Treatment of dysfunctional bleeding and fibroids by advanced endoscopic techniques with the Nd:YAG laser: from the present to the future.
Both the electrical current of the resectoscope and the energy of the Nd:YAG laser have been effective tools in the destruction of endometrial tissue to a sufficient depth to avoid regeneration. GnRH-agonist therapy effects a decrease in the total uterine cavity area which facilitates surgical treatment and reduces the risk of fluid overload syndrome. The recurrence rate of meno/metrorrhagia is higher when the uterine cavity is more than 10 cm2. The use of GnRH-agonists represents an adjunct for preoperative reduction of submucosal myomas so that subsequent hysteroscopic myomectomy is possible. A two-step hysteroscopic therapy combined with GnRH-agonist therapy is performed when the largest portion of the submucosal myoma is located in the uterine wall. In cases of numerous submucosal and intramural myomas, a laparoscopic supracervical hysterectomy is performed because of the high risk of recurrence after the hysteroscopic procedure.
Donnez
J
J
Cliniques Universitaires St-Luc, Catholic University of Louvain, Bruxelles, Belgium.
Polet
R
R
Anaf
V
V
Mathieu
P E
PE
Casanas-Roux
F
F
Nisolle
M
M
D000328:Adult; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000627:therapeutic use; D006801:Humans; D015907:Hysteroscopy; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D018579:Patient Selection; D011292:Premedication; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*
D007987:Gonadotropin-Releasing Hormone