OBJECTIVE: Research suggests that the resectoscopic management of abnormal uterine bleeding (AUB) following cesarean section (CS) is safe and effective. There is, however, a lack of complementary data from routine clinical practice. We aimed to evaluate the efficacy of resectoscopic remodeling of the CS scar in the management of post CS AUB (pCSAUB). STUDY DESIGN: The case notes of 57 women with pCSAUB who had undergone a resectoscopic remodeling procedure were reviewed retrospectively. Primary outcome measures were the duration of preoperative and postoperative menstruation, and postoperative menstrual change. Secondary outcome measures were the impact of patient-dependent variables on the success of the resectoscopic remodeling procedure. The CS scar was located using transvaginal ultrasonography and hysteroscopy. The remodeling procedure was performed with a hysteroscopic resectoscope, and commenced with resection of the fibromuscular scar. This started at the roof of the scar pouch and progressed towards the external os. It then continued along a line parallel to the axis of the cervical canal. The exposed dilated blood vessels and endometrial-like tissue in the roof of the remaining pouch were electrocauterized with a roller-ball electrode. RESULTS: The mean operating time was 30.2 ± 6.6 min. There was a significant difference in the mean duration of preoperative and postoperative menstruation (12.9 ± 2.9 days and 9.4 ± 4.1 days, respectively; p < 0.001). However, only 59.6% of patients (34/57) reported a postoperative improvement in symptoms. A significant postoperative improvement was observed more frequently in patients with anteflexed uteri than in patients with retroflexed uteri, and this difference was significant (90.6% (29/32) and 20.0% (5/25), respectively; p < 0.001). No correlations were found between treatment outcome and age, body weight, parity, number of cesarean deliveries, duration of preoperative menstruation, or operating time. CONCLUSIONS: Resectoscopic uterine remodeling is an appropriate therapy in patients with pCSAUB and an anteflexed uterus.
OBJECTIVE: Research suggests that the resectoscopic management of abnormal uterine bleeding (AUB) following cesarean section (CS) is safe and effective. There is, however, a lack of complementary data from routine clinical practice. We aimed to evaluate the efficacy of resectoscopic remodeling of the CS scar in the management of post CS AUB (pCSAUB). STUDY DESIGN: The case notes of 57 women with pCSAUB who had undergone a resectoscopic remodeling procedure were reviewed retrospectively. Primary outcome measures were the duration of preoperative and postoperative menstruation, and postoperative menstrual change. Secondary outcome measures were the impact of patient-dependent variables on the success of the resectoscopic remodeling procedure. The CS scar was located using transvaginal ultrasonography and hysteroscopy. The remodeling procedure was performed with a hysteroscopic resectoscope, and commenced with resection of the fibromuscular scar. This started at the roof of the scar pouch and progressed towards the external os. It then continued along a line parallel to the axis of the cervical canal. The exposed dilated blood vessels and endometrial-like tissue in the roof of the remaining pouch were electrocauterized with a roller-ball electrode. RESULTS: The mean operating time was 30.2 ± 6.6 min. There was a significant difference in the mean duration of preoperative and postoperative menstruation (12.9 ± 2.9 days and 9.4 ± 4.1 days, respectively; p < 0.001). However, only 59.6% of patients (34/57) reported a postoperative improvement in symptoms. A significant postoperative improvement was observed more frequently in patients with anteflexed uteri than in patients with retroflexed uteri, and this difference was significant (90.6% (29/32) and 20.0% (5/25), respectively; p < 0.001). No correlations were found between treatment outcome and age, body weight, parity, number of cesarean deliveries, duration of preoperative menstruation, or operating time. CONCLUSIONS: Resectoscopic uterine remodeling is an appropriate therapy in patients with pCSAUB and an anteflexed uterus.
Authors: Ajmw Vervoort; L F van der Voet; Wjk Hehenkamp; A L Thurkow; Pjm van Kesteren; H Quartero; W Kuchenbecker; M Bongers; P Geomini; Lhm de Vleeschouwer; Mha van Hooff; H van Vliet; S Veersema; W B Renes; K Oude Rengerink; S E Zwolsman; Ham Brölmann; Bwj Mol; Jaf Huirne Journal: BJOG Date: 2017-07-05 Impact factor: 6.531
Authors: Ana Vegas Carrillo de Albornoz; Irene López Carrasco; Nerea Montero Pastor; Carmen Martín Blanco; María Miró Matos; Luis Alonso Pacheco; Enrique Moratalla Bartolomé Journal: Int J Fertil Steril Date: 2019-04-27
Authors: Sanne I Stegwee; Astrid Beij; Robert A de Leeuw; Lidwine B Mokkink; Lucet F van der Voet; Judith A F Huirne Journal: Qual Life Res Date: 2019-12-16 Impact factor: 4.147
Authors: A J M W Vervoort; L F Van der Voet; M Witmer; A L Thurkow; C M Radder; P J M van Kesteren; H W P Quartero; W K H Kuchenbecker; M Y Bongers; P M A J Geomini; L H M de Vleeschouwer; M H A van Hooff; H A A M van Vliet; S Veersema; W B Renes; H S van Meurs; J Bosmans; K Oude Rengerink; H A M Brölmann; B W J Mol; J A F Huirne Journal: BMC Womens Health Date: 2015-11-12 Impact factor: 2.809