Transcervical resection of endometrium: A novel mode of management of patients with abnormal uterine bleeding with chronic kidney disease and renal transplant recipients

Abstract

Objective: Abnormal uterine bleeding (AUB), especially in cases with chronic kidney diseases (CKDs) have a significant impact on physical, social, economic, and material quality of life of women. The objective of this study was to evaluate the efficacy, change in menstrual pattern, and patient satisfaction after transcervical resection of endometrium (TCRE) in women with AUB and CKD who underwent or were awaiting renal transplant and nonrespondents to medical management. Materials and Methodology: Eleven women with CKD (either underwent renal transplant or on dialysis) and AUB who did not respond to medical management underwent TCRE. The study period was 5 years. The main outcome measures were change in menstrual status, level of satisfaction with the procedure, and the need for repeat TCRE or hysterectomy. Results: The average age of the patients was 44.9 years. Out of the 22 women enrolled, 11 responded to medical management and only the remaining 11 women required TCRE. All 11 women underwent hysteroscopic-guided biopsy, and their histopathological reports revealed nonmalignant status. The average operating time for TCRE was 21.5 ± 8.02 min. Postoperatively 9 (81.81%) women had achieved amenorrhea while 2 (18.18%) developed oligomenorrhea. The duration from TCRE to amenorrhea ranges between 7 and 60 days with an average of 31.54 days. None of the women required hysterectomy. Conclusion: TCRE is clinically and cost effective alternative to medical management or hysterectomy in women with AUB and CKD. The cost-effectiveness, work performance, rapid convalescence, and improved the quality of life provide TCRE a “distinct edge” over the definitive management – hysterectomy.

Keywords

• Abnormal uterine bleeding
• chronic kidney disease
• hysterectomy
• renal transplant
• transcervical resection of endometrium