Hysteroscopic Treatment of Symptomatic Cesarean-induced Isthmocele: A Prospective Study

Raimondo, Gennaro; Grifone, G; Raimondo, Diego; Seracchioli, Renato; Scambia, Giovanni; Masciullo, Valeria

doi:10.1016/j.jmig.2014.09.011

Cited by 126 publications

(86 citation statements)

References 21 publications

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“…The mean reported reduction in spotting in one prospective and one retrospective cohort study varied between 2 and 4 days 15, 17. Two recent non‐comparative studies in 144 women reported a resolution of spotting in 80% of women; however, a reduction in the number of days of spotting was not reported 22, 23…”

Section: Discussionmentioning

confidence: 96%

“…The cut‐off value of the residual myometrium in various studies varies between 2.5 and 4.0 mm, as measured using sonohysterography 13, 22, 23…”

Section: Discussionmentioning

confidence: 99%

“…A hysteroscopic niche resection can be performed in different ways: the lower rim (closest to the external cervical os) can be resected to facilitate menstrual outflow (Figure1);14, 15, 16, 17 both the lower and the upper part of the niche can be resected;18, 19, 20, 21 and this can be combined with coagulation of the vessels in the niche,16, 18, 19, 20, 21 or the entire niche surface 14, 15. Previous cohort studies reported a reduction of postmenstrual spotting in 80–90% of women, and a reduction in pain in 97% of women, in the absence of complications 13, 22, 23. The mean reduction in the number of days of spotting compared with baseline was reported in two studies, and varied between 2 and 4 days in 119 women.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Vervoort

Voet

Hehenkamp

et al. 2017

BJOG

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ObjectiveTo compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect.DesignMulticentre randomised controlled trial.SettingEleven hospitals collaborating in a consortium for women's health research in the Netherlands.PopulationWomen reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3 mm, measured during sonohysterography.MethodsWomen were randomly allocated to hysteroscopic niche resection or expectant management for 6 months.Main outcome measuresThe primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of life, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation.ResultsWe randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2–7 days) in the intervention group and 7 days (IQR 3–10 days) in the control group (P = 0.04); on a scale of 0–10, discomfort as a result of spotting had a median score of 2 (IQR 0–7) in the intervention group, compared with 7 (IQR 0–8) in the control group (P = 0.02).ConclusionsIn women with a niche with a residual myometrium of ≥3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting‐related discomfort.Tweetable abstractA hysteroscopic niche resection is an effective treatment to reduce niche‐related spotting.

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Section: Discussionmentioning

confidence: 96%

“…The cut‐off value of the residual myometrium in various studies varies between 2.5 and 4.0 mm, as measured using sonohysterography 13, 22, 23…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Vervoort

Voet

Hehenkamp

et al. 2017

BJOG

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“…Gennaro Raimondo from Clinica Mediterranea, Naples, Italy, presented his experience on the hysteroscopic treatment of hystmocele [69], a uterine pathology localized exactly in the cervical canal, linked exclusively to Caesarean Section (CS), with a very characteristic symptom -postmenstrual spotting. Hystmocele is often confused with other diseases (hormonal imbalance or inflammation) which usually follows the unreasonable taking of drugs without solving the problem.…”

Section: Drmentioning

confidence: 99%

Nesa Days 2015, Conference Report

Tinelli¹

2015

Int. J. Gynecol. Obstet. & Neona. Care

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“…The most reported symptoms about isthmocele are postmenstrual spotting and infertility. The main risk factors are uterine incision closure techniques, suture materials, transverse lower uterine incision and wound healing [2]. The main reason for the increase in all these risk factors is increased cesarean rates.…”

Section: Introductionmentioning

confidence: 99%

A New Problem Arising After the Cesarean, Cesarean Scar Defect (Isthmocele) a Case Report

Nazık¹,

Nazik²

2017

OGIJ

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Background: Cesarean rates continue to increase all over the world. This has led to a particularly rapid increase in placenta-induced complications. A definition has emerged which is now called the new name istmosel, also called cesarean scar defect. Globally, the frequency is between 6.2% and 36%. Scar tissue in the old cesarean section causes problems such as menometrorrhagia, staining and infertility in patients. There are laparoscopic and hysteroscopic treatment approaches. Since there is a new terminology, there is no comprehensive publication in the literature to provide a general view on diagnosis and treatment. The primary treatment approach we offer in this case is laparoscopic surgery.Case Presentaion: A 37-year-old patient with gravida 2, parity 2, two previous cesarean section stories had complaints of continuing intermenstrual bleeding for 2 years. When the patient's examination and radiological evaluation is done, there was fluid accumulation in the old cesarean section.In the ultrasonographic examination; a dome-shaped fluid collection of about 2.3x1.4 cm was observed in the uterine lower segment anterior Wall. As a result, laparoscopic approach was decided for istmosel treatment. Conclusion:There is no consensus in the literature as to what type of suture or energy modality should be used to repair the isthmocele. In addition, there is no consensus on the superiority of double-layer suturing and superiority of the laparoscopic or hysteroscopic approach in cesarean scar repair.

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Hysteroscopic Treatment of Symptomatic Cesarean-induced Isthmocele: A Prospective Study

Cited by 126 publications

References 21 publications

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Nesa Days 2015, Conference Report

A New Problem Arising After the Cesarean, Cesarean Scar Defect (Isthmocele) a Case Report

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