1
|
Black N, Clarke A, Rowe P, Mott S, Howie K. A prospective cohort study of the clinical management of total abdominal hysterectomy for benign disease. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619509009173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
2
|
Smith RNJ, Mould TAJ, Cockell A, Coltart TM. Endometrial resection increases demand for surgical treatment of menorrhagia. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619409030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
3
|
Molnár BG, Kormányos Z, Kovács L, Pál A. Long-term efficacy of transcervical endometrial resection with no preoperative hormonal preparation. Eur J Obstet Gynecol Reprod Biol 2006; 127:115-22. [PMID: 16815473 DOI: 10.1016/j.ejogrb.2004.07.037] [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: 04/24/2004] [Revised: 07/02/2004] [Accepted: 07/31/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the level of patient satisfaction after transcervical endometrial resection (TCRE) with no preoperative hormonal preparation. STUDY DESIGN A retrospective audit of a continuous case series was accomplished on 131 consecutive patients who underwent TCRE for dysfunctional uterine bleeding. Data of postal questionnaires were analysed and subjected to survival analysis. RESULTS Thirty-three cases were lost to follow-up; thus, the data on 98 of the 131 (74.8%) patients were analysed. The average follow-up period was 94.8 months (60-132). Twenty (20.4%) women required D&C and 15 (15.3%) had hysterectomy. In eight of the 15 cases, the indication for hysterectomy was not related with the primary operation. The chance of avoiding hysterectomy reached a plateau after 72 months, at 78.3% (SE: 5.05%). The chance of avoiding D&C at up to 36 months was 98.6% (SE: 1.4%), and reached a plateau after 107 months at 67.11% (SE: 6.1%); 55.8% of the patients became amenorrhoeic, the remaining cases reporting good improvements in the amount and duration of bleeding, and dysmenorrhoea. Eighty-six of the 98 patients (88%) were satisfied or very satisfied with the result. CONCLUSIONS TCRE affords reasonable long-term effectiveness in the treatment of dysfunctional uterine bleeding, even without any preoperative hormonal endometrial preparation.
Collapse
Affiliation(s)
- Béla G Molnár
- Department of Obstetrics and Gynaecology, Consultant Obstetrician and Gynaecologist, University of Szeged, Semmelweis u. 1, H-6725 Szeged, Hungary.
| | | | | | | |
Collapse
|
4
|
Barr F, Brabin L, Agbaje S, Buseri F, Ikimalo J, Briggs N. Reducing iron deficiency anaemia due to heavy menstural blood loss in Nigerian rural adolescents. Reprinted from Public Health Nutrition Volume 1 (4), 249–257, 1998. Public Health Nutr 2005. [DOI: 10.1079/phn2005818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveMenstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to make the problems. We investigated the prevelance of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia.SettingRural village in south-east Nigeria.DesignCross-sectional survey.SubjectsThe studdy included all non-pregnant, unmarried nulliparous girls (< 20 years) who had menstruated, and who lived in K'Dere village.MethodsA field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (HB), serum iron, transferin saturation and protoporphyrin levels (ZPP) were also measured.Results307 girls completed MBL measurements; 11.9% refused to participate. 12.1% had menorrhagia (> 80 ml);. median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years (p = 0.048), and had longer duration of meneses (p < 0.001). Iron status as measured by haematocrit, serum iron, transferrin saturation and ZPP values was inversely related to MBL. Neither height nor body mass index for age was associated with current iron status.ConclusionsThe level of menorrhagia detected (12%) may be an ‘expected’ level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.
Collapse
|
5
|
Agostini A, Cravello L, Desbrière R, Maisonneuve AS, Roger V, Blanc B. Hemorrhage risk during operative hysteroscopy. Acta Obstet Gynecol Scand 2002; 81:878-81. [PMID: 12225306 DOI: 10.1034/j.1600-0412.2002.810914.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND To evaluate the risk of hemorrhage during hysteroscopic surgery. METHODS Cases of hemorrhage during hysteroscopic surgery were assessed in a single center, observational, prospective study conducted from 1990 to 2000, including 2116 surgical hysteroscopies. Risk of hemorrhage was evaluated according to the hysteroscopic procedure. The management of this complication was also noted. RESULTS Thirteen cases (0.61%) were reported. In six cases, hemorrhage stopped spontaneously. For six patients, a Foley (no. 10) probe was introduced into the uterine cavity and inflated for 24 h to stop hemorrhage. For one patient, immediately from the start of the procedure, the uterine arteries were ligatured through the vaginal route in order to stop bleeding. Haemorrhage risk was higher during hysteroscopic adhesiolysis compared with endometrial ablation (Relative risk [RR] 5.22 (1.26-21.64); p = 0.02), polyp [RR 5.3 (1.04-27.09); p = 0.04], and fibroid resections [RR 6.55 (1.58-27.17); p = 0.01]. Haemorrhage risk was however, comparable for endometrial ablation, uterus septa section, polyp, and fibroid resections (p = 0.92). CONCLUSIONS Hemorrhage risk is higher during synechiolysis compared with other procedures. An inflated Foley probe may be an efficient means of stopping hemorrhage.
Collapse
Affiliation(s)
- Aubert Agostini
- Department of Obstetrics and Gynecology, La Conception Hospital, 147 Boulevard Baille, 13385 Marseille Cedex 05, France.
| | | | | | | | | | | |
Collapse
|
6
|
Agostini A, Cravello L, Bretelle F, Shojai R, Roger V, Blanc B. Risk of uterine perforation during hysteroscopic surgery. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2002; 9:264-7. [PMID: 12101319 DOI: 10.1016/s1074-3804(05)60401-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To evaluate the rate of uterine perforation during different operative hysteroscopy procedures. DESIGN Observational study (Canadian Task Force classification II-2). SETTING Department of Obstetrics and Gynecology, La Conception Hospital, Marseille, France. PATIENTS One thousand nine hundred fifty-two women. INTERVENTION Of 2116 operative hysteroscopies performed, there were 623 endometrectomies, 782 myoma resections, 422 polyp resections, 199 adhesiolyses, and 90 uterine septa sections. MEASUREMENTS AND MAIN RESULTS Risk of perforation was evaluated according to hysteroscopic procedure. Severity of complications were also noted. In case of perforation, a management protocol was applied to prevent metabolic disorders and pelvic infections. Thirty-four perforations (1.61%) were reported. In 33 cases (97%) it was realized during the procedure and no complications occurred during follow-up. One perforation with hemorrhage was misdiagnosed during the intervention and required laparotomy. Perforation risk was higher during hysteroscopic adhesiolysis than during other procedures [endometrial ablation RR 9.39 (3.46-25.52), p <0.0001; uterine septa section RR 6.78 (0.91-50.6), p = 0.026; polyp RR 8.52 (2.60-30.80), p <0.0001 or myoma resection RR 7 (2.83-17.62), p <0.0001]. Perforation risk was comparable during endometrial ablation, uterine septa section, and polyp or myoma resection (p = 0.93). CONCLUSION Perforation risk is higher during synechiolysis than in other indications for hysteroscopy. Severe complications are rare but may be avoided if precautions are taken.
Collapse
Affiliation(s)
- Aubert Agostini
- Service de Gynécologie-Obstétrique B, Hôpital de la Conception, 147 Boulevard Baille, 13385 Marseille Cedex 05, France
| | | | | | | | | | | |
Collapse
|
7
|
Agostini A, Cravello L, Shojai R, Ronda I, Roger V, Blanc B. Postoperative infection and surgical hysteroscopy. Fertil Steril 2002; 77:766-8. [PMID: 11937131 DOI: 10.1016/s0015-0282(01)03252-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the risk of infection after surgical hysteroscopy. DESIGN Prospective observational study. SETTING University hospital. PATIENT(S) One thousand nine hundred fifty-two patients requiring operative hysteroscopy during a 10-year period from January 1990 to January 2000. INTERVENTION(S) Two thousand one hundred sixteen operative hysteroscopies were performed: 782 fibroma resections, 422 polyp resections, 623 endometrectomies, 90 uterine septa sections, and 199 lyses of synechiae. MAIN OUTCOME MEASURE(S) Postoperative infectious complications. RESULT(S) Thirty (1.42%) infections occurred. There were 18 (0.85%) cases of endometritis and 12 urinary tract infections. No other severe infectious complications were reported. The risk for early-onset endometritis was higher after lysis of synechiae compared with endometrectomy, fibroma, or polyp resections. However, the risk for early-onset endometritis was similar for endometrectomy, septa, fibroma, or polyp resections. CONCLUSION(S) Infectious risk following surgical hysteroscopy is low. No major infectious complications occurred. Risk for early-onset endometritis was higher after lysis of synechiae compared with other procedures.
Collapse
Affiliation(s)
- Aubert Agostini
- Service de Gynécologie, Hôpital la Conception, Marseille, France.
| | | | | | | | | | | |
Collapse
|
8
|
A randomised trial of endometrial ablation versus hysterectomy for the treatment of dysfunctional uterine bleeding: outcome at four years. Aberdeen Endometrial Ablation Trials Group. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999; 106:360-6. [PMID: 10426244 DOI: 10.1111/j.1471-0528.1999.tb08275.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the long term impact of initial management by endometrial ablation for women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. DESIGN Long term follow up of randomised cohorts of women. SETTING Gynaecology department of a large teaching hospital. SAMPLE Two hundred and four women who had joined a randomised comparison of endometrial ablation with hysterectomy, 4 to 5.6 years previously. METHODS Postal questionnaire and casenote review. MAIN OUTCOME MEASURES Women's satisfaction with treatment, gynaecological symptoms and psychological outcomes at four years; further surgical treatment and differential resource use at a minimum of four years' follow up. RESULTS Further surgical treatment was received by 39 (38%) women randomised to endometrial ablation, including six women who each had two additional treatments. At four years, the probability of receiving further surgical treatment by any method was 36% and by hysterectomy was 24% (compared with 29% and 14% respectively at one year). Satisfaction rates were high (80% ablation group vs 89% hysterectomy group), the difference reflecting re-treatment. Premenstrual symptoms improved over time but more so in the hysterectomy group, who also rated their improvements in general health higher. The estimated overall mean cost of the endometrial ablation group is 93% of that of the hysterectomy group (pound sterling 1231 vs pound sterling 1332). CONCLUSIONS While about two out of every five women allocated to endometrial ablation eventually received further surgical treatment, hysterectomy with its associated morbidity was still avoided by 76% of women with dysfunctional uterine bleeding who would otherwise have had a hysterectomy. At four years, the difference in the costs of endometrial ablation and hysterectomy policies had narrowed.
Collapse
|
9
|
Barr F, Brabin L, Agbaje S, Buseri F, Ikimalo J, Briggs N. Reducing iron deficiency anaemia due to heavy menstrual blood loss in Nigerian rural adolescents. Public Health Nutr 1998; 1:249-57. [PMID: 10933425 DOI: 10.1079/phn19980041] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Menstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to mask the problems. We investigated the prevalence of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia. SETTING Rural village in south-east Nigeria. DESIGN Cross-sectional survey. SUBJECTS The study included all non-pregnant, unmarried nulliparous girls (< 20 years) who had menstruated, and who lived in K'Dere village. METHODS A field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (Hb), serum iron, transferrin saturation and protoporphyrin levels (ZPP) were also measured. RESULTS 307 girls completed MBL measurements; 11.9% refused to participate. 12.1% had menorrhagia (> 80 ml); median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years (P = 0.048), and had longer duration of menses (P < 0.001). Iron status as measured by haematocrit, serum iron, transferrin saturation and ZPP values was inversely related to MBL. Neither height nor body mass index for age was associated with current iron status. CONCLUSIONS The level of menorrhagia detected (12%) may be an 'expected' level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders, and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.
Collapse
Affiliation(s)
- F Barr
- Liverpool School of Tropical Medicine, UK
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
OBJECTIVE To determine why women choose endometrial ablation rather than hysterectomy for the treatment of menorrhagia. DESIGN Observational study based on postal questionnaires. SETTING A university hospital. PATIENT(S) One hundred eighty randomly selected patients from a cohort of 658 patients who underwent endometrial ablation for the treatment of menorrhagia during the past 7 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Patient attitude about endometrial ablation. RESULT(S) One hundred six questionnaires (58.9%) were completed satisfactorily. The average postoperative follow-up period was 45.1 months (range, 3-80 months). Eleven women (10.4%) had undergone repeated endometrial ablation and 8 (7.5%) had undergone hysterectomy. More than half the women indicated that they would find endometrial ablation acceptable even if there was no chance of amenorrhea, if the probability of menstruation becoming lighter was > or = 4:10, if the likelihood of menstrual pain decreasing was > or = 3:10, if the chance of requiring repeated endometrial ablation or hysterectomy was < or = 1:4, and if the risk of uterine cancer after surgery was < or = 1:200. The three most important advantages of endometrial ablation over hysterectomy were perceived to be the avoidance of major surgery, the fast return to normal functioning, and the short hospitalization. CONCLUSION(S) Most women who choose endometrial ablation rather than hysterectomy as therapy for menorrhagia are prepared to undergo hysteroscopic surgery even if the chance of success is relatively poor.
Collapse
Affiliation(s)
- F Nagele
- University Department of Obstetrics and Gynaecology, The Royal Free Hospital, London, United Kingdom
| | | | | |
Collapse
|
11
|
Felmar E. Menstrual Disorders. Fam Med 1998. [DOI: 10.1007/978-1-4757-2947-4_103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
12
|
Affiliation(s)
- R W Ke
- University of Tennessee, Memphis 38163, USA
| |
Collapse
|
13
|
Thijssen RF. Radiofrequency induced endometrial ablation: an update. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:608-13. [PMID: 9166206 DOI: 10.1111/j.1471-0528.1997.tb11541.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To test the safety and efficiency of radiofrequency endometrial ablation as a nonhysteroscopic treatment of dysfunctional uterine bleeding. DESIGN A multicentre trial. SETTING Nineteen clinics in six countries. METHODS From February 1990 to December 1994, 1280 women were treated with radiofrequency endometrial ablation. Inclusion criteria were: menorrhagia, age 30-55 years, a completed family, a wish to retain the uterus, no hypergonadotropic state indicating an approaching menopause, a normal sized uterus, normal cervical cytology, normal adnexa, no prolapse, no intrauterine abnormalities, and no history of a bleeding disorder. Treatment was performed according to a standard operating protocol. RESULTS Either amenorrhoea or a satisfactory improvement of menstruation was obtained in 78.5% of 944 women followed for six months or more. The design of the equipment has been thoroughly revised and improved during the last four years. The complications encountered were mostly related to the handling of radiofrequency and sometimes due to failures in following the safety protocol. CONCLUSIONS Although the technology is complicated, the treatment is simple, fast and effective. The complications have often been unpredictable. Despite the improvements made during this period, safety must be further enhanced to develop the original concept into an established technique.
Collapse
|
14
|
O'Connor H, Broadbent JA, Magos AL, McPherson K. Medical Research Council randomised trial of endometrial resection versus hysterectomy in management of menorrhagia. Lancet 1997; 349:897-901. [PMID: 9093249 DOI: 10.1016/s0140-6736(96)07285-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The most frequent indication for hysterectomy is menorrhagia, even though the uterus is normal in a large number of patients. Transcervical resection of the endometrium (TCRE) is a less drastic alternative, but success rates have varied and menorrhagia can recur. We have tested the hypothesis that the difference in the proportion of women dissatisfied and requiring further surgery within 3 years of TCRE or hysterectomy would be no more than 15%. METHODS 202 women with symptomatic menorrhagia were recruited to a multicentre, randomised, controlled trial to compare the two interventions. TCRE and hysterectomy were randomly assigned in a ratio of two to one. The primary endpoints were women's satisfaction and need for further surgery. The patients' psychological and social states were monitored before surgery, then annually with a questionnaire. Analysis was by intention to treat. FINDINGS Data were available for 172 women (56 hysterectomy, 116 TCRE); 26 withdrew before surgery and four were lost to follow-up. Satisfaction scores were higher for hysterectomy than for TCRE throughout follow-up (median 2 years), but the differences were not significant (at 3 years 27 [96%] of 28 in hysterectomy group vs 46 [85%] of 54 in TCRE group were satisfied; p = 0.16). 25 (22%) women in the TCRE group and five (9%) in the hysterectomy group required further surgery (relative risk 0.46 [95% CI 0.2-1.1], p = 0.053). TCRE had the benefits of shorter operating time, fewer complications, and faster rates of recovery. INTERPRETATION TCRE is an acceptable alternative to hysterectomy in the treatment of menorrhagia for many women with no other serious disorders.
Collapse
Affiliation(s)
- H O'Connor
- Minimally Invasive Therapy Unit, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
| | | | | | | |
Collapse
|
15
|
Abstract
The levonorgestrel-releasing intrauterine system (LNG-IUS), has been developed by Leiras Pharmaceuticals, Turku, Finland. It is a new systemic hormonal contraceptive that releases levonorgestrel 20 micrograms every 24 hours. The device provides fertility control comparable with that of female sterilisation, complete reversibility and convenience, and has an excellent tolerability record. The low dosage of levonorgestrel released by its unique delivery system ensures minimal hormone-related systemic adverse effects, which tend to be in the category of 'nuisance' rather than hazardous, and gradually diminish after the first few months of use. In some respects, the contraceptive characteristics of the LNG-IUS have over-shadowed a substantial range of noncontraceptive beneficial effects that are rarely seen with inert or copper-releasing intrauterine contraceptive devices (IUDs), and have important and positive gynaecological and public health implications. This applies particularly to the profound reduction in duration and quantity of menstrual bleeding, and alleviation of dysmenorrhoea, which are associated with the use of the device. Recent studies have shown that the LNG-IUS is effective in preventing endometrial proliferation associated with oral or transdermal estradiol therapy, and in inducing regression of endometrial hyperplasia. Further research is required to determine whether it has a role in regulating the growth of uterine fibroids, and preventing pelvic inflammatory disease. The unique unwanted noncontraceptive effects of the system, including possible development of functional ovarian cysts, and the relationship between menstrual bleeding pattern and ovarian function, also require better understanding, in order to offer appropriate patient counselling and maximise acceptability and continuation of use of the method.
Collapse
Affiliation(s)
- F Sturridge
- Research Unit, Margaret Pyke Family Planning Centre, London, England
| | | |
Collapse
|
16
|
Abstract
BACKGROUND Endometrial resection is an alternative to hysterectomy in the treatment of women with menorrhagia, but it may not control the condition. We sought to evaluate the effectiveness of such resection. METHODS We followed 525 consecutive women (mean age at initial surgery, 42 years) for up to five years after endometrial resection. The women were examined 6 to 12 weeks after the operation and were then sent yearly questionnaires seeking information about their condition. The mean duration of follow-up was 31 months. Thirty-seven women (86 percent of the 43 women available for five years of follow-up) were followed for the entire period. RESULTS Endometrial resection was completed successfully in 95 percent of the women, with operative complications in 6 percent. Forty-eight women underwent subsequent resection. The yearly questionnaires indicated that 85 to 100 percent of the women (depending on the year of follow-up) had adequately controlled menorrhagia, 26 to 40 percent had amenorrhea, 71 to 80 percent reported either a lessening of menstrual pain or no pain, and 79 to 87 percent were satisfied with the results of their surgery. No further surgery was needed by 80 percent of the women, and only 9 percent underwent hysterectomy during the five years of follow-up, with 98 percent of those operations being performed in the first three postoperative years. CONCLUSIONS Endometrial resection is an effective alternative to hysterectomy in women with menorrhagia.
Collapse
Affiliation(s)
- H O'Connor
- University Department of Obstetrics and Gynaecology, Royal Free Hospital, Hampstead, London, United Kingdom
| | | |
Collapse
|
17
|
Vercellini P, Perino A, Consonni R, Trespidi L, Parazzini F, Crosignani PG. Treatment with a gonadotrophin releasing hormone agonist before endometrial resection: a multicentre, randomised controlled trial. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1996; 103:562-8. [PMID: 8645650 DOI: 10.1111/j.1471-0528.1996.tb09807.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To ascertain whether treatment with a gonadotrophin releasing hormone agonist before endometrial resection reduces absorption of distension fluid and operating time and facilitates the procedure. DESIGN A multicentre, prospective, randomised controlled study. PARTICIPANTS Seventy-one premenopausal women with established menorrhagia. INTERVENTIONS Eight weeks of goserelin depot treatment before endometrial resection of immediate surgery in the early proliferative phase of the cycle. MAIN OUTCOME MEASURES Irrigation fluid deficit, operating time and degree or difficulty of the procedure. RESULTS After randomisation eight women withdrew from the study, leaving 33 women in the goserelin arm and 30 in the immediate surgery arm. Mean (SD) operating time was 15.1 (9.0) min in the goserelin group versus 16.9 (9.5) min in the controls; mean difference + 1.8 min, 95% CI, -2.9 to + 6.4. Mean (SD) distension medium deficit was, respectively, 422 (287) ml versus 564 (291 ml); mean difference + 142 ml, 95% CI -4 to + 288. The goserelin effect was restricted to the 29 women with adenomyosis as the mean (SD) fluid deficit was considerably less in the 19 treated women than in the 10 controls (299 (206) ml versus 597 (135) ml; mean difference + 298 ml, 95% CI + 149 to + 447). The surgeons classified the intraoperative difficulties as none in 6, minimal in 20, moderate in 7, and severe in no cases in the goserelin group; corresponding figures in the group without pretreatment were 2, 14, 13, and 1. CONCLUSIONS Goserelin administration before endometrial resection may reduce absorption of fluid at surgery in women with adenomyosis and may facilitate intrauterine operating conditions.
Collapse
Affiliation(s)
- P Vercellini
- Luigi Mangiagalli Department of Obstetrics and Gynaecology, University of Milano, Italy
| | | | | | | | | | | |
Collapse
|
18
|
Khastgir G, Mascarenhas LJ, Shaxted EJ. The role of transvaginal ultrasonography in pre-operative case selection and post-operative follow up of endometrial resection. Br J Radiol 1993; 66:600-4. [PMID: 8374724 DOI: 10.1259/0007-1285-66-787-600] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
50 patients undergoing transcervical endometrial resection (TCRE) for abnormal uterine bleeding underwent transvaginal ultrasonography (TVUS) before danazol therapy, immediately pre-operatively, and 3 months post-operatively. There were no significant changes in the uterine dimensions but as expected the endometrium became thinner (p < 0.0005) after treatment with danazol facilitating endometrial resection. 12 cases (24%) continued to have menstrual problems. In those cases TVUS showed unchanged endometrium (4), minimum residual endometrium (5), irregular uterine cavity (5), and fibroids (2) as probable causes of failure. These findings guided the choice of further management as follows: conservative for minimum residual endometrium, repeat TCRE for unchanged endometrium, and hysterectomy for irregular uterine cavity and fibroids. The value of TVUS in diagnosing the cause of post-operative pain was limited to the cases (2) of haematometra. The smaller transverse (< 6 cm) and anteroposterior (AP) (< 4.5 cm) dimensions of the uterus (p < 0.05, < 0.05), a significant reduction in these dimensions after the operation (p < 0.0005, p < 0.01) along with the absence of endometrium (p < 0.0001), fibroids and irregular uterine cavity (p < 0.005) predicted a favourable outcome of TCRE. This study substantiates the role of TVUS in TCRE for proper selection of cases, determination of the causes of failure and their subsequent management, leading to an improved outcome.
Collapse
Affiliation(s)
- G Khastgir
- Department of Obstetrics & Gynaecology, Northampton General Hospital, UK
| | | | | |
Collapse
|
19
|
Dwyer N, Hutton J, Stirrat GM. Randomised controlled trial comparing endometrial resection with abdominal hysterectomy for the surgical treatment of menorrhagia. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1993; 100:237-43. [PMID: 8476829 DOI: 10.1111/j.1471-0528.1993.tb15237.x] [Citation(s) in RCA: 225] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of endometrial resection as a surgical treatment for menorrhagia. DESIGN Randomised controlled trial. SETTING Gynaecology department at a teaching hospital. SUBJECTS Two hundred women needing surgical treatment for menorrhagia between January 1990 and May 1991. After withdrawal of four women 97 underwent hysterectomy and 99 underwent endometrial resection. MAIN OUTCOME MEASURES Patient satisfaction 4 months after surgery; post-operative complications; length of hospital stay; duration of time before return to work, normal daily activities and sexual intercourse; change in premenstrual symptoms. RESULTS The difference in patient satisfaction between endometrial resection (84 out of 99) and abdominal hysterectomy (89 out of 95) just reached statistical significance in favour of abdominal hysterectomy at 4 months after surgery (difference = 9%, 95% confidence intervals (CI) 1.1%-17.5%). Post-operative morbidity, length of hospital stay and time taken to return to work, normal daily activities and sexual intercourse were significantly less in the endometrial resection group. However, the premenstrual symptoms of dysmenorrhoea, bloating and breast tenderness were less frequent after hysterectomy. CONCLUSION In the short term, endometrial resection was almost as satisfactory as abdominal hysterectomy for the surgical treatment of menorrhagia, and was associated with less morbidity. However, even at 4 months after surgery, there was a failure rate of at least 10% in those in whom endometrial resection appeared complete. Longer term comparative studies are necessary before the widespread introduction of endometrial resection as an alternative to abdominal hysterectomy for the surgical treatment of menorrhagia.
Collapse
Affiliation(s)
- N Dwyer
- St Michael's Hospital, Bristol, UK
| | | | | |
Collapse
|
20
|
Wynne HA, Campbell M. Pharmacoeconomics of nonsteroidal anti-inflammatory drugs (NSAIDs). PHARMACOECONOMICS 1993; 3:107-123. [PMID: 10146960 DOI: 10.2165/00019053-199303020-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the relief of the symptoms of osteoarthritis (OA), rheumatoid arthritis (RA), sprains and strains, sports injuries and menstrual disorders, and have a small role in the management of patent ductus arteriosus in the neonate. In patients with RA, symptom relief through use of NSAIDs is firmly established, although it remains unclear whether they influence the course and outcome of the disease. For the average patient with RA taking NSAIDs, the attributable risk of hospitalisation with gastrointestinal problems related to NSAIDs is 1.3 to 1.6% annually and risk of death is 0.15%. Associations of therapy with risk are greatest with age, corticosteroid use and previous NSAID-related gastrointestinal adverse effects, and less marked with disability and high NSAID dose. These are important data in attempting to balance risk of therapy with clinical efficacy in an individual patient, and assessing the cost-effectiveness of prophylaxis. Although half of all NSAID consumption is for control of pain associated with degenerative conditions, their superiority over simple analgesics in osteoarthritis is poorly documented. This finding supports the use of the simple analgesic paracetamol (acetaminophen) as the preferred therapy of osteoarthritis, especially when its lower cost and low incidence of adverse effects are taken into consideration. Consistent differences in clinical effectiveness of individual NSAIDs have not been demonstrated, although unpredictable interpatient variation in response to individual agents is of considerable clinical importance, and a more expensive NSAID may prove cost effective for some patients. Cost effectiveness can be improved by a self-adjusted dosage regime which also leads to lower overall drug consumption. The adverse gastrointestinal effects of these drugs account for about 30% of the overall cost of arthritis treatment, and although studies to date have been too limited to assess the relative risk of gastrointestinal toxicity of the different NSAIDs reliably, ibuprofen appears to be one of the least hazardous, and azapropazone one of the most hazardous. Although the effectiveness of prophylaxis with H 2-antagonists and with prostaglandin E 1 analogues (prostaglandin-E 1 analogues) has been established, estimates of cost-benefit ratios are widely divergent. To establish the most cost-effective therapy with NSAIDs, more data are required to establish multivariable risk profiles for identification of patients at particular risk, the optimal drug, and its optimal dosage and duration of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
Affiliation(s)
- H A Wynne
- Wolfson Unit of Clinical Pharmacology, University of Newcastle Upon Tyne, England
| | | |
Collapse
|
21
|
|
22
|
Rutherford AJ, Glass MR, Wells M. Patient selection for hysteroscopic endometrial resection. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1991; 98:228-30. [PMID: 2004064 DOI: 10.1111/j.1471-0528.1991.tb13378.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- A J Rutherford
- Department of Obstetrics and Gynaecology, Leeds General Infirmary
| | | | | |
Collapse
|
23
|
Management of menorrhagia. BMJ (CLINICAL RESEARCH ED.) 1990; 301:290-1. [PMID: 2117975 PMCID: PMC1663453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
24
|
|