Prospective follow-up study (Canadian Task Force classification II-2).
SETTING: Teaching hospital.
PATIENTS: From January 1990 through December 2012, one of us performed 4729 primary resectoscopic
endometrial ablation procedures in women with AUB. This group included 161 women with
endometrial hyperplasia, identified either at office biopsy (n = 62) or incidentally during routine hysteroscopic
endometrial ablation (n = 99). Endometrial tissue obtained at dilation and
curettage and/or resected during resectoscopic surgery enabled identification of atypical
hyperplasia in 6 patients (4 CH, 2 SH) and 1 patient with
adenosarcoma. One patient with atypical CH and the patient with
adenosarcoma underwent
hysterectomy. The remaining 159 women, including 5 with atypical
hyperplasia (3 CH, 2 SH), underwent resectoscopic
endometrial ablation (102 SH, 52 CH) as primary treatment. Patient median age was 50 years (range, 30-87 years), and body mass index was 32 (range, 17-59). Comorbidities included
hypertension in 25 patients, diabetes in 14,
cerebrovascular disease in 3,
cardiovascular disease in 7, and
hypothyroidism in 8. Office biopsy demonstrated proliferative endometrium in 68 patients, SH in 43, CH in 19, and inadequate findings in 13. In 18 women, we were unable to perform biopsy because of cervical
stenosis,
morbid obesity, or patient intolerance. Endometrium was resected in 120 patients, electrocoagulated in 34, and a combination of procedures in 5, using a 9-mm (26F) resectoscope, 1.5%
glycine, and 120W power. Patients were followed up annually. Three patients were lost to follow-up, and 1 died of an unrelated cause 5 years after surgery.
MEASUREMENTS AND MAIN RESULTS: One
uterine perforation occurred, which required no additional treatment. After
endometrial ablation, SH was identified in 70 patients, and CH in 35 patients. At a median follow-up of 7 years (range, 1.5-18), 12 patients underwent
hysterectomy to treat persistent
bleeding (n = 6), benign
ovarian cyst (n = 2),
pelvic organ prolapse (n = 1), chronic
pelvic pain (n = 2), or
myomas (n = 1). Uterine histopathology in 11 patients demonstrated no residual
endometrial hyperplasia. We were unable to obtain a pathology report for 1 patient. The remaining 138 women were satisfied with the treatment, with no further
bleeding or
pain in 132 (95.7%). Six patients (4.3%) had monthly
spotting.
CONCLUSION: When performed by surgeons experienced in hysteroscopy, resectoscopic
endometrial ablation is feasible, safe, and effective for treatment of SH and CH without atypia in women with AUB.