Effects of operative hysteroscopy with anti-adhesive solution in the patients who have abnormal uterine bleeding or intrauterine lesions

Abstract

Study Objective: The purpose of this study was to evaluate the efficacy, safety, and benefits of hysteroscopic surgery in the treatment of dysfunctional uterine bleeding (DUB) or intrauterine lesions causing uterine bleeding in pre- and postmenopausal women. Design: We prospectively enrolled 100 patients who underwent operative hysteroscopy because of uterine bleeding due to endometrial polyps or uterine submucosal myomas diagnosed by transvaginal ultrasonogram. Setting: Tertiary referral university center. Patients: Indications for the operative hysteroscopies included abnormal uterine bleeding (AUB), ultrasound findings indicative of intrauterine lesions, and dysfunctional uterine bleeding (DUB). Intervention: After operative hysteroscopic management, we inserted antiadhesive solution, (sodium hyaluronate and sodium carboxymethyl cellulose) into the uterine cavity. Measurements and Main Results: Operative hysteroscopy was a successful procedure in 100 of 100 cases(100%) but it needed to be repeated in three cases with large uterine submucosal myomas and after two polypectomies. Mean duration of the procedure was 23.2 minutes (range 5-67) and postoperative hospital stay was 7 hours (range 3-48). Most common indication was DUB (39%), submucosal myoma was 21%, and endometrial polyp was 17%. There were five cases with postoperative uterine bleeding and none with fluid overload syndrome. During postoperative follow-up (3-28 months) 90/100 patients (90%) were free of clinical symptoms like menstrual disorders and abnormal uterine bleeding. Conclusion: Hysteroscopic procedure is an effective and safe method for the management of benign intracavitary pathology or the treatment of dysfunctional uterine bleeding. We can confirm that there was no intrauterine adhesion in 5 patients who underwent a second operative hysteroscopy. Although anti-adhesive solution, (sodium hyaluronate and sodium carboxymethyl cellulose) seems to be effective in the prevention of adhesion in uterine cavity, further study will be needed to prove the effectiveness of anti-adhesive solution.