Original articleResectoscopic Correction of the “Isthmocele” in Women with Postmenstrual Abnormal Uterine Bleeding and Secondary Infertility
Section snippets
Materials and Methods
This study was conducted at the private clinic “Madre Fortunata Toniolo” and at the Department of Gynaecology and Obstetrics I of the University Hospital S. Orsola-Malpighi in Bologna. Our 26 study patients, aged 29 to 42 years, who previously underwent cesarean section deliveries (the number of previous cesarean deliveries ranged from 1–3), were studied from 2001 through 2005 because of postmenstrual abnormal uterine bleeding (PAUB). Nine of them had secondary infertility, too. All patients
Results
The office hysteroscopic follow-up, using the same setting of the preoperative diagnostic hysteroscopy, confirmed the success of the surgical procedure in correcting the previous anatomic defect and in reconstructing the cervical canal in the interested tract. There was a replacement by the endocervical mucosa. Only a partially cicatrized “fovea” remained. The clinical outcome was the resolution of PAUB in all cases. Seven of 9 patients who desired another pregnancy became pregnant
Discussion
Diagnostic hysteroscopy, with both gas and solution as a distension medium, allow us to identify the “isthmocele” as a pouchlike anatomic defect on the anterior wall of the isthmus or of the cervical canal, at its superior third or less frequently at its mean-inferior third. More precisely, the defect appeared anteriorly near the right as an outcome of the physiological uterine involution after delivery. The benefit of using the physiological solution as a medium of distension is to wash the
Conclusions
A cesarean section scar may have some reproductive and gynecologic consequences, such as abnormal postmenstrual uterine bleeding, entering into the differential diagnosis with other causes of bleeding disorders. The office hysteroscopic examination allows us to easily identify the described isthmic defect, because it is not very invasive and extremely accurate. The resectoscopic surgery represents the choice treatment of the “isthmocele,” guaranteeing excellent results in terms of therapeutic
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The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.
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