[Hysteroscopic resection of submucosal myomas in abnormal uterine bleeding: results of a 4-year prospective study].

OBJECTIVE

The evaluation of the effect of transcervical resection of submucous myoma/s in patients with abnormal uterine bleeding.

METHODS

Prospective clinical study.

METHODS

Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University and General Faculty Hospital in Prague, Czech Republic.

METHODS

45 patients with resected submucous myoma/s within the period 1995-1998 were selected. Patients in whom resection of myoma was combined with endometrial ablation were excluded. The average age of the cohort was 43 years (29-53). In 37 patients (82%) therapeutical curettage was performed for severe bleeding in the past (3 procedures on average, interval 1-7). In 16 patients (36%) transfusion was administered in the treatment of anaemia secondary to abnormal uterine bleeding in the past. Hysteroscopy, ultrasound scan or both techniques were used to diagnose 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 to the ESH classification. In case of several myomas, the classification was based on the one of the highest 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 using loop high frequency electroendoresection technique. In 3 (7%) patients myomas of ESH II. were resected in more steps--in 2 cases (5%) in 2 steps and in 1 case (2%) in 3 steps. In patients with myomas classified as a 0. and I., only the character of menstrual cycle has been monitored after surgery. Ultrasound investigation was performed in patients with myomas of II. 3 months after surgery.

RESULTS

The bleeding was controlled in terms of eumenorrhoea or hypomenorrhoea in all 45 patients (100%). Ultrasound investigation showed no residual myoma in any of 4 patients after resection of II. myoma. One case fluid overload syndrome of minor degree was documented as the only complication.

CONCLUSIONS

Hysteroscopic high frequency endorsection is a safe and effective method and method 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 included and by the length of follow-up.