Hysteroscopic Polypectomy in Premenopausal women with Abnormal Uterine Bleeding: Followup & Outcomes
Aisha M Elbareg, Fathi M Essadi, Kamal I Anwar and Mohamed O Elmehashi
Misurata Central Hospital, Misurata Cancer Centre, Misurata University, Misurata, Libya
Misurata Central Hospital
Iben-Sina Teaching Hospital, Sirt, Libya
: Androl Gynecol: Curr Res
Abstract
Backgrounds & Objectives: Endometrial polyps, are more common during reproductive years, causing abnormal uterine bleeding (AUB) in form of menorrhagia, metrorrhagia and intermenstrual bleeding, in addition to the risk of premalignant and malignant changes. Hysteroscopy provides direct visualization of the uterine cavity and being more effective in the diagnosis and treatment of such endometrial disease. Aim of this study is to evaluate effectiveness and outcomes of hysteroscopic transcervical resection (HR) of endometrial polyps in premenopausal patients with AUB. Subjects and methods: Total of 132 patients aged 35 to 50 years with AUB, undergone HR of endometrial polyps from July 2009 through December 2013, were studied prospectively. Patients had laboratory investigations, physical examination, pelvic ultrasound, diagnostic hysteroscopy and biopsy, those with myomectomy or septum resection, or received preoperatively hormonal treatment, or planned for IUD insertion following polyp removal were excluded. Outcomes: treatment success (flow reduction), degree of pain, need of second operation, patient satisfaction, short & long-term complications. Treatment considered as a failure in patients with repeated attacks of AUB after resection necessitating medical therapy or surgical reintervention. Statistical analysis performed using SPSS package. P-value considered to be significant if (< 0.05). Results: Mean follow-up period was 24 months. 34 patients were lost to follow up, only 98(74.2%) completed evaluation. 85(86.7%) patients showed menstrual improvement: amenorrhea 36(36.7%), hypomenorrhea 49(50%), no improvement (treatment failure) 13(13.26%). Number of patients satisfied were 79(80.6%), unsatisfied, because of heavy bleeding or cyclic pain were 19(19.38%), this difference was statistically significant (P < 0.05), also the success rate was significantly higher (P < 0.05) in those > 40 years of age. Seven recurrences were detected,(7.14%).No pathological findings indicating cancer or a precancerous lesion were found. No complications were encountered during diagnostic hysteroscopy. Conclusions: Hysteroscopic polypectomy, a minimally invasive procedure, found to be safe, effective and with a favorable outcomes by reducing the monthly blood loss significantly and with a high satisfaction rate. Keywords: Abnormal Uterine Bleeding, Hysteroscopy, Polypectomy
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