Current Issue

Volume 13, Number 2, Jul-Sep 2019 Pages: 108-112

Outcomes after Hysteroscopic Treatment of Symptomatic Isthmoceles in Patients with Abnormal Uterine Bleeding and Pelvic Pain: A Prospective Case Series


Ana Vegas Carrillo de Albornoz, M.D, 1, Irene López Carrasco, Ph.D, 1, *, Nerea Montero Pastor, M.D, 1, Carmen Martín Blanco, M.D, 1, María Miró Matos, M.D, 1, Luis Alonso Pacheco, M.D, 2, Enrique Moratalla Bartolomé, M.D, 1, 3,
Department of Obstetrics and Gynecology, University Hospital HM Montepríncipe, Madrid, Spain
Department of Gynaecological Endoscopy, Gutenberg Center, Xanit International Hospital, Malaga, Spain
Department of Obstetrics and Gynecology, University Hospital Ramón y Cajal, Madrid, Spain
*Corresponding Address: Department of Obstetrics and Gynecology University Hospital HM Montepríncipe Madrid Spain Email:ire.lopez.carrasco@gmail.com

Abstract

Background

Isthmoceles are described as complications associated with caesarean section (CS). Only symptomatic isthmoceles should be treated. The main symptoms are abnormal uterine bleeding (AUB) in the absence of any other causes, pelvic pain and secondary infertility. There are several techniques described for the correction of isthmoceles. Isthmoplasty can be performed by hysteroscopy, laparoscopy or vaginal surgery. The aim of this study was to assess the effectiveness of hysteroscopic surgical treatment of isthmoceles in women with associated symptoms such as pelvic pain and AUB.

Materials and Methods

A prospective case series study was performed; this study included all women with AUB, pelvic pain and ultrasonographic (US) diagnosis of isthmocele, who had undergone hysteroscopic correction between June 2014 and December 2017 in our Hospital.

Results

Thirty eight women underwent surgical hysteroscopy for correction of symptomatic isthmoceles. All patients presented AUB, 42.1% experienced pelvic pain and 28.9% had secondary infertility. US evaluation of isthmoceles was performed using 2D ultrasound. The residual myometrial thickness (RMT) above the isthmocele was measured in women who expected future pregnancy; if it was <2.5 mm the patient was not included in the study because the cor- rection was performed laparoscopically. Follow-up was performed one and two months after the surgery. In all cases, pelvic pain was resolved one month after the surgery. AUB disappeared within the first month in 87.5% of patients and in the second month in 96.8% of subjects; however, one patient needed further surgery to alleviate her symptoms. Secondary infertility was assessed one year after surgical isthmoplasty. Seven women completed the first year of fol- low up, and three of them (42.8%) reported pregnancy after treatment between six and eight months after the surgery.

Conclusion

Hysteroscopic correction of symptomatic isthmoceles may constitute a safe and effective technique for patients who present AUB and pelvic pain.