Frequency of symptomatic cornual hematometra and postablation tubal sterilization syndrome after total rollerball endometrial ablation: A 10-year follow-up

McCausland, Arthur M.; McCausland, Vance M.

doi:10.1067/mob.2002.123730

Cited by 63 publications

(37 citation statements)

References 15 publications

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“…Conversely, the presence of an intramural leiomyoma, which is not removed during the hysteroscopic procedure, might interfere with the myometrium's ability to contract during menses if any endometrium remains or regenerates, increasing the probability of failure. Invariably, hysterectomy might also be recommended for symptoms other than bleeding [16,17] .…”

Section: Discussionmentioning

confidence: 99%

Perioperative Predictors of Successful Hysteroscopic Endometrial Ablation

Gemer

Kruchkovich²,

Huerta³

et al. 2006

Gynecol Obstet Invest

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Objective: To determine which perioperative factors influence the success of hysteroscopic endometrial ablation in patients with menorrhagia. Study Design: A longitudinal study of 128 women who underwent hysteroscopic endometrial ablation or resection. Clinical data included age, uterine size, the presence of intramural or submucosal myomas and polyps, and length of follow-up from initial hysteroscopic ablation to re-ablation or hysterectomy (‘failure’). Kaplan-Meier survival analysis, log-rank tests and Cox proportional hazard regression were used to evaluate the equality of survival distributions and to model the overall effects of the various predictor variables on surgical outcomes. Results: Patients were followed for a median time of 44 months. Thirteen women (10.2%) underwent a second operative procedure. Multivariate analysis identified submucosal myoma as a statistically significant positive predictor of the risk of failure [hazard ratio (HR) 5.22, 95% confidence interval (CI) = 1.63, 16.73)]. Older age was associated with a marginally lower risk of subsequent surgery (HR 0.90 per additional year of age, 95% CI = 0.81, 1.00). Conclusions: The presence of submucosal myoma increases the risk of subsequent surgery in patients undergoing endometrial ablation.

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Section: Discussionmentioning

confidence: 99%

Perioperative Predictors of Successful Hysteroscopic Endometrial Ablation

Gemer

Kruchkovich²,

Huerta³

et al. 2006

Gynecol Obstet Invest

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“…Most cases of PATSS discussed in the literature were complications of first-generation resectoscopic ablation procedures such as the rollerball endometrial ablation [1][2][3][4][5][6][7][8]. A 10 % incidence of symptomatic hematometra and PATSS were diagnosed primarily after total rollerball endometrial ablation [5].…”

Section: Discussionmentioning

confidence: 99%

“…Table 1 shows published cases of PATSS documented by histopathology. Majority of cases occurred after rollerball endometrial ablation/resection technique [1][2][3][4][5][6][7][8], one case post-microwave endometrial ablation [12] and one case after thermal balloon endometrial ablation [13].…”

Section: Discussionmentioning

confidence: 99%

Post-ablation tubal sterilization syndrome following NovaSure endometrial ablation: two case reports

et al. 2012

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Endometrial ablation procedures are extensively used for the treatment of menorrhagia on premenopausal patients who failed medical therapy. The increasing popularity of safe, effective, less invasive, nonresectoscopic global endometrial ablation procedures could potentially increase the incidence of unusual adverse outcomes. Postablation tubal sterilization (PATSS) is one of these delayed complications, which could be challenging to diagnose. PATSS is a complication that potentially occurs following a global endometrial ablation in women with previous tubal sterilization. PATSS presents as cyclic pelvic pain caused by tubal distention from occult bleeding into the obstructed tubes. Review of the literature shows that majority of PATSS occurred after rollerball resection and ablation. We report two cases of PATSS after NovaSure® radiofrequency endometrial ablation.Keywords Post-ablation tubal sterilization syndrome, PATSS . Novasure . Endometrial ablation . Tubal ligation . Pelvic pain Case report no. 1A 47-year-old woman (gravida 3, para 3) had a 4-year history of cyclic pelvic pain primarily on the left side. Due to a long history of menorrhagia with resulting anemia, in spite of medical therapy, the patient underwent an endometrial ablation in 2007 using NovaSure® radiofrequency energy (Hologic, USA). The patient had a laparoscopic tubal ligation with bipolar coagulation in 1993 with another provider. The patient was referred by her primary care physician because of the patient's complaints of chronic pelvic pain and severe dysmenorrhea, which started a few months after the Novasure® endometrial ablation. The pelvic ultrasound showed a 2.0-cm left-sided hydrosalpinx, but the right ovary was not identified. The patient had an unremarkable medical and gynecological history.Physical examination revealed a soft abdomen without rebound or guarding. Bimanual examination showed a normal-size uterus but elicited cervical motion tenderness and bilateral adnexal tenderness primarily on the left side. Her vital signs were stable.Laboratory results showed a normal white blood cell count and urinalysis. Serum pregnancy test was negative. Genital cultures with gonorrhea and chlamydia were negative.On laparoscopy, both tubes were approximately 2-0-cm dilated. The uterus and bilateral ovaries appeared normal. The left hydrosalpinx was identified (Fig. 1). Endometrial lesions were absent. Laparoscopic bilateral salpingectomy and pelvic adhesiolysis were performed using Gyrus PKS™ advanced bipolar forceps.She was discharged home the same day, and her postoperative course was without incident. The final pathological diagnosis reported bilateral sterile hydrosalpinx. Case report no. 2A 42-year-old woman (gravida 3, para 3) presented to the Emergency Department with complaints of right lower quadrant pain, watery vaginal discharge, fever, and chills. The patient had NovaSure endometrial ablation 6 weeks

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“…This mechanism is responsible for the occurrence of synechiae in 40 % of women submitted to total TCER [2] that may limit the access to the uterine cavity, hematometra, that usually localizes in the fundus of the uterus, or obstruction of the cornual area in 13 % of cases [11,22,23]. The persistence in these obstructed areas of islands of endometrial tissue may cause retrograde menstruation or symptomatic cornual hematometra, with an incidence of even 18 %, causing painful distention of the uterus [24]. The potential of all these complications may limit the clinical efficacy of hysteroscopic TCER and can require hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Proposal of a modified transcervical endometrial resection (TCER) technique for menorrhagia treatment. Feasibility, efficacy, and patients’ acceptability

et al. 2014

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The aim of this study is to evaluate the feasibility, efficacy, safeness, and patients' acceptability of a modified transcervical endometrial resection (TCER) technique for the treatment of menorrhagia. Eighty-four premenopausal women with menorrhagia after careful investigation and 2 months therapy with GnRHa underwent a modified TCER. It was performed with a standard dual channel, 26 French irrigating resectoscope (Karl Storz, GmbH, Germany) after cervix dilatation to 10 mm and sorbitol mannitol solution used as distension medium. The modified technique was based on the resection of the endometrium and of the first myometrial layers only on the anterior and posterior walls, without treating fundus and cornual areas as usually performed. Endometrial resection was performed to a depth of 4 to 5 mm. Clinical and hysteroscopic follow-up was performed for 60 months. Early and late complications, changing in bleeding patterns, and patients' satisfaction were recorded. Sixty-four out of 73 patients that completed the 60 months improved. Eumenorrhea was achieved in 68.5 %, hypomenorrhea in 5.5 %, and amenorrhea in 13.7 %. Most of the patients (86.3 %) showed satisfaction at the follow-up interview. Control hysteroscopy showed that post modified TCER uterine cavity maintained the possibility of macroscopic and histopathology investigation during follow-up. Modified TCER is a technique easy to perform and effective in the long-term resolution of menorrhagia. In particular, it avoids the formation of synechiae and the shrinkage of the uterine cavity that may be the cause of various long-term complications, such as the delay in the diagnosis of endometrial carcinoma onset.

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Frequency of symptomatic cornual hematometra and postablation tubal sterilization syndrome after total rollerball endometrial ablation: A 10-year follow-up

Cited by 63 publications

References 15 publications

Perioperative Predictors of Successful Hysteroscopic Endometrial Ablation

Perioperative Predictors of Successful Hysteroscopic Endometrial Ablation

Post-ablation tubal sterilization syndrome following NovaSure endometrial ablation: two case reports

Proposal of a modified transcervical endometrial resection (TCER) technique for menorrhagia treatment. Feasibility, efficacy, and patients’ acceptability

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