Medical Research Council randomised trial of endometrial resection versus hysterectomy in management of menorrhagia

O’Connor, Hugh; Broadbent, J. A. Mark; Magos, Adam; McPherson, Klim

doi:10.1016/s0140-6736(96)07285-6

Cited by 174 publications

(127 citation statements)

References 24 publications

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“…Satisfaction rates were high in both groups and similar to those reported in previous trials of both traditional techniques of endometrial ablation 2,3,5,6,21 and second generation techniques 8 -10,21 -25 . Patient satisfaction results at 12 months are more biased than those seen at 6 months due to a reduction in responses from women who had had repeat surgery.…”

Section: Discussionsupporting

confidence: 86%

A randomised controlled trial comparing the Cavaterm endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding

Hawe

2003

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To compare the effectiveness of the Cavaterm thermal balloon endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding. Design Randomised controlled trial.Setting Minimal access gynaecological surgery unit in a district general hospital.Population Seventy-two women with dysfunctional uterine bleeding requesting conservative surgical management of their condition. Methods Women with a normal endometrial biopsy and normal uterine cavity were randomly allocated to endometrial ablation by Cavaterm or Nd:YAG laser. Patients completed pre-operative and 6-and 12-month post-operative questionnaires assessing menstrual symptoms, quality of life, sexual activity and procedural satisfaction and acceptability. All patients received a single dose of gonadotropin-releasing hormone analogue one month pre-operatively and kept blinded to the procedure performed until after the 6-month assessment. Main outcome measures The primary outcome measure was amenorrhoea rate. Secondary outcomes were effect on blood loss, quality of life, sexual activity, patient satisfaction and procedure acceptability. Results Seventy-two women were randomised. Amenorrhoea rates at 12 months in the Cavaterm and endometrial laser ablation groups were 29% vs 39% ( P ¼ 0.286), with combined amenorrhoea and hypomenorrhoea rates of 73% vs 69%, respectively. At 12 months, repeat surgery rates were higher in the endometrial laser ablation group (15% vs 12%, P ¼ 0.395). Cavaterm was an acceptable procedure and 93% of patients satisfied or very satisfied at 12 months (95% endometrial laser ablation). Both treatments were associated with an increase from baseline in the SF-12 physical score (Cavaterm mean difference À3.9, 95% CI À7.9, 0.2, ns; endometrial laser ablation mean difference À5.1, 95% CI À9.5, À0.7, P ¼ 0.003) and mental health score (Cavaterm mean difference À5.6, 95% CI À9.9, À1.3, P ¼ 0.001; endometrial laser ablation mean difference À5.9, 95% CI À11.7, À0.2, P ¼ 0.04). Patient's own assessment of health (EQ-5D VAS) improved from baseline in both groups (Cavaterm mean difference À7.6, 95% CI À13.9, À1.3, P ¼ 0.02; endometrial laser ablation mean difference À5.4, 95% CI À14.9, 4.2, ns). EQ-5D index scores also improved (Cavaterm mean difference À0.06, 95% CI À0.2, 0.005, ns; endometrial laser ablation mean difference À0.17, 95% CI À0.3, À0.02, P ¼ 0.02). There were no major complications in either group. Conclusions The results with the Cavaterm thermal balloon endometrial ablation system are as good as those obtained with the Nd:YAG laser when used for the treatment of dysfunctional uterine bleeding in the short term. It results in a significant reduction in menstrual blood loss, patient satisfaction and improvement in patient quality of life. Larger studies with longer follow up are required to determine its place in the modern treatment of dysfunctional uterine bleeding.

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Section: Discussionsupporting

confidence: 86%

A randomised controlled trial comparing the Cavaterm endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding

Hawe

2003

BJOG: An International Journal of Obstetrics and Gynaecology

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“…Although none guarantees amenorrhoea, their effectiveness (in comparison with hysterectomy) has been demonstrated in a number of RCTs. [41][42][43][44][45][46] National audits 47,48 revealed that, although first-generation ablative techniques were less morbid than hysterectomy, they were associated with a number of complications, including uterine perforation, cervical laceration, false passage creation, haemorrhage, sepsis and bowel injury. In addition, fluid overload associated with the use of 1.5% urological glycine (non-ionic) irrigation fluid in TCRE and RBEA resulted in serious and occasionally fatal consequences due to hyponatraemia.…”

Section: Endometrial Ablationmentioning

confidence: 99%

Hysterectomy, endometrial ablation and Mirena® for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis

Bhattacharya

Middleton²,

Tsourapas³

et al. 2011

Health Technol Assess

100

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of project...

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“…Resection of endometrium procedure is a safe and effective in selected patients and most women undergoing resection of endometrium will avoid hysterectomy [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Effects of operative hysteroscopy with anti-adhesive solution in the patients who have abnormal uterine bleeding or intrauterine lesions

Kim¹,

Lee²,

Chung³

et al. 2013

OJOG

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Objective: The purpose of this study was to evaluate the efficacy, safety, and benefits of hysteroscopic surgery in the treatment of dysfunctional uterine bleeding (DUB) or intrauterine lesions causing uterine bleeding. Methods: This study prospectively enrolled 100 patients who underwent operative hysteroscopy in tertiary referral university center because of uterine bleeding due to endometrial polyps or uterine submucosal leiomyomas diagnosed by transvaginal ultrasonogram. Indications for the operative hysteroscopies included abnormal uterine bleeding (AUB), ultrasound findings indicative of intrauterine lesions, and DUB. After operative hysteroscopic management, we inserted anti-adhesive solution, sodium hyaluronate and carboxymethyl cellulose into the uterine cavity. Results: Operative hysteroscopy was a successful procedure in 100 of 100 cases (100%) but it needed to be repeated in three cases with large uterine submucosal leiomyoma and after two endometrial polypectomy. Mean duration of the procedure was 23.2 minutes (range 5 -67) and postoperative hospital stay was 7 hours (range 3 -48). Most common indication was DUB (39%), submucosal leiomyoma was 21%, and endometrial polyp was 17%. There were five cases with postoperative uterine bleeding and none with fluid overload syndrome. During postoperative follow-up (3 -28 months) the majority of patients (90/100, 90%) were free of symptoms. Conclusion: Hysteroscopic procedure is an effective and safe method for the management of benign intracavitary pathology or the treatment of dysfunctional uterine bleeding. Although sodium hyaluronate and carboxymethyl cellulose seems to be effective in the prevention of adhesion in uterine cavity, further study will be needed to prove the effectiveness of anti-adhesive solution.

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Medical Research Council randomised trial of endometrial resection versus hysterectomy in management of menorrhagia

Cited by 174 publications

References 24 publications

A randomised controlled trial comparing the Cavaterm endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding

A randomised controlled trial comparing the Cavaterm endometrial ablation system with the Nd:YAG laser for the treatment of dysfunctional uterine bleeding

Hysterectomy, endometrial ablation and Mirena® for heavy menstrual bleeding: a systematic review of clinical effectiveness and cost-effectiveness analysis

Effects of operative hysteroscopy with anti-adhesive solution in the patients who have abnormal uterine bleeding or intrauterine lesions

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