.8) for controls. Regardless of trachelectomy indication, adjusted average nerve counts/HPF were 17.7 (95% CI, 13.4-22.0) for patients with endometriosis and 14.6 (95% CI, 12.2-17.1) for patients without endometriosis.
  
  
  CONCLUSIONS
  Nerve fibers in the cervical stump after supracervical hysterectomy are significantly increased in women undergoing trachelectomy for pain indications compared with those who underwent trachelectomy for nonpain indications and controls. Although not statistically significant, endometriosis may be an independent risk factor for increased nerve fibers. These histopathologic observations may support the idea that the cervix should be removed in women undergoing hysterectomy for chronic pelvic pain or endometriosis.
authors.affiliation: Vanderbilt Medical Center, Nashville, Tennessee. Electronic address: Amanda.yunker@vanderbilt.edu.
authors.forename: Amanda
authors.initials: A
authors.lastname: Yunker
authors.affiliation: Vanderbilt Medical Center, Nashville, Tennessee.
authors.forename: Howard
authors.initials: H
authors.lastname: Curlin
authors.affiliation: University of North Carolina Medical Center, Chapel Hill, North Carolina.
authors.forename: Natalie
authors.initials: N
authors.lastname: Banet
authors.affiliation: Vanderbilt Medical Center, Nashville, Tennessee.
authors.forename: Oluwole
authors.initials: O
authors.lastname: Fadare
authors.affiliation: University of North Carolina Medical Center, Chapel Hill, North Carolina.
authors.forename: John
authors.initials: J
authors.lastname: Steege
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000294:innervation* / Q000601:surgery; D059350:Chronic Pain / Q000601:surgery; D004715:Endometriosis / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D017699:Pelvic Pain / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Endometriosis; Nerve; Pain; Subtotal hysterectomy; Trachelectomy