Outcomes after hysteroscopic repair of symptomatic isthmocele: a single center experience in Ukraine

Abstract

Рurpose of the study was to evaluate the influence of Isthmocele (IC) hysteroscopic repair on symptoms (abnormal uterine bleeding, dysmenorrhea) in premenopausal patients with residual myometrium thickness more than 2.4 mm and to assess myometrial thickness 3, 6 and 12 month post surgery. Materials and methods. It was a prospective case series of symptoms evaluation and myometrium thickness following hysteroscopic IC repair in premenopausal women not willing to conceive. Diagnosis of IC was based on 2D transvaginal ultrasound and symptom evaluation. Symptom frequency and residual myometrium thickness by ultrasound were evaluated before hysteroscopic repair and after 3, 6 and 12 months after it in patients with IC as single possible cause of symptoms. Results. In the period from January 2017 to January 2018 there were 32 cases of symptomatic IC in premenopausal women. 8 (25%) of them had coexisting uterine pathology that could cause AUB, these women were not included in hysteroscopic treatment efficacy analysis. Thus 24 patients with residual myometrium thickness of more than 2.4mm and not willing to conceive underwent hysteroscopic repaire of IC. Three months after surgery, most patients reported a complete relief of symptoms: abnormal uterine bleeding reduced from 33.3% (8 patients) to 4.2% (1 patient); intermenstrual bleeding form 75% (18 patients) to 12.5% (3 patients); dysmenorrhea – from 91.7% (22 patients) to 29.2 (7 patients). This effect was even more prominent after 6 and 12 months. Average residual myometrium thickness values changed in the following way: 3.6 ± 0.9 before surgery; 4.9 ± 1.2 mm after 3 months; 5.9 ± 1.0 mm after 6 month and 6.5 ± 1.1 mm after 12 months. Conclusion. Hysteroscopic repair of IC is a technically feasible, safe and highly effective procedure for symptoms (abnormal uterine bleeding, pelvic pain, dysmenorrhea) in women with other uterine pathology excluded and not willing to conceive. Efficacy and specific features technical performance and medical treatment in cases with coexisting adenomyosis and other uterine pathology are to be defined in future studies as such cases are frequent.

Keywords

• isthmocele
• transvaginal ultrasound
• adenomyosis
• abnormal uterine bleeding
• dysmenorrhea
• hysteroscopy