Manchester repair revised 2021

Question 1

How common is uterine prolapse in postmenopausal women

Answer 1

14%

Question 2

When is Manchester repair offered>

Answer 2

Cervical elongation
2nd or 3rd degree uterine prolapse who wish to preserve uterus/reproductive function

Question 3

Contraindications to uterine preserving surgery

Answer 3

Abnormal or PMB
Endometrial pathology
Hx of recurrent or current cervical dysplasia
Tamoxifen therapy
Hereditary nonpolyposis colonic cancer (40-50% risk endometrial cancer)
BRAC1 or BRAC 2
Unable to complete with routine gynae FU/surveillance

Question 4

Complications of Manchester repair

Answer 4

Haemorrhage
Bladder/bowel injury
Infection
Cervixal stenosis (haemometra/pyometra)
Cervical incompetence
Dyspareuina

Question 5

Steps of Manchester repair

Answer 5

1. Cervical dilatation and endometrial biopsy
2. Circumferential cervical incision
3. Securing cardinal complex
4. Amputation of the cervix
5. Insertion of Sturmdorf suture, plication of cardinal ligament followed by Fothergill suture

Anterior and posterior colporrhaphy if required

Question 6

Compare risks vaginal hysterectomy vs Manchester repair?

Answer 6

Recurrence POP higher after VH

No difference sexual function, QoL, urinary dysfunction

Less need of blood transfusion with MR