Hysteroscopic Resection of Submucous Myomas inAbnormal Uterine Bleeding: Results of a Four-yearProspective Study

Overview

Objective:
The evaluation of the effect of transcervical resection of submucous myoma/s in pati-ents with abnormal uterine bleeding.Design: Prospective clinical study.Setting: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University andGeneral Faculty Hospital in Prague, Czech Republic.Methods: 45 patients with resected submucous myoma/s within the period 1995-1998 were selec-ted. Patients in whom resection of myoma was combined with endometrial ablation were exclu-ded. The average age of the cohort was 43 years (29-53). In 37 patients (82%) therapeuticalcurettage was performed for severe bleeding in the past (3 procedures on average, interval 1-7). In16 patients (36%) transfusion was administered in the treatment of anaemia secondary to abnor-mal uterine bleeding in the past. Hysteroscopy, ultrasound scan or both techniques were used todiagnose and classify myomas. In 39 patients 1 myoma was resected, in 6 patients 2 myomas. In 12(27%) patients myoma of 0°, in 29 (64%) of I° and in 4 (9%) of II° has been diagnosed according tothe ESH classification. In case of several myomas, the classification was based on the one of thehighest degree. Surgery was performed in the early proliferative phase of the menstrual cycle.Purisol (sorbitol and mannitol) was used as a distension medium. Myomas were resected usingloop high frequency electroendoresection technique. In 3 (7%) patients myomas of ESH II° wereresected in more steps - in 2 cases (5%) in 2 steps and in 1 case (2%) in 3 steps. In patients withmyomas classified as a 0° and I°, only the character of menstrual cycle has been monitored aftersurgery. Ultrasound investigation was performed in patients with myomas of II° 3 months aftersurgery.Results: The bleeding was controlled in terms of eumenorrhoea or hypomenorrhoea in all 45patients (100%). Ultrasound investigation showed no residual myoma in any of 4 patients afterresection of II° myoma. One case fluid overload syndrome of minor degree was documented as theonly complication.Conclusion: Hysteroscopic high frequency endoresection is a safe and effective method and met-hod of choice in the treatment of submucous myomas in patients with abnormal uterine bleeding.The high success rate in our cohort is certainly influenced by the number of patients includedand by the length of follow-up.

Key words:
operative hysteroscopy, myoma, fibroma, abnormal uterine bleeding