1
|
Acharya N, Mishra P, Mohammad S, Karnik M, Muneeba S, Gemnani R, Saboo K, Shukla S, Acharya S. Hysteroscopy as a Therapeutic Tool: A Vision to Spare the Uterus in Premenopausal Abnormal Uterine Bleeding (AUB)/Heavy Menstrual Bleeding (HMB), an Update. Cureus 2023; 15:e47877. [PMID: 38021492 PMCID: PMC10681274 DOI: 10.7759/cureus.47877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Heavy menstrual bleeding (HMB) or abnormal uterine bleeding (AUB) is a common cause of gynecological complaints in perimenopausal women. The treatment chosen by most of the women having HMB/AUB in the perimenopausal age group when medical therapy fails is hysterectomy, which unfortunately has significant issues related to safety and long-term quality of life apart from being a burden on the health care system and cost to patients. Minimal access surgical techniques like hysteroscopic targeted therapies are available which are conservative and spare the uterus and major surgery and its complications and sequelae. Hysteroscopic management of HMB is a minimally invasive and targeted approach in diagnosing and treating the pathological lesions causing the symptoms and not radical like hysterectomy which has more chances of occurrence of adverse events both intra and postoperatively. In terms of health-related quality of life, women suffering from HMB who underwent a hysteroscopic conservative approach had better scores when compared to those with hysterectomy. The present review aims to review the evidence generated to compare the two surgical modalities, hysteroscopic targeted therapy and hysterectomy, in terms of their effectiveness, safety, and effect on the quality of life of these perimenopausal women having HMB/AUB.
Collapse
Affiliation(s)
- Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Preeti Mishra
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Megha Karnik
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shaikh Muneeba
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rinkle Gemnani
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keyur Saboo
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
2
|
Vitale SG, Della Corte L, Ciebiera M, Carugno J, Riemma G, Lasmar RB, Lasmar BP, Kahramanoglu I, Urman B, Mikuš M, De Angelis C, Török P, Angioni S. Hysteroscopic Endometrial Ablation: From Indications to Instrumentation and Techniques-A Call to Action. Diagnostics (Basel) 2023; 13:diagnostics13030339. [PMID: 36766443 PMCID: PMC9914843 DOI: 10.3390/diagnostics13030339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
The development of minimally invasive techniques has led to the creation of innovative alternatives in cases where traditional methods are not applicable. In modern gynecology, hysteroscopy has become the gold standard for the evaluation and treatment of intrauterine pathology. Endometrial ablation (EA) is a procedure that uses different types of energy to destroy the endometrium and is currently used as an alternative technique in cases of heavy menstrual bleeding when medical treatment has failed and uterine preservation is desired. The aim of this review was to evaluate the feasibility, safety, and clinical outcomes of hysteroscopic EA as an alternative in patients with abnormal uterine bleeding. A detailed computerized search of the literature was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science, PubMed, and Cochrane Library), from 1994 to June 2022, to evaluate the outcomes in patients with abnormal uterine bleeding (AUB) undergoing EA using hysteroscopic and non-hysteroscopic techniques. Only scientific publications in English were included. Twelve articles on the current use of endometrial ablation were included. Data on patient symptoms, tools used for EA, primary outcomes, and adverse events were recorded. EA should be considered an effective and safe approach in the management of patients with abnormal uterine bleeding caused by benign pathology, in whom medical treatment has failed or is contraindicated. Due to the lack of evidence, it would be interesting to determine whether EA would also have a role in the treatment of women with premalignant lesions, avoiding invasive surgical procedures or medical treatment in those patients for whom hysterectomy or the use of hormonal treatment is contraindicated.
Collapse
Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-3479354575
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, 00189 Warsaw, Poland
| | - Josè Carugno
- Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy
| | - Ricardo Bassil Lasmar
- Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro 24020-140, Brazil
| | - Bernardo Portugal Lasmar
- Department of Surgery and Specialities, Federal Fluminense University, Rio de Janeiro 24020-140, Brazil
| | - Ilker Kahramanoglu
- Department of Gynecologic Oncology, Emsey Hospital, 34912 Istanbul, Turkey
| | - Bulent Urman
- Department of Obstetrics and Gynecology, Koc University School of Medicine, 34010 Istanbul, Turkey
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, Petrova 13, 10000 Zagreb, Croatia
| | - Carlo De Angelis
- Department of Maternal and Child Health and Urological Sciences, “Sapienza“ University of Rome, 00185 Rome, Italy
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| |
Collapse
|
3
|
Nakayama K, Razia S, Ishibashi T, Ishikawa M, Yamashita H, Nakamura K, Sawada K, Yoshimura Y, Tatsumi N, Kurose S, Minamoto T, Iida K, Ishikawa N, Kyo S. Pathological findings in the endometrium after microwave endometrial ablation. Sci Rep 2020; 10:20766. [PMID: 33247224 PMCID: PMC7695731 DOI: 10.1038/s41598-020-77594-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 10/12/2020] [Indexed: 01/04/2023] Open
Abstract
The acceptance of MEA in Japan is well demand due to its outstanding effectiveness and safety. Infrequently, a repeat MEA or hysterectomy is needed for recurrent menorrhagia in case of failure ablation. The reasons of recurrent menorrhagia subsequent MEA treatment are unclear. The objective of current study is to identify the possible causes of menorrhagia repetition following MEA, together with the observation of histological changes in the endometrium due to this treatment compared with normal cycling endometrial tissue. A total of 170 patients, 8 (4.7%) of them carried out hysterectomy after 16.8 months (range, 2-29 months) of MEA treatment. Normal (n = 47) and MEA (n = 8) treated paraffin embedded endometrial tissue were prepared for hematoxylin and eosin (H&E) and immunostaining study to recognize the histological changes in the endometrium as a result of MEA treatment. The histological features observed increased tubal metaplasia (TM) including negative expression of the estrogen receptor (ER) and progesterone receptor (PR) in the endometrium subsequent MEA treatment. Increased TM together with the absence of ER and PR expression might be a reasonable explanation for repetition menorrhagia in cases of failure ablation. Further study is required to clarify the molecular mechanisms of tubal metaplasia and the expression loss of hormone receptor in the endometrium as a result of MEA treatment. Current studies propose that low dose estrogen-progestin may not be effective with recurrent menorrhagia patient's due to the inadequacy of hormone receptor expression in the endometrium following MEA.
Collapse
Affiliation(s)
- Kentaro Nakayama
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan.
| | - Sultana Razia
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Tomoka Ishibashi
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Masako Ishikawa
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Hitomi Yamashita
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Kohei Nakamura
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Kiyoka Sawada
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Yuki Yoshimura
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Nagisa Tatsumi
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Sonomi Kurose
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Toshiko Minamoto
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Kouji Iida
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| | - Noriyoshi Ishikawa
- Department of Organ Pathology, Shimane University School of Medicine, Izumo, 6938501, Japan
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, Enyacho 89-1, Izumo, Shimane, 6938501, Japan
| |
Collapse
|
4
|
Maheux-Lacroix S, Mennen J, Arnold A, Budden A, Nesbitt-Hawes E, Won H, Abbott J. The need for further surgical intervention following primary hysteroscopic morcellation of submucosal leiomyomas in women with abnormal uterine bleeding. Aust N Z J Obstet Gynaecol 2018; 58:570-575. [DOI: 10.1111/ajo.12781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/21/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Sarah Maheux-Lacroix
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Jennifer Mennen
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Amy Arnold
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Aaron Budden
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Erin Nesbitt-Hawes
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - HaRyun Won
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| | - Jason Abbott
- School of Women's and Children's Health; University of New South Wales; Sydney New South Wales Australia
| |
Collapse
|
5
|
Singh S, Best C, Dunn S, Leyland N, Wolfman WL. Saignements utérins anormaux chez les femmes préménopausées. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S231-S263. [PMID: 28063539 DOI: 10.1016/j.jogc.2016.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
6
|
Kumar V, Chodankar R, Gupta JK. Endometrial ablation for heavy menstrual bleeding. ACTA ACUST UNITED AC 2016; 12:45-52. [PMID: 26756668 DOI: 10.2217/whe.15.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endometrial ablation can be described as one of the great gynecological success stories. It has changed the management of heavy menstrual bleeding dramatically. The development of newer (second generation) endometrial ablative techniques has enabled clinicians to set up comprehensive 'one stop clinics' based on an outpatient service to treat heavy menstrual bleeding effectively without the need for general anesthetic or conscious sedation. This article describes the rationale and evidence for use of different endometrial auto-ablative systems along with relevant technical and clinical aspects. It also addresses the essentials of a successful approach to outpatient endometrial ablation along with discussion on risks, complications and contraindications of the procedure.
Collapse
Affiliation(s)
- Vinod Kumar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rohan Chodankar
- Heatherwood & Wexham Park Hospitals NHS Foundation Trust, Slough, UK
| | | |
Collapse
|
7
|
Bongers M. Hysteroscopy and heavy menstrual bleeding (to cover TCRE and second-generation endometrial ablation). Best Pract Res Clin Obstet Gynaecol 2015; 29:930-9. [DOI: 10.1016/j.bpobgyn.2015.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/18/2015] [Indexed: 11/24/2022]
|
8
|
Chapter 4 Surgical Management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013. [DOI: 10.1016/s1701-2163(15)30737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
9
|
HUQ FY, AL-HADERI M, KADIR RA. The outcome of endometrial ablation in women with inherited bleeding disorders. Haemophilia 2011; 18:413-20. [DOI: 10.1111/j.1365-2516.2011.02712.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Chapa H, Antonetti A, Sandate J, Bakker K, Silver L. Incidence of de Novo Pelvic Pain After Radiofrequency or Thermal Balloon Global Endometrial Ablation Therapy. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hector Chapa
- Women's Specialty Center and Department of Obstetrics/Gynecology, Methodists' Medical Center, Dallas, TX
| | - Alfred Antonetti
- Women's Specialty Center and Department of Obstetrics/Gynecology, Methodists' Medical Center, Dallas, TX
| | - Jeffrey Sandate
- Women's Specialty Center and Department of Obstetrics/Gynecology, Methodists' Medical Center, Dallas, TX
| | - Ken Bakker
- Women's Specialty Center and Department of Obstetrics/Gynecology, Methodists' Medical Center, Dallas, TX
| | - Lori Silver
- Women's Specialty Center and Department of Obstetrics/Gynecology, Methodists' Medical Center, Dallas, TX
| |
Collapse
|
11
|
Edlund M. Nonhormonal Treatments for Heavy Menstrual Bleeding. J Womens Health (Larchmt) 2011; 20:1645-53. [DOI: 10.1089/jwh.2010.2696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Måns Edlund
- Department of Obstetrics and Gynecology, Danderyds Hospital, Stockholm, Sweden
| |
Collapse
|
12
|
Success rate, quality of life, and descriptive analysis after generalized endometrial ablation in an obese population. Int J Gynaecol Obstet 2011; 113:120-3. [PMID: 21420088 DOI: 10.1016/j.ijgo.2010.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 11/24/2010] [Accepted: 01/27/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the success rate of and the quality of life after global endometrial ablation in an obese population. METHODS A follow-up survey was mailed to 72 women who had undergone global endometrial ablation. The survey included a menorrhagia-specific NovaSure endometrial ablation questionnaire. The mean follow-up time was 2.5years. RESULTS Forty-four women (61%) responded, with a mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of 30.5. Overall, patients reported a decrease in missed social activities, in inability to perform activities of daily living, in missed work days, in bleeding tendencies, and in pain. The amenorrhea rate was 37%, and the success rate (those not requiring any further therapeutic treatment) was 86%. Patient satisfaction was 93%. CONCLUSION Global endometrial ablation improved quality of life for obese women with menorrhagia and had a high rate of satisfaction, even for patients not achieving amenorrhea. Patients with a BMI of more than 34 showed a trend toward failure and a higher rate of hysterectomy.
Collapse
|
13
|
Kadir RA, Edlund M, Von Mackensen S. The impact of menstrual disorders on quality of life in women with inherited bleeding disorders. Haemophilia 2010; 16:832-9. [PMID: 20584085 DOI: 10.1111/j.1365-2516.2010.02269.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
SUMMARY Menorrhagia, heavy menstrual bleeding, is a common condition that has a substantial impact on the lives of many women. The objective measurement of menorrhagia is often impractical; therefore diagnosis and treatment are usually based on the direct perception of the woman. Menstrual problems are likely to be worse in women with bleeding disorders, as they are more likely to have heavy and painful menstrual periods and ovulation bleeding and pain. These can have a major impact on the quality of women's lives, especially those who suffer heavy menstruation. These problems can also lead to limitations at work and school and hinder educational and academic achievements. Only few studies describe how quality of life (QOL) changes in women with an underlying haemostatic defect; poorer QOL being associated with more frequent bleeding symptoms. Early recognition, accurate diagnosis and appropriate management of bleeding disorders should improve not only the quality of care for affected women but also their QOL. Increased awareness of the high prevalence of menstrual problems especially menorrhagia is essential for early diagnosis and provision of appropriate treatments without any delay. Accurate knowledge of the impact of menorrhagia on health-related quality of life (HRQOL) and its adequate assessment help individualize treatment and assess the magnitude of changes in HRQOL. An ideal situation would be to use a generic and a disease-specific measure together so that comparisons can be made on a general and disease-specific level.
Collapse
Affiliation(s)
- R A Kadir
- Haemophilia Centre and Haemostasis Unit, Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK.
| | | | | |
Collapse
|
14
|
Practical Tips for Office Hysteroscopy and Second-Generation “Global” Endometrial Ablation. J Minim Invasive Gynecol 2009; 16:384-99. [DOI: 10.1016/j.jmig.2009.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 03/23/2009] [Accepted: 04/03/2009] [Indexed: 11/19/2022]
|
15
|
Abnormal uterine bleeding: a review of patient-based outcome measures. Fertil Steril 2008; 92:205-16. [PMID: 18635169 DOI: 10.1016/j.fertnstert.2008.04.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 04/11/2008] [Accepted: 04/11/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To summarize and evaluate the patient-based outcome measures (PBOMs) that have been used to study women with abnormal uterine bleeding (AUB). DESIGN Systematic review. SETTING Original articles that used at least one PBOM and were conducted within a population of women with AUB. PATIENT(S) Women with AUB. INTERVENTION(S) The titles, abstracts, and studies were systematically reviewed for eligibility. The PBOMs used in eligible studies were summarized. Essential psychometric properties were identified, and a list of criteria for each property was generated. MAIN OUTCOME MEASURE(S) "Quality" of individual PBOMs as determined using the listed criteria for psychometric properties. RESULT(S) Nine hundred eighty-three studies referenced AUB and patient-reported outcomes. Of these, 80 studies met the eligibility criteria. Fifty different instruments were used to evaluate amount of bleeding, bleeding-related symptoms, or menstrual bleeding-specific quality of life. The quality of each of these instruments was evaluated on eight psychometric properties. The majority of instruments had no documentation of reliability, precision, or feasibility. There was no satisfactory evidence that any one instrument completely addressed all eight psychometric properties. CONCLUSION(S) Studies of women with AUB are increasingly using PBOMs. Many different PBOMs were used; however, no single instrument completely addressed eight important measurement properties.
Collapse
|
16
|
Vilos GA, Edris F. Second-generation endometrial ablation technologies: the hot liquid balloons. Best Pract Res Clin Obstet Gynaecol 2007; 21:947-67. [PMID: 17543585 DOI: 10.1016/j.bpobgyn.2007.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hysteroscopic endometrial ablation (HEA) was introduced in the 1980s to treat menorrhagia. Its use required additional training, surgical expertise and specialized equipment to minimize emergent complications such as uterine perforations, thermal injuries and excessive fluid absorption. To overcome these difficulties and concerns, thermal balloon endometrial ablation (TBEA) was introduced in the 1990s. Four hot liquid balloons have been introduced into clinical practice. All systems consist of a catheter (4-10mm diameter), a silicone balloon and a control unit. Liquids used to inflate the balloons include internally heated dextrose in water (ThermaChoice, 87 degrees C), and externally heated glycine (Cavaterm, 78 degrees C), saline (Menotreat, 85 degrees ) and glycerine (Thermablate, 173 degrees C). All balloons require pressurization from 160 to 240 mmHg for treatment cycles of 2 to 10 minutes. Prior to TBEA, preoperative endometrial thinning, including suction curettage, is optional. Several RCTs and cohort studies indicate that the advantages of TBEA include portability, ease of use and short learning curve. In addition, small diameter catheters requiring minimal cervical dilatation (5-7 mm) and short duration of treatment cycles (2-8 min) allow treatment under minimal analgesia/anesthesia requirements in a clinic setting. Following TBEA serious adverse events, including thermal injuries to viscera have been experienced. To minimize such injuries some surgeons advocate the use of routine post-dilatation hysteroscopy and/or ultrasonography to confirm correct intrauterine placement of the balloon prior to initiating the treatment cycle. After 10 years of clinical practice, TBEA is thought to be the preferred first-line surgical treatment of menorrhagia in appropriately selected candidates. Economic modeling also suggested that TBEA may be more cost-effective than HEA.
Collapse
Affiliation(s)
- George A Vilos
- Department of Obstetrics and Gynecology, The University of Western Ontario, London, ON, Canada.
| | | |
Collapse
|
17
|
Shankar M, Chi C, Kadir RA. Review of quality of life: menorrhagia in women with or without inherited bleeding disorders. Haemophilia 2007; 14:15-20. [PMID: 17961167 DOI: 10.1111/j.1365-2516.2007.01586.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objectives of this study were to identify the impact of menorrhagia on the health-related quality of life (HRQOL) of women in general and those with inherited bleeding disorders and to identify the commonly used tools in assessing quality of life. A review of studies evaluating quality of life in women suffering from menorrhagia was conducted. Data sources used included electronic databases Medline and Embase. Reference lists and bibliographies of the relevant papers and books were hand-searched for additional studies. Eighteen of the 53 studies identified measured quality of life prior to treatment of menorrhagia. Ten of the studies used a validated measure of quality of life. Five studies involving a total of 1171 women with menorrhagia in general and using SF-36 were considered for further review. The mean SF-36 scores in women with menorrhagia were worse in all the eight scales when compared with normative scores from a general population of women. Three studies, involving 187 women, assessed the quality of life in women with menorrhagia and inherited bleeding disorders. None of these studies used a validated HRQOL score making it difficult for comparison. However, all reported poorer scores in study women compared to the controls. In conclusion, HRQOL is adversely affected in women with menorrhagia in general and in those with inherited bleeding disorders. HRQOL evaluation is useful in the management of women with menorrhagia for assessment of treatment efficacy.
Collapse
Affiliation(s)
- M Shankar
- Department of Obstetrics & Gynaecology, Royal Free Hospital, London, UK
| | | | | |
Collapse
|
18
|
Abstract
The Novasure endometrial ablation system consists of a single-use device and a radiofrequency controller. It is a three-dimensional, triangular-shaped bipolar ablation device. The generator functions at 500 kHz and has a power cut-off limit set at a tissue impedance of 50 Ohms. The self-terminating procedure is based on tissue impedance or time. A cavity assessment system works to detect perforations in the uterine cavity. No pretreatment is necessary. Randomized controlled trials have shown that the Novasure system has an amenorrhoea rate of 44-56% at 1-year follow-up, and the 5-year results of a randomized trial will be published shortly. Prospective observational studies show even higher amenorrhoea rates of up to 58-75% up to 5-year follow-up. Hysterectomy rates in the prospective trial were very low (4%). In summary, the Novasure endometrial ablation system is an effective second-generation ablation technique, resulting in a high percentage of amenorrhoea.
Collapse
Affiliation(s)
- Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, 5500 MB, Veldhoven, The Netherlands.
| |
Collapse
|
19
|
Robson S, Devine B. Two cases of leiomyoma necrosis after thermal balloon endometrial ablation. J Minim Invasive Gynecol 2007; 14:250-2. [PMID: 17368266 DOI: 10.1016/j.jmig.2006.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2006] [Revised: 09/11/2006] [Accepted: 09/15/2006] [Indexed: 12/01/2022]
Abstract
The presence of intramural leiomyomas is not necessarily a contraindication to thermal balloon endometrial ablation, provided there is minimal distortion of the endometrial cavity. We report 2 cases of necrosis of intramural leiomyomas after the procedure. These cases illustrate a potential complication of thermal balloon endometrial ablation that has been reported only once previously in the medical literature.
Collapse
Affiliation(s)
- Stephen Robson
- Department of Obstetrics and Gynecology, Australian National University Medical School, Canberra, Australia.
| | | |
Collapse
|
20
|
Onoglu A, Taskin O, Inal M, Sadik S, Simsek M, Akar M, Kursun S, Mendilcioglu I, Postaci H, Ispahi C. Comparison of the long-term histopathologic and morphologic changes after endometrial rollerball ablation and resection: A prospective randomized trial. J Minim Invasive Gynecol 2007; 14:39-42. [PMID: 17218227 DOI: 10.1016/j.jmig.2006.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Revised: 06/19/2006] [Accepted: 06/24/2006] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To compare long-term histologic features of endometrial rollerball ablation versus resection. DESIGN Randomized clinical trial (Canadian Task Force classification I). SETTING Akdeniz University School of Medicine. PATIENTS Women with menorrhagia undergoing endometrial ablation. INTERVENTION Comparison of patients with menorrhagia undergoing endometrial resection and ablation. MEASUREMENTS AND MAIN RESULTS Endometrial rollerball ablation (n = 23 women) and resection (n = 25) were followed by second-look office hysteroscopy with endometrial biopsy. Mean follow-up to second look hysteroscopy after rollerball ablation and loop resection was 33.4 +/- 2.1 and 31.1 +/- 2.6 months, respectively. Complete atrophy and partial adhesion or obliteration of the cavity and fibrosis were observed at second-look hysteroscopy and were similar in both groups. Whereas all random biopsy specimens after both ablation and resection revealed diminished endometrial glands with varied necrosis and scarring, the number of endometrial glands per field was not correlated with amount of bleeding or menstrual pattern. Bleeding patterns were similar between the groups. No precancerous or malignant lesion was found after the procedures. CONCLUSION Although efficacy of both endometrial ablation and resection is related to initial thermal destruction and correlated with postablation hysteroscopic and histologic findings, endometrial regrowth may be expected and is not a failure of ablation. Both procedures revealed histopathologically and clinically similar results.
Collapse
|
21
|
Amso NN. Clinical and health service implications of second generation endometrial ablation devices. Curr Opin Obstet Gynecol 2006; 18:457-63. [PMID: 16794429 DOI: 10.1097/01.gco.0000233943.74672.2e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review evaluates the current evidence on the efficacy, safety and cost-effectiveness of the ever-increasing number of second-generation endometrial ablation devices. RECENT FINDINGS The literature covered by this review includes (1) evidence on long-term benefit, avoidance of hysterectomy and improvement in quality of life, (2) applicability of these techniques in the outpatient environment under local or no anaesthesia, (3) frequency and nature of early and delayed complications associated with these devices, (4) impact on clinical practice and the health service, and (5) implications for research. SUMMARY Where appropriate, second-generation devices are rapidly becoming the first-line surgical choice for the management of heavy menstrual bleeding. This has both cost-savings and negative implications for the health service. There is also emerging evidence that improvement in quality of life is more relevant to women than amenorrhoea rates. What has come to light from this review is the lack of accurate data on adverse events rate, and the urgent need for a better appreciation of the frequency and nature of complications.
Collapse
Affiliation(s)
- Nazar N Amso
- Department of Obstetrics and Gynaecology, Wales College of Medicine, Cardiff University, University Hospital of Wales and Vale NHS Trust, Cardiff, UK.
| |
Collapse
|
22
|
Julian S, Habiba M. Factors affecting the outcome of endometrial ablation using Cavaterm plus. Eur J Obstet Gynecol Reprod Biol 2006; 123:92-7. [PMID: 15893872 DOI: 10.1016/j.ejogrb.2005.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2004] [Revised: 01/20/2005] [Accepted: 03/25/2005] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study treatment outcome using the modified technique: Cavaterm plus. STUDY DESIGN Retrospective postal questionnaire, in a large teaching hospital. One hundred and twenty-eight women with menorrhagia were treated between February 2001 and April 2003. Data were collected prospectively for the duration of the procedure and alternatives offered. Follow up questionnaire was distributed during November 2003 to assess menstrual status. Multiple binary logistic regression was performed to assess factors influencing success. RESULTS The mean follow up was 72 weeks, 103 patients (80.5%) completed the questionnaire. In 26 (25.2%) cases, there were one or more important deviations from recommended procedure. Twenty (19.4%) women had procedure-related amenorrhoea, 6 (5.8%) had spotting, 35 (34%) had light, and 26 (25.2%) had moderate bleeding. Eleven (10.7%) had a hysterectomy. The risk of failure was inversely related to age (OR 0.778, 95% CI 0.669-0.905), was higher in women who prior to surgery had longer duration of bleeding (OR 1.29, 95% CI 1.1-1.52), and when recommended selection or operative procedures were not followed (OR 5.056, 95% CI 1.097-23.3). CONCLUSION Cavaterm plus is associated with high patient satisfaction. The technique remains a good choice for women wishing to avoid hysterectomy, but there is a need to observe determinants of poor outcome.
Collapse
Affiliation(s)
- Sophia Julian
- Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK
| | | |
Collapse
|
23
|
Cooley S, Yuddandi V, Walsh T, Geary M, McKenna P. The medium- and long-term outcome of endometrial ablative techniques. Eur J Obstet Gynecol Reprod Biol 2005; 121:233-5. [PMID: 16054968 DOI: 10.1016/j.ejogrb.2004.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Revised: 08/24/2004] [Accepted: 12/23/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the medium-term (1-3 years) and long-term (3-5 years) outcome for women who underwent endometrial ablative techniques. To determine the uptake of these operations and the outcome results. STUDY DESIGN The hospital records of all women who underwent either Uterine Balloon Therapy (UBT) or VESTA (Multiple Electrode Device) since our commencement of use of these procedures in the Rotunda Hospital, Dublin were reviewed. Medium-term assessment was by retrospective analysis of the patient records for the incidence of complications and the necessity of further medical and surgical treatment. Long-term outcome was assessed by completion of a questionnaire by all patients. Demography, complications, patient satisfaction, new symptomatology and the need for further treatment were assessed. Forty-four women who underwent UBT and 40 women who had VESTA ablation formed our study group. RESULTS Our main outcome measures were assessment of the amenorrhoea rate and patient satisfaction in the long-term. Medium-term follow-up revealed a 90% success rate. Long-term follow-up showed on overall treatment success of 80% and a patient satisfaction rate of 73%. CONCLUSION Both UBT and VESTA were associated with high rates of amenorrhoea and patient satisfaction in the long-term.
Collapse
Affiliation(s)
- Sharon Cooley
- Rotunda Hospital, Obstetrics and Gynaecology, Parnell Street, Dublin 1, Ireland.
| | | | | | | | | |
Collapse
|
24
|
Qian Y, Gan N, Zhou J, Lu W, Ma Y, Zhang W. Microwave endometrial ablation for menorrhagia in patients with systemic disorders. Int J Gynaecol Obstet 2005; 91:32-5. [PMID: 16043180 DOI: 10.1016/j.ijgo.2005.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Revised: 06/06/2005] [Accepted: 06/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of microwave endometrial ablation (MEA) in the treatment of menorrhagia in patients with severe systemic disease or medical conditions. METHODS Forty-two menorrhagic women undergoing systemic disorders with failure of medical management were treated with MEA under local or general anesthesia, and were followed-up for 1 year. RESULTS The women had a mean age of 39.4 years (range, 17-49). The procedure was successfully completed in all patients, and no intraoperative complications occurred. Two cases died of their primary severe medical diseases within 2 months of treatment but these cases were not associated with MEA. Among the remaining 40 patients, 24 (60.0%) had amenorrhea within 12 months. The duration of hospitalization and the amount of blood transfusion were significantly reduced after treatment, and the quality of life of these patients was improved significantly. CONCLUSIONS MEA is a safe and effective treatment for the management of severe menorrhagia in patients undergoing systemic illness or severe medical conditions.
Collapse
Affiliation(s)
- Yuanshu Qian
- Department of Gynecology, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
| | | | | | | | | | | |
Collapse
|
25
|
Affiliation(s)
- Gerald J Shirk
- Department of Obstetrics and Gynecology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
| |
Collapse
|