<![CDATA[Apical prolapse associated with cervical elongation is a complex condition requiring correction of both apical support and excessive cervical length. We report a 45-year-old woman presenting with a vaginal bulge and abnormal uterine bleeding for more than four years. Examination revealed stage IV apical prolapse with cervical elongation, accompanied by grade II cystocele and rectocele. Transvaginal ultrasonography demonstrated a 7.9 × 7.5 × 9.7 cm intramural uterine myoma (FIGO type 2–5) and a cervical length of 5.5 cm. Cervical cytology was negative for intraepithelial lesion or malignancy (NILM). The patient no longer desired pregnancy but wished to preserve sexual function with a low risk of recurrence. An abdominal supracervical hysterectomy was performed. Following maximal upward traction of the cervical stump toward the sacral promontory, cervical elongation remained evident, with the portio positioned <5 cm proximal to the hymenal ring. A Manchester procedure was performed to correct the cervical elongation, followed by abdominal sacrocervicopexy (ASC) using mesh. The final cervical position was approximately 7 cm proximal to the hymenal ring. At 3-month and 1-year follow-up, cervical position was maintained without prolapse recurrence or mesh erosion. Combined ASC and the Manchester procedure may represent an alternative surgical approach in selected patients with apical prolapse and cervical elongation, addressing both anatomical defects while considering preservation of vaginal anatomy and sexual function.]]>
