Outcome and Hemodynamic Alternation in Uterine Artery Following Hysteroscopic Roller-Ball Endometrial Ablation

Abstract

Objectives: To detect the outcome and changes in uterine arteries blood flow after hysteroscopic roller-ball endometrial ablation. [2,3]. HMB is a significant health problem in premenopausal women, it can cause anemia and reduce quality of life [4]. Menorrhagia is one of the most common causes for referral of pre-menopausal women to gynecologists, and, inspite of medical therapy, many women will eventually require hysterectomy [4,5]. Hysterectomy is invasive option associated with significant in-patient hospitalization for many women [4,5]. Introduction Outcome and Hemodynamic Alternation in Uterine ArteryMethods: 84 women with menorrhagia refused to continue or had failed medical treatment with uterine size <12 weeks were included in this study. Diagnostic hysteroscopy was done for women included in this study prior to endometrial ablation. A rigid operative hysteroscopy, with normal saline distention media and roller-ball electrode were used for endometrial ablation procedure. Preoperative findings of studied women including Doppler findings were compared to 3, 6 and 12 months post-operative findings to detect outcome and changes in uterine arteries blood flow after hysteroscopic roller-ball endometrial ablation.Results: 77/84 (91.7%) women were satisfied and their HMB was improved after rollerball endometrial ablation (33/84 (39.30%) amenorrhea, 27/84 (32.14%) hypo-menorrhea and 17/84 (20.24%) euomenorrhea = normal menstrual flow). ED (End Diastolic velocity), (9.2±7.4 cm/s before ablation) was significantly decreased 6 and 12 months after roller-ball endometrial ablation (5.0±6.0 and 4.6±6.1; respectively), also, TAMX (Time-averaged maximum velocity), (21.8±8.2 cm/s before ablation) was significantly decreased 6 and 12 months after roller-ball ablation (14.8±6.4 and 13.9±6.3; respectively). PI (Pulsatiliy Index), (1.32±0.5 cm/s before ablation) was significantly increased 6 and 12 months after roller-ball ablation (1.64±0.45 and 1.69±0.4; respectively), also, RI (Resistance Index), (0.80±0.2 cm/s before ablation) was significantly increased 3, 6 and 12 months after roller-ball ablation (0.84±0.4, 0.89±0.2 and 0.90±0.3; respectively). Conclusion:Hysteroscopic roller-ball endometrial ablation is a safe and effective therapeutic option for selected cases of menorrhagia. It increases stiffness and decreases mobility of uterine arteries during cardiac cycle, also, it induces rise in impedance with subsequent decrease in uterine blood flow and menstrual flow which completed 6-12 months following ablation procedure.

Pregnancy outcome after hysteroscopic synechiolysis for intrauterine synechiae (Asherman’s syndrome): case report

“…Diagnostic hysteroscopy was done under general anesthesia using a 5 mm rigid hysteroscope (Olympus, KeyMed House, Stock Road, UK), after evacuation of the bladder, and dilatation of the cervix, to confirm the diagnosis of IUS [9] ( Figure 2).…”

“…Normal saline in room temperature under 75-100 mm Hg pressure was used as distention medium during the synechiolysis procedure. Synechiolysis was done using a 3 mm electrode, with 60-100 W electrosurgical bipolar cutting current, guided by trans-abdominal ultrasound to avoid uterine perforation during the procedure [9] ( Figures 3 and 4).…”