Hysterectomy after endometrial ablation.
ABSTRACT Our purpose was to determine the number of women undergoing hysterectomy after endometrial ablation and the indications for the subsequent surgery.
Forty-two premenopausal women, who had severe menorrhagia associated with a clinically normal examination result, underwent rollerball endometrial ablation between November 1990 and December 1991. Thirty-seven women whom we gave ongoing care were evaluated by chart review. Four women who received care elsewhere were interviewed by telephone. One woman was lost to follow-up. Patients were followed up a minimum of 4 years. Age, parity, operating time, endometrial preparation, preablation sterilization, and preablation dysmenorrhea were assessed in regard to subsequent hysterectomy. Patient satisfaction was assessed at 24 months. Life-table analysis was performed to determine cumulative probability of hysterectomy.
Fourteen of the 41 women (34%) underwent hysterectomy within 5 years after rollerball endometrial ablation. Continued abnormal menstrual bleeding and menstrual pain were significantly associated with subsequent hysterectomy. Eleven of the 14 cases of hysterectomy were associated with gross abnormality such as myomas, adenomyosis, endometriosis, and chronic hematosalpinx. A linear relationship between hysterectomy and time was noted.
On the basis of our findings one third of women undergoing rollerball endometrial ablation for menorrhagia can expect to have a hysterectomy within 5 years. If the linear relationship noted during the first 5 years is extrapolated, theoretically, all women may need hysterectomy by 13 years. Most patients undergo hysterectomy because of significant pelvic abnormality. Further studies with longterm follow-up are needed to define the role of endometrial ablation for menorrhagia.
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ABSTRACT: Endometrial ablation procedures are extensively used for the treatment of menorrhagia on premenopausal patients who failed medical therapy. The increasing popularity of safe, effective, less invasive, nonresectoscopic global endometrial ablation procedures could potentially increase the incidence of unusual adverse outcomes. Post-ablation tubal sterilization (PATSS) is one of these delayed complications, which could be challenging to diagnose. PATSS is a complication that potentially occurs following a global endometrial ablation in women with previous tubal sterilization. PATSS presents as cyclic pelvic pain caused by tubal distention from occult bleeding into the obstructed tubes. Review of the literature shows that majority of PATSS occurred after rollerball resection and ablation. We report two cases of PATSS after NovaSure® radiofrequency endometrial ablation.Gynecological Surgery 9(4).
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ABSTRACT: Adenomyosis is an important clinical challenge in gynecology and healthcare economics; in its fully developed form, hysterectomy is often used to treat it in premenopausal and perimenopausal women. Symptoms of adenomyosis typically include menorrhagia, pelvic pain and dysmenorrhea. Moreover, adenomyosis and leiomyomas commonly coexist in the same uterus, and differentiating the symptoms for each pathological process can be problematic. Although it has been recognized for over a century, reliable epidemiological studies on this condition are limited, because only postoperative diagnoses were possible in the past. Minimally invasive surgical techniques (endometrial ablation/resection, myometrial excision/reduction, myometrial electrocoagulation, uterine artery ligation) have had limited success in the treatment of adenomyosis, and the reported data for these procedures have been obtained from case reports or small case series with only short follow-up times. However, newer techniques including uterine artery embolization (UAE) and magnetic resonance imaging guided focused ultrasound (MRgFUS) show promise in treating adenomyosis. The data is strongest for UAE; these studies have the largest patient cohorts. However, none of the UAE studies were randomized or controlled. Thus, despite the clinical importance of adenomyosis, there is little evidence on which to base treatment decisions. The objective of this review is to summarize the epidemiology, risk factors, clinical phenotype and to evaluate the accrued experience with surgical and interventional alternatives to hysterectomy.Geburtshilfe und Frauenheilkunde 09/2013; 73(9):924-931. · 0.85 Impact Factor
Article: Reply to Letter to the Editor.Journal of Minimally Invasive Gynecology 12/2013; · 1.61 Impact Factor