Effect of Endometrium Ablation in Cases of Submucous Uterine Myoma/s

Overview

Objective:
The evaluation of the effect of both transcervical resection of submucous myoma/s andendometrial ablation during the same procedure in patients with abnormal uterine bleeding.Design: Prospective clinical study.Setting: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University andGeneral Faculty Hospital in Prague, Czech Republic.Methods: 34 patients with submucous myoma/s were selected for both transcervical myoma/sresection and endometrial ablation as treatment for abnormal uterine bleeding. The average ageof the cohort was 44,3 years (29-66). Hysteroscopy, ultrasound scan or both techniques were usedto diagnose and classify myomas. In 34 patients were resected 52 myomas. In 21 (62%) patients 1myoma was resected, in 8 (34%) 2 and in 5 (14%) patients 3 submucous myomas were resected. Thehighest ESH (Eur. Society of Hysteroscopy) myomas classification was 0° in 29 (85%) patients andI° in 5 (15%) patients. The maximal size of resected myoma in cases with endometrial ablation was3 cm. Surgery was performed in early proliferative phase of menstrual cycle but in 2 (6%) casesthe endometrium was prepared with short term Danol administration. Purisol (sorbitol and mannitol) was used as a distention medium. Myomas were resected using loop high frequency electroendoresection technique, endometrium ablation was performed in 28 (82%) cases using thecombination of loop high frequency electroendoresection and "roller ballie coagulation" but 6 (18%)cases using loop technique only. "Follow upil" of the study is 51-2 months.Results: The hysteroscopical procedures were successfully performed in all cases without perioperative complications. The average operative time was 45 min. (15-60). We have not repeated theprocedure in any case. The bleeding was controlled in terms of amenorrhoea 7 (21%), hypomenorrhoea 18 (53%) or eumenorrhoea 9 (26%) in all 34 (100%) patients. In 2 (6%) patients we performedhysterectomy in the postoperative period (the indication for hysterectomy was the growing subserous myoma in both cases). Also in prevention of hysterectomy we were successfull in only 32(94%) patients.Conclusion: Hysteroscopic resection of submucous myoma/s in connection with endometrial ablation could be a modality of surgical management, an alternative of hysterectomy in cases ofuterine abnormal bleeding and where the small uterine myoma/s of the ESH 0° or I° classificationis found.

Key words:
uterus, bleeding, hysteroscopy, myoma, endometrium, resection