Long-term results of hysteroscopic myomectomy in 235 patients

Polena, Viola; Mergui, J.-L.; Perrot, Nicolas; Poncelet, Christophe; Barranger, Emmanuel; Uzan, Serge

doi:10.1016/j.ejogrb.2006.01.014

Cited by 83 publications

(62 citation statements)

References 15 publications

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“…As it is also reported, hysteroscopic treatment of submucous fibroids is associated with good reproductive outcomes [45,46]. A systematic review of 11 cohort studies suggests that women with submucous myoma have lower pregnancy rates compared with women with other causes for their infertility, and myomectomy was not associated with an increase in live birth rate but was associated with a higher pregnancy rate [47].…”

Section: Review Of the Literaturementioning

confidence: 89%

Hysteroscopic myomectomy

Stamatellos

Bontis

2007

Eur Clinics Obstet Gynaecol

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Hysteroscopic treatment of submucous myomas is a safe and effective treatment in patients presenting with abnormal uterine bleeding and subfertility. Resection of fibroids can be performed with the assistance of monopolar or bipolar energy, hysteroscopic scissors or by applying yttrium aluminium garnet (Nd:YAG) laser. Modern resectoscopic techniques have expanded treatment options for these patients. Before surgery, the size, number, localization and intramural extent should be determined by hysteroscopy and/or sonohysterography to be able to ascertain the possibilities for resection and the technique to be used. Appropriate patient preparation will make the operation easier and reduce complication rates. There is a greater chance of successful procedure with the smaller proportion of the myoma within the myometrium. Long-term results have shown high satisfaction rates with improved menstrual symptoms and pregnancy rates. Pre-operative counseling and accurate documentation is essential. When complications do occur, it is rarely required to have prompt diagnosis and immediate treatment.

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Section: Review Of the Literaturementioning

confidence: 89%

Hysteroscopic myomectomy

Stamatellos

Bontis

2007

Eur Clinics Obstet Gynaecol

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“…23,97 The majority of studies defined the primary outcome as an improvement in symptoms of AUB as perceived by the patient. All of the studies 23,75,91,97,101,[105][106][107][108][109][110][111][112][113][114][115] (plus TJ Clark, unpublished) reported an improvement in symptoms from 60% to 100%. The study looking exclusively at postmenopausal patients presented a survival analysis curve.…”

Section: Discussionmentioning

confidence: 99%

“…The 17 studies 23,75,91,97,101,[105][106][107][108][109][110][111][112][113][114] (including TJ Clark, Birmingham Women's Hospital, 2013, unpublished) that met our inclusion criteria enrolled a total of 1829 patients between 1989 and 2009. The population size ranged from 8 to 311, with only five studies having a population size of > 100.…”

Section: Included Studiesmentioning

confidence: 99%

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A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding

Clark

Middleton

Cooper

et al. 2015

Health Technol Assess

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BackgroundUterine polyps cause abnormal bleeding in women and conventional practice is to remove them in hospital under general anaesthetic. Advances in technology make it possible to perform polypectomy in an outpatient setting, yet evidence of effectiveness is limited.ObjectivesTo test the hypothesis that in women with abnormal uterine bleeding (AUB) associated with benign uterine polyp(s), outpatient polyp treatment achieved as good, or no more than 25% worse, alleviation of bleeding symptoms at 6 months compared with standard inpatient treatment. The hypothesis that response to uterine polyp treatment differed according to the pattern of AUB, menopausal status and longer-term follow-up was tested. The cost-effectiveness and acceptability of outpatient polypectomy was examined.DesignA multicentre, non-inferiority, randomised controlled trial, incorporating a cost-effectiveness analysis and supplemented by a parallel patient preference study. Patient acceptability was evaluated by interview in a qualitative study.SettingOutpatient hysteroscopy clinics and inpatient gynaecology departments within UK NHS hospitals.ParticipantsWomen with AUB – defined as heavy menstrual bleeding (formerly known as menorrhagia) (HMB), intermenstrual bleeding or postmenopausal bleeding – and hysteroscopically diagnosed uterine polyps.InterventionsWe randomly assigned 507 women, using a minimisation algorithm, to outpatient polypectomy compared with conventional inpatient polypectomy as a day case in hospital under general anaesthesia.Main outcome measuresThe primary outcome was successful treatment at 6 months, determined by the woman’s assessment of her bleeding. Secondary outcomes included quality of life, procedure feasibility, acceptability and cost per quality-adjusted life-year (QALY) gained.ResultsAt 6 months, 73% (166/228) of women who underwent outpatient polypectomy were successfully treated compared with 80% (168/211) following inpatient polypectomy [relative risk (RR) 0.91, 95% confidence interval (CI) 0.82 to 1.02]. The lower end of the CIs showed that outpatient polypectomy was at most 18% worse, in relative terms, than inpatient treatment, within the 25% margin of non-inferiority set at the outset of the study. By 1 and 2 years the corresponding proportions were similar producing RRs close to unity. There was no evidence that the treatment effect differed according to any of the predefined subgroups when treatments by variable interaction parameters were examined. Failure to completely remove polyps was higher (19% vs. 7%; RR 2.5, 95% CI 1.5 to 4.1) with outpatient polypectomy. Procedure acceptability was reduced with outpatient compared with inpatient polyp treatment (83% vs. 92%; RR 0.90, 95% CI 0.84 to 0.97). There were no significant differences in quality of life. The incremental cost-effectiveness ratios at 6 and 12 months for inpatient treatment were £1,099,167 and £668,800 per additional QALY, respectively.ConclusionsWhen treating women with AUB associated with uterine polyps, outpatient polypectomy was non-inferior to inpatient polypectomy at 6 and 12 months, and relatively cost-effective. However, patients need to be aware that failure to remove a polyp is more likely with outpatient polypectomy and procedure acceptability lower.Trial registrationCurrent Controlled Trials ISRCTN 65868569.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 61. See the NIHR Journals Library website for further project information.

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“…Nine studies reported satisfaction after transcervical myomectomy but seven were rejected because they had fewer than 40 patients 121,122 or reported satisfaction data from more than 3 years after treatment. 44,[123][124][125][126] The two remaining studies 42,46 were both prospectively conducted and had populations of over 100 women, with more than 90% being pre-menopausal. The first study examined resection of SMFs using a resectoscope under general anaesthesia (90%) or local anaesthesia with sedation.…”

Section: Polyp/submucosal Fibroids Removalmentioning

confidence: 99%