Resectoscopic treatment combined with sonohysterographic evaluation of women with postmenstrual bleeding as a result of previous cesarean delivery scar defects

Chang, Yu Chi; Tsai, Eing Mei; Cheng, Longfei; Lee, Chyi Long; Kay, Nari

doi:10.1016/j.ajog.2008.11.038

Cited by 130 publications

(112 citation statements)

References 13 publications

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“…A similar improvement in uterine bleeding in 59% to 100% of cases were detected after laparoscopic or vaginal approach and channel like repair [15].…”

Section: Discussionsupporting

confidence: 63%

Small Size Resectoscope in Isthmocele Repair: Case Report

Gubbini¹

2017

OGIJ

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The presence of a uterine cesarean scar defect (CSD) is usually asymptomatic or relates to postmenstrual spotting and dark red or brown discharge, pelvic pain or infertility. Since hysteroscopic isthmoplasty has been documented to be minimally invasive and effective for symptomatic relief, we prefer channel-like resectoscopic treatment for symptomatic CDS with small size resectoscope. 16-Fr resectoscope allows us to perform standard maneuvers of resectoscopic CSD repair according to the anatomy of cervical canal with the advantages of miniaturized instrumentation. In the present case report asymptomatic patient underwent hysteroscopic isthmoplasty after shared decision-making and medical treatment have been evaluated.

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“…A similar improvement in uterine bleeding in 59% to 100% of cases were detected after laparoscopic or vaginal approach and channel like repair [15].…”

Section: Discussionsupporting

confidence: 63%

Small Size Resectoscope in Isthmocele Repair: Case Report

Gubbini¹

2017

OGIJ

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“…The median reduction was 3.8 days, with an estimated standard deviation of 2.7 days 17. We expected a difference of 2 days in postmenstrual spotting to be clinically relevant.…”

Section: Methodsmentioning

confidence: 91%

“…The lower rim of the niche, if prominently visible, was resected as described by Chang et al and Fabres et al14, 17 The niche surface was superficially coagulated with the use of a rollerball (Figures 1 and S2). 24 …”

Section: Methodsmentioning

confidence: 99%

“…A hysteroscopic niche resection is the least invasive of these techniques, but requires a sufficient thick residual myometrium between the niche and the bladder to prevent bladder injury 13. 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.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Chang et al used this technique in 22 patients and the symptoms resolved in 14 (63%) and significantly decreased in the rest of them [30]. In another paper published in 2008, hysteroscopic roller-ball coagulation of scar tissue was used in 26 patients.…”

Section: Surgical Treatment -Hysteroscopymentioning

confidence: 99%

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

Futyma

Gałczyński

Romanek³

et al. 2016

Ginekol Pol

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The reported number of cesarean sections in Poland is approximately 30% and is associated with increasing number of early and late complications. The myometrial discontinuity at the site of previous cesarean section is known in the literature as "isthmocoele", "niche", "pouch" or cesarean scar defect. In most cases presence of isthmocoele has no clinical significance, but in some patients it may cause abnormal uterine bleeding, dysmenorrhea, dyspareunia, pelvic pain or be associated with secondary infertility. This defect may be treated by laparoscopy, hysteroscopy or vaginal surgery.

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Resectoscopic treatment combined with sonohysterographic evaluation of women with postmenstrual bleeding as a result of previous cesarean delivery scar defects

Cited by 130 publications

References 13 publications

Small Size Resectoscope in Isthmocele Repair: Case Report

Small Size Resectoscope in Isthmocele Repair: Case Report

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

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

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