Early second-look flexible hysteroscopy is effective for the treatment of asherman's syndrome

Fumino, T.; Teranishi, A.; Wakimoto, Eiko; Hamai, H.; Kuwata, A.; Shigeta, Minoru

doi:10.1016/j.fertnstert.2007.07.764

Cited by 5 publications

(10 citation statements)

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“…Of these studies, one study [ 43 ] included IUD therapy as a single ancillary treatment and 25 studies used IUD with Foley catheter, hyaluronic acid gel, hormonal therapy, or amnion graft. Two additional studies [ 44 , 45 ] were identified from citations in these publications and were included for review. Among them 5 studies [ 12 , 19 , 30 , 32 , 33 ] were eligible for meta-analysis due to the same applied type of IUD (Lippes loop) and 3-months-follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…Characteristics of the included studies are given ( Table 1 ). In our systematic review the classification systems used included ( Table 2 ) those from the American Fertility Society [ 9 , 16 , 27 , 28 , 34 – 36 , 41 , 44 , 45 ], European Society of Gynaecological Endoscopy [ 7 , 29 , 39 ], American Society for Reproductive Medicine [ 11 ], European Society of Hysteroscopy [ 29 , 38 ], European Society of Human Reproduction and Embryology [ 45 ], modified Sugimoto criteria [ 13 ], and the March classification system [ 18 ]. Three studies [ 7 , 29 , 45 ] reported the stages of adhesion using 2 classification systems; however, several studies [ 8 , 12 , 19 , 30 – 33 , 37 , 42 , 43 ] did not provide any information of the classification system used.…”

Section: Resultsmentioning

confidence: 99%

“…In 2 studies [ 44 , 45 ], no therapy was administered after adhesiolysis. Surgical instruments and techniques used for adhesiolysis included uterine sound [ 19 , 39 ], with uterine dilators [ 7 , 29 , 32 ], mechanical D&C [ 44 ], hysteroscopic scissors [ 9 , 13 , 16 , 18 , 34 , 35 , 38 – 40 ], hysteroscopic, monopolar, or bipolar knife/needle [ 29 , 34 , 39 , 45 ], and bipolar electrosurgery system [ 7 , 16 , 39 , 45 ]. Twenty-five studies [ 7 – 9 , 11 – 13 , 16 , 18 , 19 , 27 – 42 ] used IUD in combination with at least one other ancillary treatment.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of Intrauterine Device in the Treatment of Intrauterine Adhesions

Salma

Xue

Sheikh

et al. 2014

BioMed Research International

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The primary purpose of this paper is to assess the efficacy of the use of the intrauterine device (IUD) as an adjunctive treatment modality, for intrauterine adhesions (IUAs). All eligible literatures were identified by electronic databases including PubMed, Scopus, and Web of Science. Additional relevant articles were identified from citations in these publications. There were 28 studies included for a systematic review. Of these, 5 studies were eligible for meta-analysis and 23 for qualitative assessment only. Twenty-eight studies related to the use of IUDs as ancillary treatment following adhesiolysis were identified. Of these studies, 25 studies at least one of the following methods were carried out as ancillary treatment: Foley catheter, hyaluronic acid gel, hormonal therapy, or amnion graft in addition to the IUD. There was one study that used IUD therapy as a single ancillary treatment. In 2 studies, no adjunctive therapy was used after adhesiolysis. There was a wide range of reported menstrual and fertility outcomes which were associated with the use of IUD combined with other ancillary treatments. At present, the IUD is beneficial in patients with IUA, regardless of stage of adhesions. However, IUD needs to be combined with other ancillary treatments to obtain maximal outcomes, in particular in patients with moderate to severe IUA.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Efficacy of Intrauterine Device in the Treatment of Intrauterine Adhesions

Salma

Xue

Sheikh

et al. 2014

BioMed Research International

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“…Fumino et al in an abstract recommended early second look with a flexible hysteroscope in the office setting. 34 In a similar abstract, Swedarsky et al looked at following patients postoperatively with serial flexible hysteroscopy in the office setting. 35 In this series of 22 patients, the mean number of follow-up procedures was three.…”

Section: Diagnosismentioning

confidence: 99%

Intrauterine Adhesions

Berman

2008

Semin Reprod Med

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Joseph Asherman first described intrauterine adhesions in 1948. It is commonly referred to as Asherman's syndrome and intrauterine synechiae. It is characterized by a spectrum ranging from amenorrhea to menstrual disturbance to normal menses. It is frequently associated with infertility. The true incidence is unknown. Most cases occur within close temporal proximity to a pregnancy, usually within 4 months and usually while the woman is in a hypoestrogenized state. Most cases are associated with trauma to the endometrium from surgical procedures, primarily curettage. Increasingly, cases are associated with myomectomy both abdominal and hysteroscopic, removal of septae, and any other intrauterine surgery. Pathology shows fibrous connective tissue bands with or without glandular tissue, although this may range from filmy to dense. The diagnosis is primarily by history and a high index of suspicion. Confirmatory tests are increasingly saline infusion hysterography (SIS) or hysterosalpingogram (HSG), although magnetic resonance imaging has also been used. Ultimately, hysteroscopy is employed for the final diagnosis and treatment. Hysteroscopic lysis of adhesions is the main method of treatment. Dense scar tissue and difficult entry into the cervix may require laparoscopic or ultrasound guidance. Most authors use an intrauterine stent and follow treatment with sequential estrogen and progesterone therapy. Increasingly early intervention either with repeat SIS or HSG or most recently with flexible hysteroscopy has been advocated. Treatments outcomes are difficult to assess as there are no universally agreed upon classification system. However, intrauterine pregnancies rates range from 22 to 45% and live births range from 28 to 32%. The risk of complications for those that achieve pregnancy is significant with a significant risk for placenta accreta and subsequent blood loss, transfusion, and hysterectomy. Prospective controlled studies are needed to determine the best diagnostic and treatments for intrauterine adhesions.

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“…[3] In developed countries follow-up using HSG has been replaced with office hysteroscopy using small 3-mm flexible hysteroscope. [24] The Minimally Invasive Surgical Unit of the department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital (AKTH), Kano acquired a hysteroscope in 2006 which became functional in 2007. Because of this most IUA treatment procedures are being done hysteroscopically since 2007.…”

Section: Introductionmentioning

confidence: 99%