Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility

Abstract

Isthmocele occurs after cesarean section, a common method of delivery and one of the most frequent surgical procedures, so that its upward incidence appears likely to continue in the near future. Because of its minimal invasiveness, resectoscopy may be the better choice for treatment, yielding good therapeutic results.

Cesarean scar abscess: A case report and a review of the literature

“…So far, many surgical techniques have been proposed to correct Cesarean scar dehiscence. Of these, wedge excision of the Cesarean scar dehiscence either by laparotomy or laparoscopy [8] and a resectoscopic treatment called "isthmoplasty" were reported to be successful [1]. As wedge excision of a Cesarean scar can result in postoperative adhesion, which might affect the patient's fertility, a hysteroscopic approach might be the first-choice treatment for patients who wish to preserve their fertility.…”

“…Cesarean section and the resultant Cesarean scar in the lower uterine segment are known to be associated with obstetric complications in subsequent pregnancies, such as uterine rupture; Cesarean scar pregnancy (CSP); placenta previa; and placenta accreta, increta, or percreta. Cesarean scars are also associated with gynecological conditions that can adversely affect the patient's quality of life, e.g., abnormal uterine bleeding, chronic pain, or secondary infertility [1].…”

When and how should we treat cesarean scar defect — isthmocoele?

“…There were some reports suggesting that it might also impair urinary bladder function but it was not finally proven [6,7]. Bleeding or spotting after menstruation decreases the fertility due to changes in follicular-phase mucus quality, decreasing sperm motility in cervical canal or inhibiting implantation process [8]. Abnormal uterine spotting is probably caused by impaired contractility of muscle fibers surrounding the niche [5,9].…”

Small Size Resectoscope in Isthmocele Repair: Case Report

“…Multiple techniques have been used for CSD treatment: reconstructive therapies including laparoscopic or robotassisted laparoscopic excision, vaginal repair and channel-like resectoscopic treatment [3][4][5][6]. All these procedures excise or ablate the fibrotic tissue of niche, suggesting that the removal of the local inflamed tissue may contribute to the improvement of symptoms.…”