Hysteroscopic management of intrauterine lesions and intractable uterine bleeding.

TLDR

Müllerian fusion defects, submucous myomas, and intractable uterine bleeding have been traditionally managed by major surgery, but the cystoscope‑resectoscope offers a transvaginal operative alternative. Forty women underwent hysteroscopy and cystoscope‑resectoscope treatment at Yale‑New Haven Hospital, with septate Müllerian defect patients also receiving concomitant laparoscopy. The cystoscope‑resectoscope produced no complications, enabled 9 of 11 anomaly patients to deliver term, restored normal menses in 14 lesion patients for at least a year, and controlled hemorrhage in all 11 bleeding patients, with 6 remaining amenorrheic.

Abstract

Müllerian fusion defects, submucous myomas, and intractable uterine bleeding have been managed traditionally by major surgical intervention. However, the cystoscope-resectoscope provides the operative versatility allowing transvaginal surgical management of these situations. Forty women underwent hysteroscopy and treatment with the cystoscope-resectoscope at the Yale-New Haven Hospital. Those patients treated for septate müllerian defects also underwent concomitant laparoscopy. Therapeutic surgical use of the cystoscope-resectoscope resulted in no immediate or long-term complications. Of 11 patients with uterine anomalies treated in this fashion, 9 carried to term without difficulty. Fourteen women with space-occupying intrauterine lesions were treated and resumed normal cyclical menses for a minimum of 1 year. In all 11 patients with intractable uterine bleeding hemorrhage was controlled immediately and 6 women remained amenorrheic for a sustained period. The use of the cystoscope-resectoscope for the management of these entities provides several advantages: 1) A transcervical approach obviates the necessity for abdominal surgery, and 2) the instrument is rapidly and easily accessible to the practicing gynecologist.