title: Systematic classification of uterine cervical elongation in patients with pelvic organ prolapse.
abstract: OBJECTIVE
  To define and classify cervical elongation, to compare uterine measurements after prolapse hysterectomy with a non-prolapse control group, and to associate stage of prolapse and degree of cervical elongation.
  
  
  METHODS
  This was a single-centre retrospective case-control study conducted at the University Hospital, Urogynaecological Unit, with a certified urogynaecological surgeon. Data were collected from patients with and without pelvic organ prolapse (POP) who underwent laparoscopically assisted vaginal hysterectomy. Post-hysterectomy uterine cervical elongation was examined using the corpus/cervix ratio (CCR), calculated from measurements taken on photographs. Cervical elongation was classified as physiological (grade 0, CCR>1.5) grade I (CCR>1 and ≤1.5) grade II (CCR>0.5 and ≤1), and grade III (CCR≤0.5).
  
  
  RESULTS
  Cervical elongation was detected in 288/295 (97.6%) patients in the prolapse group (grade I, 44/288 [15.2%]; grade II, 212 [73.6%]; grade III, 32 [11.1%]). Mean CCR was greater among those with stage II/III than among those with stage IV prolapse (1.0±0.4 vs. 0.8±0.2; p<0.001). Grades of cervical elongation and prolapse stages were associated (p<0.001). Grade I cervical elongation was detected in 26/69 (37.6%), grade II in 5/69, and grade III in 0/69 patients of the control group. Cervical elongation was found more often in the prolapse group compared to the control group (p<0.001). Mean total uterine length did not differ between the prolapse and control groups (8.0±1.6 vs. 8.2±1.3cm), but mean calculated cervical length was greater in the prolapse group than in the control group (4.4±1.1 vs. 3.1+0.8cm; p<0.001).
  
  
  CONCLUSIONS
  Uterine cervical elongation is found in patients undergoing hysterectomy for pelvic organ prolapse. Cervical elongation grades and prolapse stages are correlated. Defining uterine cervical elongation based on corpus/cervix ratio with grades I-III could be a valuable basic tool for further research.
authors.affiliation: Department of Gynaecology, Jena University Hospital, Friedrich-Schiller-University Jena, Germany.
authors.forename: Anke R
authors.initials: AR
authors.lastname: Mothes
authors.affiliation: Department of General, Visceral and Vascular Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Mothes
authors.affiliation: Department of Anatomy 1, Friedrich-Schiller-University Jena, Germany.
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Fröber
authors.affiliation: Department of Gynaecology, Jena University Hospital, Friedrich-Schiller-University Jena, Germany.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Radosa
authors.affiliation: Department of Gynaecology, Jena University Hospital, Friedrich-Schiller-University Jena, Germany. Electronic address: Direktion-Gyn@med.uni-jena.de.
authors.forename: Ingo B
authors.initials: IB
authors.lastname: Runnebaum
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000473:pathology* / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D014599:Uterus / Q000473:pathology
keywords: Pelvic organ prolapse; Prolapse hysterectomy; Uterine cervical elongation; Uterine corpus/cervix ratio