RESUMO
This review summarizes the history and demographics of nonresectoscopic endometrial ablation and global endometrial ablation procedures as well as the presentation, etiology, risk factors, treatment options, and prevention of late-onset endometrial ablation failures.
Assuntos
Técnicas de Ablação Endometrial/efeitos adversos , Miomectomia Uterina/efeitos adversos , Fatores Etários , Técnicas de Ablação Endometrial/história , Técnicas de Ablação Endometrial/métodos , Feminino , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Seleção de Pacientes , Fatores de Tempo , Falha de Tratamento , Miomectomia Uterina/história , Miomectomia Uterina/métodosAssuntos
Técnicas de Ablação Endometrial , Endometriose/cirurgia , Leiomioma/cirurgia , Dor Pós-Operatória/etiologia , Técnicas de Ablação Endometrial/efeitos adversos , Endometriose/complicações , Endometriose/diagnóstico , Feminino , Humanos , Leiomioma/complicações , Leiomioma/diagnóstico , Menorragia/etiologia , Menorragia/cirurgia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/cirurgiaAssuntos
Ablação por Cateter , Histerectomia , Metrorragia/cirurgia , Feminino , Humanos , ReoperaçãoRESUMO
At first, total endometrial ablation seemed extremely safe in the short term. However, as time passed, certain unique long-term complications became evident. The problem is that after this procedure, intrauterine scarring and contracture can occur. Any bleeding from persistent or regenerating endometrium behind the scar may be obstructed and cause problems such as central hematometra, cornual hematometra, postablation tubal sterilization syndrome, retrograde menstruation, and potential delay in the diagnosis of endometrial cancer. The incidence of these complications is probably understated because most radiologists and pathologists have not been educated about the findings to make the appropriate diagnosis of cornual hematometra and postablation tubal sterilization syndrome. This review will thoroughly discuss how to diagnose and treat these problems. Possible ways of preventing these long-term complications will also be discussed.
Assuntos
Ablação por Cateter/efeitos adversos , Endométrio/cirurgia , Hematometra , Distúrbios Menstruais , Esterilização Involuntária , Neoplasias do Endométrio/diagnóstico , Feminino , Hematometra/diagnóstico , Hematometra/etiologia , Hematometra/prevenção & controle , Hematometra/terapia , Humanos , Incidência , Imageamento por Ressonância Magnética , Distúrbios Menstruais/diagnóstico , Distúrbios Menstruais/etiologia , Distúrbios Menstruais/prevenção & controle , Distúrbios Menstruais/terapia , Resultado do TratamentoRESUMO
OBJECTIVE: This study was undertaken to determine the frequency of symptomatic cornual hematometra and postablation tubal sterilization syndrome after total rollerball endometrial ablation and to describe methods for diagnosis, treatment, and prevention. STUDY DESIGN: Retrospective cases of 50 consecutive patients who received total rollerball endometrial ablation for dysfunctional uterine bleeding were followed up for 10 years. RESULTS: Symptomatic cornual hematometra or postablation tubal sterilization syndrome was diagnosed by ultrasound scanning and/or magnetic resonance imaging in 5 of 50 patients (10%) who had a total endometrial ablation. Two patients had cornual hematometra, and 3 patients had postablation tubal sterilization syndrome 4 months to 90 months after rollerball ablation. Subsequent gonadotropin-releasing hormone agonist treatment or hysteroscopic decompression of the hematometra was only partially successful, and recurrence of symptoms necessitated hysterectomy with salpingectomy. CONCLUSION: Uterine contracture, which obstructs bleeding from persistent cornual endometrium and leads to symptomatic cornual hematometra or postablation tubal sterilization syndrome, is not uncommon after total rollerball endometrial ablation, with an incidence of 10% in our series. Satisfactory treatment requires hysterectomy with salpingectomy, but modifications such as partial endometrial ablation can prevent these complications.