Review of Intrauterine Adhesions

From June 2011 to June 2013, all hysteroscopic myoma resections at the Ospedale San Giuseppe of Milan were performed using either the IBS® or the Versapoint® bipolar resectoscope. Dilatation time of the cervical canal, resection time, fluid balance, and complete single-stage removal of the myoma have been studied. The outcome was stratified for groups of myomas larger and smaller than 3 cm. Seventy-six myomectomies were performed with the IBS® and 51 with the Versapoint®. Both groups had a similar distribution of difficult cases like G2 and larger than 3 cm myomas. The results show no difference in terms of cervical dilatation, resection time, and fluid deficit between the two groups, but, for myomas less than 3 cm and G2 myomas, the IBS® has been able to treat respectively 93.5 % (p=0.3753) and 62.5 % (p=0.5491) of cases in a single step procedure. The overall number of necessary second procedures has been statistically significantly less in the IBS® Group than in the Versapoint® Group (p=0.0067). Although no significative difference in terms of time of resection, the IBS® has proven to be able to approach all kind of submucosal myomas in a single-step procedure and in a very precise and easy way. The IBS® can be considered a valid alternative to the conventional resectoscope.

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“…Deans and Abbott have reported 31.3 % and 45.5 % adhesions formation after the removal of respectively single and multiple myomas [25].…”

Section: Discussionmentioning

confidence: 98%

Hysteroscopic myomectomy with the IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscope: a retrospective comparative study

et al. 2014

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“…Recurrent miscarriage is increased ranging from 5 to 39 % in women with IUAs according to a review of observational studies [7]. Major and, at times, devastating obstetric complications may occur, e.g., placenta accreta/ increta and higher risks for preterm delivery, uterine rupture, and peripartum hysterectomy [8].…”

Section: Clinical Significance Of Postoperative Adhesions Hysteroscopymentioning

confidence: 99%

“…The etiological role of infection in the formation of IUAs is, with the exception of genital tuberculosis, controversial [8]. IUA formation is the major long-term complication of hysteroscopic surgery in women of reproductive age.…”

Section: Pathophysiology Of Adhesion Formation Hysteroscopymentioning

confidence: 99%

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Verguts

Bosteels

Roberta³

et al. 2015

Gynecol Surg

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Intrauterine and intraabdominal adhesions are a major cause for infertility. The most recent investigations have demonstrated the potential of intraperitoneal adhesion barriers combined with good surgical technique to reduce adhesion formation. For intrauterine adhesions we suggest to minimize unipolar and bipolar instrumentation whenever possible. We advocate the use of estrogens for 10 days after adhesiolysis: 2dd two tablets of estradiol 2 mg. Instillation of Hyalobarrier Gel Endo actually is not reimbursed but may have a beneficial effect after myomectomy or adhesiolysis. Concerning laparoscopic and laparotomic prevention of adhesion also, meticulous surgical technique is of the utmost importance. Residual blood should be avoided by careful hemostasis and rinsing with Ringer's lactate with heparin. Preferably braided sutures are not to be left in the abdominal cavity. We advise to avoid unipolar and bipolar cauterization when possible and to replace with ultrasonic or laser energy. The use of floatation barriers does not seem to add substantial benefit in the prevention of adhesions. Gel barriers (Hyalobarrier Gel Endo® or Intercoat®) are proven to have a significant effect on adhesion prevention. As for sheets, there is enough evidence that they prevent adhesions. The use of NSAID in the prevention of pain and/or corticosteroids in the prevention of postoperative nausea is already mainstay after surgery and can be further endorsed in the prevention of adhesions.

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“…The mainstream clinical remedies include adhesiolysis under hysteroscope with adjuvant oestrogen therapy and post‐surgery placement of intrauterine device or balloon‐expandable stents, which manifests certain curative effect for the mild and moderate cases 3. However, the prognosis for the severe cases is unsatisfactory and the incidence of recurrent adhesion up to 20%‐62.5%, and frequently associates with irreversible impairment with respect to the receptivity and fertility 4. Therefore, to improve the proliferation and regeneration of endometrial cells, which in turn to reconstruct the endometrial structure and restore the endometrial functioning, is the radical curation for endometrial damage to improve pregnancy rate.…”

Section: Introductionmentioning

confidence: 99%

Transplant of insulin‐like growth factor‐1 expressing bone marrow stem cells improves functional regeneration of injured rat uterus by NF‐κB pathway

Wang

Yang

Jin

et al. 2018

J Cellular Molecular Medi

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To investigate the potential beneficial effect of insulin‐like growth factor‐1 (IGF‐1) in BMSC transplantation therapy of uterus injury and the underlying molecular mechanisms, rat BMSCs were isolated and cultured. The relative expressions of IGF‐1 and IL‐10 were determined by RT‐PCR and immunoblotting. The secretory IL‐10 and released E2 were measured using ELISA kits. The relative vWF and α‐SMA expressions were determined by immunohistochemistry. The direct binding of NF‐κB subunit p50 with IL‐10 promoter was analysed by chromatin immunoprecipitation assay. The regulation of IL‐10 expression by p50 was interrogated by luciferase reporter assay. Our data demonstrated that IGF‐1 expression in BMSCs induced IL‐10 expression and secretion, which was further enhanced by E2‐PLGA. IGF‐1 overexpression improved BMSCs transplantation therapy in rat uterus injury. We further demonstrated that both inhibition and knockdown of p50 abolished IGF‐1‐induced expression and secretion of IL‐10 in BMSCs, which consequently compromised the IGF‐1 conferred therapeutic benefits against uterus injury. Furthermore, we elucidated that p50 regulated IL‐10 expression via direct association with its promoter. Our data suggested that transplantation of IGF‐1 overexpressing BMSCs improved functional regeneration of injured uterus by inducing IL‐10 expression and secretion via activation of NF‐κB signalling.

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Review of Intrauterine Adhesions

Cited by 416 publications

References 95 publications

Hysteroscopic myomectomy with the IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscope: a retrospective comparative study

Hysteroscopic myomectomy with the IBS® Integrated Bigatti Shaver versus conventional bipolar resectoscope: a retrospective comparative study

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Transplant of insulin‐like growth factor‐1 expressing bone marrow stem cells improves functional regeneration of injured rat uterus by NF‐κB pathway

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