Postoperative Outcomes of the Manchester-Fothergill Procedure: Cervical Cytology Adequacy and Transformation Zone Accessibility: A Prospective Cohort Study.

INTRODUCTION AND HYPOTHESIS: The Manchester-Fothergill procedure has re-emerged as a uterus-preserving surgical option for pelvic organ prolapse, particularly in women with cervical elongation. However, postoperative anatomical changes may affect the cervical assessment and screening performance. This study aimed to evaluate the adequacy of cervical smears and the accessibility of the transformation zone after the Manchester procedure. METHODS: This prospective cohort study was conducted at a tertiary center between May 2025 and February 2026. Women who underwent the Manchester procedure (n = 24) were compared with age- and menopausal status-matched controls (n = 51). The primary outcomes were smear adequacy and the presence of endocervical cells. The secondary outcomes included the transformation zone type, HPV DNA status, and colposcopic findings. Cytology was evaluated using the Bethesda System, and transformation zone classification followed International Federation for Cervical Pathology and Colposcopy criteria. Statistical analyses used chi-square or Fisher's exact tests for categorical variables and Student's t-test or the Mann-Whitney U test for continuous variables. RESULTS: Smear adequacy was high and comparable between the groups (95.8% vs. 92.2%, p > 0.05). Cytological findings and HPV-DNA status did not differ (p > 0.05). Endocervical cell presence was significantly lower postoperatively (62.5% vs. 96.1%, p < 0.001). The type 3 transformation zone was more frequent after surgery (25.0% vs. 5.9%, p = 0.026), indicating reduced accessibility. Colposcopy was performed more frequently postoperatively (33.3% vs. 2.0%, p < 0.001). No increase in abnormal cytology was observed. CONCLUSIONS: The Manchester procedure preserves smear adequacy but alters the cervical anatomy, reducing the accessibility of the transformation zone. These changes may limit the sensitivity of cytology. HPV-DNA-based or combined screening may improve diagnostic accuracy in women with limited access to the transformation zone.