Symptoms and Quality of Life Changes after Hysteroscopic Treatment in Patients with Symptomatic Isthmocele—Preliminary Results

Abstract

Due to an increasing number of cesarean section deliveries, the common consequences of that surgery are observed more often in the population. One of them is the uterine cesarean scar defect known as niche or isthmocele. Most patients with that aliment are asymptomatic, but some of them can report abnormal uterine bleeding, pelvic pain, subfertility which can be the reason for reduced quality of life (QoL) of the patients. In our study, we analyzed the subjective feelings of changes in the severity of symptoms and quality of life of women with niche after diagnostic and operative hysteroscopy. The patients n = 85 included in the study group completed a follow up questionnaire six months after the procedure. Patients after operative hysteroscopy in comparison to patients after diagnostic procedure reported statistically significant reduction in post-menstruation bleeding/spotting and improvement in the quality of sexual activity. We have also noticed a higher pregnancy rate in the operative group, however, the difference was not statistically significant. According to our study, most women reported a positive effect of hysteroscopy on their QoL in social, psychological, environmental, and health domains.

Effectiveness of Three Steps Hysteroscopic Repair of Isthmocele in Patients with Post Menstrual Spotting

“…In addition, no complication occurred for any of our patients' .This proves that hysteroscopy is an ideal tool for management in patient with RMT > 2.5mm. Improvement in the abnormal uterine bleeding was in line with results of other previous studies [2,14,[18][19][20] .…”

Fertility and pregnancy outcomes after a uterine niche resection in women with and without infertility: a systematic review and meta-analysis

“…None of the studies included a combination of women with and without infertility. An overview of the baseline characteristics, including niche features, is reported for the studies that included women diagnosed with infertility (Table 1) (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) and women without infertility (Table 2) (36)(37)(38)(39)(40). Most studies evaluated HNR (N ¼ 14), and 7, 7, and 2 studies reported on VNR, LSNR, and LTNR, respectively.…”

“…None of the studies that report about HNR, LTNR, or LSNR mentioned perioperative complications. However, 4 and 4 studies did not reported details about complications after HNR (25,29,33,38,39), and LSNR (30,33,38,39), respectively. In the 16 studies that reported on women with infertility, 8 reported a definition or duration of infertility.…”

“…In 7 of 16 studies, the primary outcome measure was the reproductive outcome (21-23, 26, 27, 33, 34). Four studies focused on reproductive outcome and abnormal uterine bleeding (AUB) (25,30,32,35), 4 on AUB (20, 24, 28, 31), and 1 on the quality of life after hysteroscopy (29).…”

“…In the group of women with a niche without a diagnosis of infertility, a number of these niches may be not contributing, and therefore, expectant management of at least 1 year should be considered. However, it is important to realize that 8 of 21 included studies were designed for other primary outcomes rather than reproductive outcomes (20,24,28,29,31,36,39,40) and were not powered to assess these outcomes.…”