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Mulliez D, Poncelet E, Ferret L, Hoeffel C, Hamet B, Dang LA, Laurent N, Ramette G. Three-Dimensional Measurement of the Uterus on Magnetic Resonance Images: Development and Performance Analysis of an Automated Deep-Learning Tool. Diagnostics (Basel) 2023; 13:2662. [PMID: 37627920 PMCID: PMC10453745 DOI: 10.3390/diagnostics13162662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Uterus measurements are useful for assessing both the treatment and follow-ups of gynaecological patients. The aim of our study was to develop a deep learning (DL) tool for fully automated measurement of the three-dimensional size of the uterus on magnetic resonance imaging (MRI). In this single-centre retrospective study, 900 cases were included to train, validate, and test a VGG-16/VGG-11 convolutional neural network (CNN). The ground truth was manual measurement. The performance of the model was evaluated using the objective key point similarity (OKS), the mean difference in millimetres, and coefficient of determination R2. The OKS of our model was 0.92 (validation) and 0.96 (test). The average deviation and R2 coefficient between the AI measurements and the manual ones were, respectively, 3.9 mm and 0.93 for two-point length, 3.7 mm and 0.94 for three-point length, 2.6 mm and 0.93 for width, 4.2 mm and 0.75 for thickness. The inter-radiologist variability was 1.4 mm. A three-dimensional automated measurement was obtained in 1.6 s. In conclusion, our model was able to locate the uterus on MRIs and place measurement points on it to obtain its three-dimensional measurement with a very good correlation compared to manual measurements.
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Affiliation(s)
- Daphné Mulliez
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France; (E.P.); (B.H.); (L.A.D.); (N.L.); (G.R.)
| | - Edouard Poncelet
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France; (E.P.); (B.H.); (L.A.D.); (N.L.); (G.R.)
| | - Laurie Ferret
- Unité de Recherche Clinique, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France;
| | - Christine Hoeffel
- Service de Radiologie, Hôpital Maison Blanche, Avenue du Général Koenig, 51092 Reims, France;
| | - Blandine Hamet
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France; (E.P.); (B.H.); (L.A.D.); (N.L.); (G.R.)
| | - Lan Anh Dang
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France; (E.P.); (B.H.); (L.A.D.); (N.L.); (G.R.)
| | - Nicolas Laurent
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France; (E.P.); (B.H.); (L.A.D.); (N.L.); (G.R.)
| | - Guillaume Ramette
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France; (E.P.); (B.H.); (L.A.D.); (N.L.); (G.R.)
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Humo Al-Ibrahim B, Al Husaynei A. Modified thermal balloon endometrial ablation for treatment of heavy menstrual bleeding. Gynecol Minim Invasive Ther 2022; 11:100-104. [PMID: 35746908 PMCID: PMC9212179 DOI: 10.4103/gmit.gmit_147_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/22/2021] [Accepted: 07/08/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives: The objective of this study was to determine the efficacy of modified thermal balloon ablation using Foley's catheter in the treatment of heavy menstrual bleeding (HMB). Materials and Methods: Twelve patients with HMB aged 35–55 years underwent modified thermal balloon ablation using Foley's catheter. Patients were selected after complete clinical evaluation and investigations. The procedure was undertaken in the operation theater under general anesthesia/intravenous sedation. Three cycles of modified thermal balloon ablation using Foley's catheter were performed to ablate the endometrium. The time given to each cycle was 7 min. All the cycles were performed in the same setting. The main outcome measures that were studied were reduction in the menstrual flow, the need for further treatment, and relief of dysmenorrhea if present. Outcome measure regarding reduction in menstrual flow was statistically analyzed using Fisher's exact test. Statistical significance was determined at a level of P < 0.05. Results: Eighty-two percent of patients experienced a reasonable reduction in menstrual blood flow at 3-month follow-up. Eighteen percent observed no change in bleeding pattern and needed further treatment after failure of the procedure. Forty-two percent of patients complained of minor side effects such as cramp lower abdominal pain and fever. Rupture of balloon during the procedure occurred in only one case (8%). Conclusion: Modified thermal balloon ablation with Foley's catheter can be a promising management of HMB in resource-poor settings. It is a cost-effective alternative to the original endometrial ablation techniques.
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Marchand GJ, Azadi A, Sainz K, Masoud A, Anderson S, Ruther S, Ware K, Hopewell S, Brazil G, King A, Vallejo J, Cieminski K, Galitsky A, Steele A, Love J. Systematic review, meta-analysis and statistical analysis of laparoscopic supracervical hysterectomy vs. endometrial ablation. J Turk Ger Gynecol Assoc 2021; 22:97-106. [PMID: 33663195 PMCID: PMC8187984 DOI: 10.4274/jtgga.galenos.2021.2020.0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: This meta-analysis aimed to compare the effect of laparoscopic supracervical hysterectomy (LSH) with endometrial ablation (EA) in terms of general and menstrual-related quality of life in women opting for surgical treatment for abnormal uterine bleeding. Material and Methods: Sources searched included PubMed, Cochrane library, Scopus, and Web of Science for relevant clinical trials. Main outcomes of interest included: quality of life assessed using medical outcomes survey short form-36 (SF-36), (SF-12), operation time, time from operation to discharge, pain, fever, and hemoglobin level. Screening and data extraction were performed independently and the analysis was conducted using Review Manager Software v5.4.1. Results: Four clinical trials were included. Results of SF-12 score showed that there was no significant difference between the LSH and EA groups for either mental or physical component score overall mean difference (MD): -4.15 (-16.01, 7.71; p=0.49) and MD: 2.67 (-0.37, 5.71; p=0.08), respectively. Subgroup analysis of the SF-36 showed that only two components, general health and social function, were significantly improved in the LSH group (p<0.01) while the other six sub-scores did not differ between groups. The overall MD significantly favored the EA group for: operation time [MD: 72.65 (35.48, 109.82; p=0.0001)], time from operation to discharge [MD: 13.61 (3.21, 24.01; p=0.01)], hemoglobin level outcome [MD: 0.57 (0.40, 0.74); p<0.01], and pain score [standardized MD: 0.46 (0.32, 0.60; p<0.01)]. Conclusion: LSH has better outcomes for quality of life. This includes patient indicated responses to social health, general health, and superior hemoglobin levels at all measured points postoperatively. EA, however, was consistently associated with less operative time, a shorter hospital stay and is also considered by the authors to be a more minimally invasive technique which can also result in satisfying outcomes.
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Affiliation(s)
- Greg J Marchand
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Ali Azadi
- Department of Urogynecology, Star Urogynecology Advanced Pelvic Health Institute for Women, Arizona, United States of America
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Ahmed Masoud
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Sienna Anderson
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Kelly Ware
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis
| | - Sophia Hopewell
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Alexa King
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Jannelle Vallejo
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Anthony Galitsky
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Allison Steele
- International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis,Midwestern University School of Medicine, Arizona, United States of America
| | - Jennifer Love
- International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis,Midwestern University School of Medicine, Arizona, United States of America
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Al-Shaikh G, Almalki G, Bukhari M, Fayed A, Al-Mandeel H. Effectiveness and outcomes of thermablate endometrial ablation system in women with heavy menstrual bleeding. J OBSTET GYNAECOL 2017; 37:770-774. [PMID: 28418720 DOI: 10.1080/01443615.2017.1292228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Heavy menstrual bleeding (HMB) is a common problem in women of reproductive age group with major impact on their quality of life (QoL). The aim was to study the short-term effectiveness of Thermablate Endometrial Ablation System (EAS) and its impact on QoL in women with HMB. This was a prospective cohort study conducted on consecutive 72 women suffering from HMB. The success rate was estimated and patients' QoL was compared before and after the procedure using the Aberdeen menorrhagia severity scale. The mean follow-up period was 18 months (6-24 months). The mean age and body mass index were 48 (±5.2) years 33.2 (±7.4) kg/m2 respectively. Among treated participants, 58 (80.6%) reported the absence of bleeding. A significant decrease was observed in the rate of missed social activity and increase in the leisure time activities. The overall patient satisfaction was 95.7%. Thermablate EAS is an effective minimally invasive treatment with marked improvement in QoL in women with HMB. Impact statement Heavy menstrual bleeding (HMB) is a common problem that affects 11-13% of reproductive age women with major impact on their quality of life (QoL). A variety of methods for endometrial ablation has been used for the destruction of the endometrial lining to treat HMB. The short-term results of this study shows amenorrhoea rate of (80.6%) after the procedure and a significant decrease in the rate of missed social activity and increase in the leisure time activities with marked improvement in QoL. The overall patient satisfaction was 95.7%. Thermablate Endometrial Ablation System is an effective minimally invasive treatment for HMB with advantages of shorter operating time, shorter hospital stay and high-level patient satisfaction. However, further clinical research with large-scale studies and possible comparison with other treatment options are recommended.
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Affiliation(s)
- Ghadeer Al-Shaikh
- a Department of Obstetrics and Gynecology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
| | - Ghada Almalki
- b Department of Obstetrics and Gynecology , King Saud University Medical City , Riyadh , Saudi Arabia
| | - Mujahed Bukhari
- b Department of Obstetrics and Gynecology , King Saud University Medical City , Riyadh , Saudi Arabia
| | - Amel Fayed
- c King Khalid University Hospital , Riyadh , Saudi Arabia
| | - Hazem Al-Mandeel
- a Department of Obstetrics and Gynecology , College of Medicine, King Saud University , Riyadh , Saudi Arabia
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Penezic L, Riley K, Harkins G. Long-term patient satisfaction with thermal balloon ablation for abnormal uterine bleeding. JSLS 2016; 18:JSLS-D-13-00325. [PMID: 25392642 PMCID: PMC4154432 DOI: 10.4293/jsls.2014.00325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Thermal balloon ablation is a minimally invasive surgical technique that can be used to treat abnormal uterine bleeding/heavy menstrual bleeding (AUB/HMB). Most published studies to date provide information on short-term patient satisfaction and outcomes. The purpose of this study was to determine long-term patient satisfaction after thermal balloon endometrial ablation 7 to 10 years postoperatively in a population previously surveyed at the Penn State Milton S. Hershey Medical Center at 1 to 5 years postoperatively. Methods: Two-hundred fourteen patients were identified who underwent thermal balloon ablation at our institution between January 1, 2001 and December 31, 2004. These patients were mailed a 2-page survey asking for information on demographics, patient satisfaction, postoperative bleeding patterns, and the need for subsequent surgery. Satisfaction rates, amenorrhea rates, and the rates of women who required hysterectomy were calculated as percentages. Results: Ninety-seven patients returned completed surveys. The survey response rate was 62%, excluding 57 surveys that were returned as undeliverable. The follow-up interval was 93 to 129 months. Eighty-seven percent of respondents were satisfied with the results of their procedure compared with 88% in the original study. Subsequent hysterectomy was required in 21.6% of women after 7 to 10 years compared with 9% after the 1- to 5-year follow-up period. Of the 76 women who did not undergo hysterectomy, 58% reported amenorrhea and 35.5% reported minimal to light bleeding. Conclusion: This study demonstrates a consistently high patient satisfaction rate with thermal balloon ablation at our institution at 7 to 11 years postoperatively compared with 1 to 5 years postoperatively. The hysterectomy rate, however, was 2.4 times greater in the long-term follow-up period.
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Affiliation(s)
- Lindsey Penezic
- Penn State Hershey Medical Center Department of Obstetrics and Gynecology, Hershey, PA, USA
| | - Kristin Riley
- Penn State Hershey Medical Center Department of Obstetrics and Gynecology, Hershey, PA, USA
| | - Gerald Harkins
- Penn State Hershey Medical Center Department of Obstetrics and Gynecology, Hershey, PA, USA
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Singh M, Hosni MM, Jones SE. Is endometrial ablation protective against endometrial cancer? A retrospective observational study. Arch Gynecol Obstet 2015; 293:1033-7. [DOI: 10.1007/s00404-015-3909-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
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Bouzari Z, Yazdani S, Azimi S, Delavar MA. Thermal balloon endometrial ablation in the treatment of heavy menstrual bleeding. Med Arch 2014; 68:411-3. [PMID: 25648851 PMCID: PMC4314175 DOI: 10.5455/medarh.2014.68.411-413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
Aim: Heavy menstrual bleeding is one of the common health problems in women. The first-line therapy of heavy menstrual bleeding is the medical therapy, but this is not successful. Currently, global ablation procedures were introduced for treating of heavy menstrual bleeding. The aim of this study was to the analysis of the patient with menorrhagia performed operations of Cavaterm in our university affiliated hospital, and explores its effectiveness and acceptability. Methods: A retrospective study was conducted on 30 patients with menorrhagia who were unresponsive to hormone therapy or not candidates for hysterectomy underwent endometrial ablation using Cavaterm. Preoperative and postoperative PBAC Scoring System was used to assess menorrhagia. Outcome measures were amenorrhea rates, reduction of menstrual flow rates, heavy bleeding, menstrual and patients’ satisfaction rates at 3, 6 and 12 months postoperative. Results: After a follow-up at 3, 6, and 12 months postoperative, 36.7%, 43.3%, and 36.7% of women had a reduction in vaginal bleeding, respectively. Amenorrhea rates were 56.7%, 50.0%, and 56.7% in the Cavaterm at 3, 6, and 12 months. The rate of women’s reported good or excellent satisfaction was 93.3% in 12 months. During the follow-up period, no woman received a subsequent hysterectomy. Conclusion: The findings of this research indicated that outcome with the Cavaterm was as good for women with menorrhagia. Therefore, it is necessary to emphasize on lower operative and post-operative procedural risk and a deleterious effect on patients who were unresponsive to hormone therapy.
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Affiliation(s)
- Zinatossadat Bouzari
- Fatemezahra Infertility and Reproductive Health Research Center, Department of Obstetrics and Gynecology, Babol University of Medical Sciences, Iran
| | - Shahla Yazdani
- Fatemezahra Infertility and Reproductive Health Research Center, Department of Obstetrics and Gynecology, Babol University of Medical Sciences, Iran
| | - Samira Azimi
- Resident of Department of Obstetrics and Gynecology of Babol University of Medical Sciences, Iran
| | - Mouloud Agajani Delavar
- Fatemezahra Infertility and Reproductive Health Research Center, Department of Midwifery, Babol University of Medical Sciences, Iran
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Levy-Zauberman Y, Legendre G, Nazac A, Faivre E, Deffieux X, Fernandez H. Concomitant hysteroscopic endometrial ablation and Essure procedure: feasibility, efficacy and satisfaction. Eur J Obstet Gynecol Reprod Biol 2014; 178:51-5. [PMID: 24813100 DOI: 10.1016/j.ejogrb.2014.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/18/2014] [Accepted: 03/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Hysteroscopic endometrial destruction procedures for abnormal uterine bleeding are an alternative to hysterectomy. Such procedures are not contraceptive and are performed on fertile patients, requiring long-term contraception. This is the first study evaluating long-term results of a combined procedure associating endometrial destruction and concomitant hysteroscopic tubal sterilization by Essure(®) micro-inserts. Our goal is to evaluate efficacy of endometrial destruction as well as hysteroscopic sterilization and satisfaction after a combined procedure in the case of abnormal uterine bleeding in non-menopausal patients. STUDY DESIGN This is a retrospective study (Canadian task force II-2) that includes 131 patients operated with combined endometrial destruction and hysteroscopic tubal sterilization between 2002 and 2011 at our university hospital. The patients were contacted to answer a questionnaire. Statistical analysis was performed with SAS© version 9.2. (SAS Institute Inc., Cary, NC). RESULTS Ninety-three patients out of 131 could be reached. The mean follow-up was of 37.8 months (min=8, max=87, SD=6.2). Thirty-eight patients (29%) were lost to follow-up. Essure(®) micro-inserts introduction success rate (evaluated on 131 patients) was 95.8%, and their position was appropriate in 81.1% of the 106 patients with position control. Efficacy of the procedure on the haemorrhagic symptoms (evaluated on 93 patients) was 80.6%. Twelve patients (12.9%) underwent a hysterectomy, 7 of which (58.3%) were a direct consequence of treatment failure. No pregnancies were reported. Satisfaction rate was of 90.3%. CONCLUSION Inadequate position rates of the micro-inserts after 3 months seem somewhat above literature findings, though no pregnancy has been reported. However, recurrent bleeding symptoms and hysterectomy rates are consistent with those observed after an endometrial destruction procedure alone. Limitations are the limited number of patients, the bias inherent to retrospective studies (lost of follow-up, selection bias). The concomitant endometrial destruction and tubal sterilization by micro-inserts is a safe and efficient procedure.
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Affiliation(s)
- Y Levy-Zauberman
- AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
| | - G Legendre
- AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - A Nazac
- AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - E Faivre
- AP-HP, Hospital Antoine Béclère, Department of Gynaecology and Obstetric, 157 rue de la Porte de Trivaux, 92140 Clamart, France
| | - X Deffieux
- AP-HP, Hospital Antoine Béclère, Department of Gynaecology and Obstetric, 157 rue de la Porte de Trivaux, 92140 Clamart, France; Université Paris-Sud, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France
| | - H Fernandez
- AP-HP, Hospital Bicêtre, Department of Gynaecology and Obstetric, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; INSERM U1018, CESP «Reproduction et développement de l'enfant», 82 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France; Université Paris-Sud, 63 rue Gabriel Péri, 94270 Le Kremlin Bicêtre, France
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Levy-Zauberman Y, Fernandez H, Pourcelot AG, Legendre G. [Does repeated endometrial destruction procedure decrease abnormal uterine bleeding, and does it reduce the number of hysterectomies in this indication?]. ACTA ACUST UNITED AC 2013; 43:35-9. [PMID: 24286929 DOI: 10.1016/j.jgyn.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/29/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Hysteroscopic endometrial resection or destruction in the indication of abnormal uterine bleeding or post-menopausal bleeding represents an alternative to hysterectomy, as it carries a lower morbidity rate. In case of failure of such procedure though, hysterectomy will most often be proposed as a second line of treatment. The place of the repetition of an endometrial destruction procedure has not yet been evaluated. The aim of our study is to evaluate the efficiency and the satisfaction after two consecutive techniques of endometrial destruction in case of abnormal uterine bleeding or post-menopausal bleeding. MATERIAL AND METHODS Nineteen patients presenting with recurring abnormal uterine bleeding after one procedure of endometrial destruction, underwent in our department, between 2004 and 2011, a second conservative endometrial procedure. RESULTS No complication occurred during the repeated procedure. Sixteen of the nineteen patients (84.2 %) included answered a questionnaire. The mean delay since the second procedure was 27 months [25; 29]. Eight patients (i.e. 50 %) later underwent a hysterectomy, with 5 of them (31.25 % of all 16 patients) being directly attributed to treatment failure. Patients said to be satisfied with the management of their condition in 68.75 % of cases, and 93.75 % of them would recommend it to a friend. CONCLUSION Our results suggest that a second conservative management in case of recurrence of AUB is effective. Hysterectomy could be avoided in 50 % of cases. A second conservative treatment could be an interesting option for patients with medical contra-indication for heavier surgery, as well as for patients willing to keep their uterus.
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Affiliation(s)
- Y Levy-Zauberman
- Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France.
| | - H Fernandez
- Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France.
| | - A-G Pourcelot
- Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France.
| | - G Legendre
- Service de gynécologie-obstétrique, hôpital de Bicêtre, Assistance publique-Hôpitaux de Paris, , 94276 Le Kremlin-Bicêtre cedex, France; CESP-Inserm, U1018, équipe 7, genre, santé sexuelle et reproductive, université Paris Sud, 94276 Le Kremlin-Bicêtre cedex, France.
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Effect of myoma size on failure of thermal balloon ablation or levonorgestrel releasing intrauterine system treatment in women with menorrhagia. Obstet Gynecol Sci 2013; 56:36-40. [PMID: 24327978 PMCID: PMC3784110 DOI: 10.5468/ogs.2013.56.1.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/20/2012] [Accepted: 09/12/2012] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of the present study was to identify variables associated with treatment failure in women with menorrhagia who were treated with thermal balloon ablation (TBA) or levonorgestrel releasing intrauterine system (LNG-IUS), and to determine if there are subgroups where one treatment type is more effective than the other. Methods The study included 106 women with menorrhagia who were treated with TBA or LNG-IUS at the study institute between January 2003 and December 2007, with a follow-up period greater than 12 months. Data were collected by retrospective review of medical records. Treatment failure was defined as persistent or recurrent menorrhagia within one year after treatment or hysterectomy at any time during follow-up. The relationships between variables and treatment outcome were analyzed using the chi-square or Fisher's exact test. The treatment outcome of TBA was compared with LNG-IUS. Results Sixty-seven women were treated with TBA and 39 women were managed with LNG-IUS. Fifty-two women had a myoma ≥2.5 cm. Treatment failure was observed in 24 women (2 recurrent or persistent menorrhagia and 22 hysterectomies) and myoma size (≥2.5 cm vs. <2.5 cm) was associated with treatment outcome. TBA and LNG-IUS showed similar treatment outcomes. Conclusion A large myoma is a risk factor for treatment failure in women with menorrhagia treated with TBA or LNG-IUS.
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Sesti F, Ruggeri V, Pietropolli A, Piancatelli R, Piccione E. Thermal balloon ablation versus laparoscopic supracervical hysterectomy for the surgical treatment of heavy menstrual bleeding: a randomized study. J Obstet Gynaecol Res 2011; 37:1650-7. [PMID: 21790890 DOI: 10.1111/j.1447-0756.2011.01596.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To compare postoperative outcomes and effects on quality of life following thermal balloon ablation (TBA) or laparoscopic supracervical hysterectomy (LSH) in women with heavy menstrual bleeding (HMB). MATERIAL AND METHODS Sixty-eight women requiring surgical treatment for HMB were randomly allocated into two treatment arms: TBA (n = 34) and LSH (n = 34). The randomization procedure was based on a computer-generated list. The primary outcome was a comparison of the effects on menstrual bleeding (Pictorial Blood Loss Assessment Chart [PBAC]) between the two procedures. The secondary outcome measures were quality of life, improvement of bleeding patterns, intensity of postoperative pain, and early postoperative complications. Continuous outcome variables were analyzed using Student's t-test. Discrete variables were analyzed with the χ2 test or Fisher's exact test. P < 0.05 was considered statistically significant. RESULTS The PBAC score was significantly reduced in both treatment groups. After LSH all women had amenorrhea. After TBA there was a significant improvement of bleeding frequency and length. The postoperative pain intensity at 24 h was significantly minor in women treated with TBA rather than with LSH. The Medical Outcomes Survey Short Form 36 (SF-36) score improved in both groups. However, LSH showed a negative impact on the emotional state. No intraoperative complications occurred, and no case was returned to the theatre in either group. CONCLUSION The effectiveness of TBA as a possible treatment of HMB is confirmed. However, LSH showed a definitive improvement of the symptoms, and a better life quality profile. Further controlled prospective studies are required for identifying the best surgical approach in women with HMB.
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Affiliation(s)
- Francesco Sesti
- Section of Gynecology and Obstetrics, Department of Surgical Sciences, School of Medicine, Tor Vergata University Hospital, Rome, Italy.
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Helal AS, Abdel-Hady ES, Mashaly AEM, Shafaie ME, Sherif L. Modified thermal balloon endometrial ablation in low resource settings: a cost-effective method using Foley's catheter. Arch Gynecol Obstet 2010; 284:671-5. [PMID: 21046129 DOI: 10.1007/s00404-010-1744-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Accepted: 10/19/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the efficacy of a modified Foley's catheter endometrial ablation in the treatment of abnormal uterine bleeding in low resource settings. METHODS Four hundred and thirty premenopausal women with abnormal uterine bleeding were subjected to thermal balloon endometrial ablation using modified Foley's catheter. The primary outcome measure was patient satisfaction regarding menstrual blood loss. Secondary measures included improvement in quality of life scores and failure rates. RESULTS Three hundred and three patients were available for evaluation at 3-year follow up. 270/303 (89.1%) reported their satisfaction as indicated by reduction in days of menstrual flow per cycle (4.2 vs. 8.8 days, p < 0.0001). There was a significant improvement in quality of life scores (p < 0.0001). The rate of failure varies according to the interval of follow up from 15.6% at 6 months to 10.9% at 3 years. CONCLUSION Modified Foley's catheter endometrial ablation is a cost effective alternative to other thermal endometrial ablation techniques in the treatment of abnormal uterine bleeding in low resource settings.
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Affiliation(s)
- Adel Saad Helal
- Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt.
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Genital tract burns: a complication of MenoTreat thermal balloon ablation. Eur J Obstet Gynecol Reprod Biol 2010; 152:228-9. [DOI: 10.1016/j.ejogrb.2010.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Revised: 12/08/2009] [Accepted: 06/25/2010] [Indexed: 11/23/2022]
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Le Marrec A, Lavoue V, Morcel K, Duval H, Bauville E, Foucher F, Leveque J. Occurrence of endometrial cancer six years after treatment with thermal balloon ablation (Thermachoice): first case report. Eur J Obstet Gynecol Reprod Biol 2010; 150:219-20. [PMID: 20304551 DOI: 10.1016/j.ejogrb.2010.02.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 01/12/2010] [Accepted: 02/20/2010] [Indexed: 10/19/2022]
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