Retrospective study on the outcomes and satisfaction with endometrial ablation by bipolar energy (NovaSure®) for the treatment of heavy menstrual bleeding.

PURPOSE: To determine the effectiveness, safety, and participant satisfaction with endometrial ablation by bipolar energy (NovaSure®) in the treatment of heavy menstrual bleeding (HMB), and to investigate factors associated with poorer outcomes. METHODS: Multicenter retrospective observational study based on medical record review of the outcomes related to endometrial ablation by the bipolar-energy technique procedure to treat HMB in the setting of three university teaching hospitals in Spain. RESULTS: A total of 333 women were included in the study. Most bipolar-energy ablations were successful (85.12%; n = 269 out of 316), with amenorrhea the most frequent outcome (39.6%, n = 131 out of 316). The majority of participants had no complications (95.5%; n = 317 out of 332), and of those who did, only 2.1% were related to the technique. No further treatment was required for HMB in 82.8% of women (n = 274 out of 331), and surgery was avoided in 91.8%; only 5.9% of women underwent ablation-related hysterectomy. In women with previous transverse cesarean sections (CS), 91.0% avoided subsequent surgical treatment. Eighty-six percent of women (n = 221 out of 257) were satisfied with the procedure. CONCLUSION: Bipolar-energy ablation is very effective and safe for the treatment of HMB and yielded a high rate of participant satisfaction in our setting. The presence of comorbidities or previous CS may slightly reduce the effectiveness of the method, while performing concomitant surgery (mainly curettage) increases the rate of complications. Notably, despite the known increased risk of hysterectomy, most participants with previous CSs who underwent ablation avoided major surgery.

Efficacy, Complications, and Factors Predictive of Response to Treatment with Transvaginal Radiofrequency Ablation for Symptomatic Uterine Myomas.

STUDY OBJECTIVE: Transvaginal radiofrequency ablation is a minimally invasive treatment for myomas in women who wish to preserve their uterus. This study aimed to evaluate the efficacy and safety of transvaginal radiofrequency to treat myomas and to identify factors predictive of the response to treatment. DESIGN: Prospective case series. SETTING: Virgen de las Nieves University Hospital, a tertiary center in Granada, Spain. PATIENTS: The participants were 59 patients with myomas. INTERVENTIONS: Transvaginal radiofrequency ablation. MEASUREMENTS AND MAIN RESULTS: The variables recorded were personal (age and type of myoma), procedure dependent (pain, need for analgesia, duration of sick leave, procedure duration, and complications), clinical (total days of menstrual bleeding and days of heavy menstrual bleeding), and score on the symptom severity scale of the Uterine Fibroid Symptom and Quality of Life Questionnaire. Myoma volume was determined by ultrasonography. Changes in clinical variables and myoma volume were analyzed 2, 6, and 12 months after the procedure. Moreover, the influence of age, initial myoma size, type of myoma, and duration of the procedure on the outcomes of treatment were analyzed. Statistically significant improvements in symptoms were seen in all variables analyzed for bleeding at 0, 2, 6, and 12 months, and a significant improvement was seen in the symptom severity scale score 12 months after the procedure. Mean myoma volume (in milliliters) was significantly lower 2, 6, and 12 months after treatment (p <.05). At 12 months, the mean reduction in myoma volume was more than 80%. Patient age and initial myoma size were identified as factors predictive of the outcomes. CONCLUSION: Transvaginal radiofrequency ablation was an effective and safe technique for the treatment of myomas. The patient's age and initial size of the myoma influenced the outcome of treatment.

Office hysteroscopic metroplasty with diode laser for septate uterus: a multicenter cohort study.

OBJECTIVE: To investigate the effectiveness and safety of office hysteroscopic metroplasty by diode laser for the treatment of septate uteri. STUDY DESIGN: We performed a prospective cohort study including 41 nulliparous women diagnosed with septate uterus and a history of primary infertility or recurrent miscarriage. All patients underwent hysteroscopic metroplasty for the treatment of the uterine septum, which was performed in-office setting using a 4.3 mm continuous-flow hysteroscope and a 15-watt diode laser at 1470 nm. Surgical and reproductive outcomes after 2 years of follow-up are reported. RESULTS: The procedure was well tolerated by 93% of patients. No surgical complications were reported. Thirty women out of 38 (78.9%) became pregnant: 17 (56.7%) pregnancies were spontaneously conceived, and 13 (43.3%) were obtained with assisted reproductive techniques. Twenty-four (80%) of the 30 pregnant women had a live birth, with a cumulative live birth of 63.2% among the 38 women (95% CI: 45.9-78.2%). There were no cases of post-partum hemorrhage or uterine rupture among 14 (58.3%) women who had vaginal deliveries. CONCLUSION: Office hysteroscopic metroplasty for septate uterus using diode laser appears to be a feasible and safe alternative to other available techniques and has sufficient efficacy in terms of reproductive outcomes to be considered for further investigations.

Hysterectomy in women with obesity: complications related to surgical site.

BACKGROUND: The aim of this study was to describe the trends in surgical routes in obese women who underwent hysterectomy for benign disease at our center and compare complications in different groups. METHODS: Retrospective study done between 2011 and 2015 in women with a Body Mass Index≥30 who underwent hysterectomy for benign disease at Virgen de las Nieves Universitary Hospital in Granada, Spain. We studied three groups based on the surgical route chosen for hysterectomy: vaginal, abdominal or laparoscopic. The rates of intraoperative and postoperative complications, major complications, reintervention and days of hospital stay were compared. RESULTS: Abdominal hysterectomy was associated with the highest risk of postoperative complications and the longest hospital stay. Laparoscopic hysterectomy had a higher risk than vaginal hysterectomy of major complications. There were no significant differences between groups for any of the other variables. CONCLUSIONS: In obese women vaginal hysterectomy was associated with the lowest morbidity, and should be the approach of choice whenever feasible.

Resultados de la Ablación-Resección Endometrial con Energía Monopolar. Análisis de Factores Pronósticos / Outcomes of Endometrial Ablation-Resection with Monopolar Electrosurgery. Prognostic Factors Analysis

INTRODUCCIÓN: La hemorragia uterina anormal (HUA) se considera una patología con importantes repercusiones sanitarias y sociales, ya que afecta a un porcentaje elevado de pacientes en edad reproductiva, deteriorando su calidad de vida y suponiendo la principal causa de anemia e histerectomía en mujeres de países desarrollados. El tratamiento dependerá de múltiples factores, siendo la ablación-resección endometrial (ARE) una alternativa apropiada para pacientes que no desean conservar la fertilidad. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo que analiza los resultados de ARE histeroscópica en el Hospital Universitario Virgen de las Nieves de Granada y los factores asociados al éxito o fracaso de la misma. RESULTADOS: Se seleccionaron 260 pacientes premenopáusicas sometidas a ARE histeroscópica acompañada de miomectomía y/o polipectomía en el 60,4 % de los casos, con un tiempo de seguimiento entre 1 y 79 meses. De estas, solo 40 continuaron con menorragia, considerándose por tanto que la técnica resultó exitosa desde el punto de vista clínico en el 84,6 % de los casos, con tasas de amenorrea del 38,5 %, siendo necesario rentervenir al 12,3 % de las pacientes. Al analizar el éxito con el tiempo, a los 5 años de seguimiento, nuestra tasa de éxito clínico ha sido del 70,8 % y nuestra tasa de reintervención del 19,9 %

INTRODUCTION: Abnormal uterine bleeding (AUB) is considered a disease with important health and social impact, as it affects a large percentage in patients of reproductive age, impairing their quality of life and assuming the leading cause of anemia and hysterectomy in women in developed countries. The treatment will depend on multiple factors, being the endometrial ablation-resection (EAR) an alternative for patients who do not wish to preserve fertility. METHODS: This observational retrospective study analyze the results of hysteroscopic EAR in the Virgen de las Nieves University Hospital, and factors associated with the success or failure of the procedure. RESULTS: We selected 260 premenopausal women who were performed hysteroscopic EAR , preceded by myomectomy and/or polypectomy in 60,4% of patients . Follow up ranged from 1 to 79 months. Only 40 of the 260 selected patientscontinued with menorrhagia, therefore the technique was clinically successful in 84,6% of them, with amenorrhea rates of 38,5%. Moreover, 12,3% of patients needed another additional operative procedure. After 5 years of follow-up our clinic succes rate was 70,8% and 19,9% of reintervention rate. Adenomyosis was a risk factor for clinical failure and reoperation in both bivariant and multivariate analysis. When we consider the follow-up time, adenomyosis triples risk of clinical failure and causes 5,3 fold increase in surgical failure risk. CONCLUSION: Hysteroscopic EAR offers favourable outcomes in patients with abnormal uterine bleeding, but when adenomyosis is suspected we must contraindicate it, or at least the patient must be informed about poor results

Epidemiología del aborto de repetición / Epidemiology of recurrent miscarriage

Objetivo. Conocer las posibles causas de aborto de repetición en nuestro medio y la tasa de embarazo en estas parejas. Material y métodos. Estudio observacional retrospectivo de 172 mujeres que consultaron en nuestra Unidad durante los años 2002 a 2008 por dos o más abortos de repetición. Resultados. El 80,2% de las mujeres quedaron gestantes, 81,2% de ellos a término. El estudio de abortabilidad fue normal en el 70,9%. Las alteraciones halladas fueron: uterinas 48%, genéticas 2% y alteraciones de la coagulación 44%, apareciendo asociadas en el 6% de las pacientes. Conclusiones. La mayoría de las parejas que consultan por abortos de repetición se van a quedar sin un diagnóstico etiológico tras el estudio de abortabilidad. El pronóstico reproductivo empeora conforme aumenta el número de abortos a la consulta. Sin embargo hasta el 80,2% vuelven a quedar gestantes, llegando a tener un hijo sano en casa el 81,1% de las embarazadas (AU)

Objective. To determine the possible causes of recurrent miscarriage in our environment and the pregnancy rate in these couples. Material and methods. An observational retrospective study was carried out in 172 women who attended our unit for two or more recurrent miscarriages between 2002 and 2008. Results. A total of 80.2% of the women became pregnant. Of these, 81.2% carried the fetus to term. The results of clinical study were normal in 70.9%. The alterations found were uterine in 48%, genetic in 2% and coagulation alterations in 44%. These alterations were associated in 6% of the patients. Conclusions. Most of the couples consulting for recurrent miscarriage will not receive an etiologic diagnosis after clinical study. Reproductive prognosis worsens as the number of miscarriages increases. However, up to 80.2% of these women become pregnant again, of whom 81.1% will deliver a healthy neonate (AU)

Alteración ecográfica del endometrio en mujeres menopáusicas sin metrorragia / Endometrial alterations on ultrasonography in asymptomatic postmenopausal women

Objetivo: Establecer la incidencia de cáncer enmujeres menopáusicas sin hemorragia vaginal ycon endometrio > 5 mm medido por ecografíavaginal.Material y métodos: Estudio retrospectivo queincluyó a 270 mujeres menopáusicas sinhemorragia de origen uterino y con endometrio> 5 mm. Se les realizó una histeroscopia conestudio histológico de cualquier anomalía yvaloramos la incidencia de cáncer de endometrio.Resultados: Detectamos 5 cánceres en 270mujeres, con una incidencia del 1,85%. De las 106pacientes con sospecha ecográfica de pólipoendometrial, diagnosticamos 4 cánceres deendometrio (3,77%), todos en estadio I. Ningunapaciente con cáncer había tenido tratamientohormonal.Conclusiones: La incidencia de cánceres enmujeres menopáusicas sin hemorragia vaginal consospecha ecográfica de pólipo de endometrio(3,77%) obligaría ha realizar una histeroscopia conbiopsia. Creemos que habría que determinar elgrosor endometrial que debemos considerarpatológico en estas mujeres

Objective: To determine the incidence ofendometrial cancer in asymptomaticpostmenopausal women with a sonographicendometrial thickness above 5 mm.Materials and methods: We performed aretrospective study of 270 asymptomaticpostmenopausal women with endometrial thickness> 5 mm on sonography. All women underwenthysteroscopy with histological evaluation ifrequired. The incidence of endometrial cancer wasevaluated.Results: Five cases of endometrial cancer werediagnosed in the 270 women, representing anincidence of 1.85%. Of the 106 patients with asonographic image leading to suspicion of polyp,four were diagnosed with endometrial cancer(3.77%), all of which were stage I tumors. None ofthe 270 women was receiving hormonereplacement therapyConclusions: The incidence of endometrial cancerin asymptomatic postmenopausal women withsonographic suspicion of polyp was 3.77%. Patientswith this sonographic finding should undergothorough hysteroscopy and biopsy to rule outmalignancy. We believe that the cut-off value forendometrial thickness in postmenopausal womenwithout vaginal bleeding should be determined

Valoración del endocérvix por legrado: correlación con citología, cambios colposcópicos y biopsias exocervicales / Evaluation of endocervical curettage: correlation with cytology, colposcopic changes and exocervical biopsy

Se analizan 1.980 legrados endocervicales realizados en la Unidad de Patología del Tracto Genital Inferior del Hospital Universitario Virgen de las Nieves de Granada y practicados durante el examen clínico con legras entre 1 y 00, en un período de 3 años. Los resultados se clasifican como: normal, LSIL, HSIL y cáncer. Se encuentra una distribución significativamente diferente cuando se comparan con las diversas categorías de la clasificación citológica de Bethesda, la categorización colposcópica de cambios mayores y menores, colposcopia satisfactoria o insatisfactoria y la histología de la biopsia dirigida exocervical

We analyzed 1980 endocervical curettage procedures carried out at the Lower Genital Tract Diseases Unit at the Virgen de las Nieves University Hospital in Granada (Spain) and performed during clinical examination with curettes sized between 1 and 00 during a 3-year period. The results were classified as normal, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions, and cancer. A significantly different distribution was found when the diverse categories of the Bethesda cytologic classification, colposcopy categorization of major and minor changes, satisfactory or unsatisfactory colposcopy, and the histological results of colposcopy-directed exocervical biopsy were compared

Tumores de colisión ováricos asociados con teratoma / Ovarian collision tumors associated with teratoma

Los tumores de colisión representan la coexistencia de 2 tumores contiguos en un órgano, pero histológicamente distintos, sin mezcla histológica. En el campo de la ginecología, se han descrito tumores de colisión en el útero (cuerpo y cérvix) y en el ovario. Se presenta aquí un caso de cistoadenoma mucinoso ovárico asociado con un teratoma quístico benigno

Collision tumors represent the coexistence of 2 adjacent but histologically distinct tumors without histologic admixture in an organ. In gynecology, collision tumors in the uterus (corpus and cervix) and ovary have been described. We report a case of ovarian mucinous cystadenoma coexisting with a benign cystic teratoma