Cervical Stenosis: A Challenging Clinical Entity (original) (raw)
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Asian Journal of case reports in surgery, 2024
Cervical stenosis can be congenital or acquired. Acquired causes could be through obliteration by mass effect or iatrogenically following cervical surgeries or more importantly in the tropics by cephalad extension of severe acquired gynaetresia induced by per vagina insertion of various corrosive agents for treatment of gynaecological ailments or for postpartum vaginal tightening. This is a case report of severe cervical occlusion as part of severe acquired gynaetresia with nonvisualization of the cervix even after vaginal reconstructive surgery presenting with amenorrhoea.
Archives of Gynecology and Obstetrics
Background To date hysteroscopy is the gold standard technique for the evaluation and management of intrauterine pathologies. The cervical canal represents the access route to the uterine cavity. The presence of cervical stenosis often makes entry into the uterine cavity difficult and occasionally impossible. Cervical stenosis has a multifactorial etiology. It is the result of adhesion processes that can lead to the narrowing or total obliteration of the cervical canal. Purpose In this review, we summarize the scientific evidence about cervical stenosis, aiming to identify the best strategy to overcome this challenging condition. Methods The literature review followed the scale for the quality assessment of narrative review articles (SANRA). All articles describing the hysteroscopic management of cervical stenosis were considered eligible. Only original papers that reported data on the topic were included. Results Various strategies have been proposed to address cervical stenosis, i...
Risk factors for cervical stenosis after loop electrocautery excision procedure
Obstetrics and Gynecology, 2000
The following abstracts are taken from journals of interest to our readers and are reviewed by Charles J. Dunton CJD), Thomas M. Julian (TMJ), Daron G. Ferris (DGF), L. Stewart Massad (LSM), Kenneth L. Noller (KLN), and Leo B. Twiggs (LBT). Conservative Management of Adenocarcinoma In Situ of the Cervix CH Shin, JO Schorge, KR Lee, EE Sheets Gynecol Oncol 2000;79:6-10
The cervical stenosis syndrome with a review of 83 patients treated by operation
International Orthopaedics, 1982
The cervical stenosis syndrome is defined from clinical considerations and the functional and organic groups are described. A classification of the causes of the syndrome is then discussed and presented in tabular form. Functional stenosis is best treated by conservative measures but organic stenosis requires operation.
Cervical Stenosis - An Unusual Clinical Presentation
COJ Nursing & Healthcare, 2018
Outflow tract obstruction of female genital tract can lead to varied presentations depending on many factors. Most of the obstructions are congenital and usually occur in the lower part. A rare case of obstruction of cervical opening is reported. 37 years old lady with two previous cesarean deliveries reported with complaints of lower abdominal pain along with difficulty in passing urine, she was detected to have a lower abdominal lump. Imaging studies suggested retention cyst. Examination under anesthesia showed obliterated external cervical opening. Dilatation resulted in extrusion of large quantity of chocolate material. She made good postoperative recovery but the cause of cervical stenosis was not clear.
Towards safe and efficient cervical dilatation
Mini-invasive Surgery
Aim: Traditional methods of cervical dilatation such as Hegar rods and laminaria are associated with the damage leading to the risk of cervical incompetence or require two sessions with higher risk of infections. In this study, a new dilator based on expanding triple balloons is assessed. Methods: Cervical dilation with the triple balloon was evaluated in 15 women with various indications. After measuring the diameter of the cervix the triple balloon was inserted and inflated for 5-7 min and thereafter measured again. Results: This time was sufficient to achieve the diameter of 4.5-9.5 mm which allowed performing all planned procedures without any need for further dilatation except for one case with cervical stenosis. Conclusion: Further studies are needed, but the triple dilating balloon might become the optimal dilatation method for universal use.
Impact of endocervical surgical margin in the treatment of dysplastic cervical lesions
European Journal of Gynaecological Oncology, 2020
Aim of the study: To describe the impact of endocervical margin involvement after cervical CO2 laser conization and to report the risks factors for positive margin and patterns of subsequent management. Methods: Clinical and pathological data of 2863 patients who underwent treatment were retrospectively reviewed. Data were obtained from consecutive patients treated from January 1990 to June 2019 at the Department of Gynecology and Obstetrics of Spedali Civili of Brescia. We used Chi-square test with significance defined at p < 0.05 to explore the results. Further, we described the "cylindrical" technique for cervical CO2 laser conization. Results: Endocervical margin involvement was found in 152 patients (5.3%), while 1795 patients with negative endocervical margin were available for followup (62.7%), the remaining were lost to follow-up. The risk factors for endocervical margin involvement were the grade of the lesion (p < 0.001), age (p < 0.001), extension to the cervical canal (p < 0.001); presence of moderate intraoperative bleeding (p = 0.04) and lack of preoperative antibiotic prophylaxis (p = 0.05). Among patients with positive endocervical margin, 21 patients (13.8%) with invasive lesion underwent definitive treatment (Group 1), 30 patients (Group 2) underwent hysterectomy or reconization, while intensive followup was offered to 101 patients (Group 3). Only 91 patients were available for follow-up in Group 3. The treatment failure/recurrence in the latter group (n = 91) of patients was higher when compared to patients (n = 1795) with negative endocervical margin (14.3% versus 6.7%; p = 0.01). Conclusion: Endocervical margin involvement after CO2 laser conization is a predictor of treatment failure/recurrence of disease. Risk factors for endocervical margin involvement should be subject of prospective multicenter studies.
Risk factors for cervical stenosis after laser cone biopsy
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2002
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 ΒΌ 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 AE 26 months after surgery. Two hundred and thirtyeight 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 1 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. #