Resectoscopic Correction of the “Isthmocele” in Women with Postmenstrual Abnormal Uterine Bleeding and Secondary Infertility

Gubbini, Giampietro; Casadio, Paolo; Marra, Elena

doi:10.1016/j.jmig.2007.10.004

Cited by 167 publications

(151 citation statements)

References 13 publications

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“…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%

“…The mean reduction in the number of days of spotting compared with baseline was reported in two studies, and varied between 2 and 4 days in 119 women. 15,17 Apart from the flawed comparability and lack of randomisation, the studies did not use validated tools to measure the outcomes 13, 14, 15, 16, 17, 18, 19, 20, 21. We initiated a randomised controlled trial assessing the effect on postmenstrual spotting of a hysteroscopic niche resection versus no treatment.…”

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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…The hysteroscopic repair is performed, with small variations among authors, by resecting only the inferior/ distal rim of the niche or with superior/proximal edge of the defectusing a 26Fr or 27Fr resectoscope. The procedure is ended with or without superficial coagulation of vessels in the niche surface with the aim at reducing blood loss from these fragile vessels [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

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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“…Moreover, recent reports have demonstrated a clear association between scar dehiscence and secondary infertility. According to a report by Gubbini et al, secondary infertility was observed in 35% of women with a history of irregular bleeding associated with a Cesarean scar defect [6]. It is hypothesized that the persistence of menstrual blood in the cervix negatively influences mucus quality, obstructs sperm transport through the cervical canal, affects sperm quality, and/or interferes with embryo implantation.…”

Section: Discussionmentioning

confidence: 99%

Cesarean scar abscess: A case report and a review of the literature

Taguchi¹,

Mabuchi²,

Kimura³

et al. 2012

OJOG

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Cesarean section and the resultant Cesarean scar are known to be associated with obstetric complications in subsequent pregnancies. Cesarean scar is also associated with gynecological conditions that can adversely affect the patient's quality of life. We describe a very rare case of Cesarean scar abscess that developed 8 years after a Cesarean delivery, which was managed by emergency hysterectomy.

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Resectoscopic Correction of the “Isthmocele” in Women with Postmenstrual Abnormal Uterine Bleeding and Secondary Infertility

Cited by 167 publications

References 13 publications

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

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

Small Size Resectoscope in Isthmocele Repair: Case Report

Cesarean scar abscess: A case report and a review of the literature

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