[Hysteroscopic resection of submucous myomas: long term results].
OBJECTIVE
To evaluate the follow-up after operative hysteroscopic resection of submucous leiomyomas.


METHODS
Between January 1990 and December 1996, 200 patients underwent operative hysteroscopic resection of 289 uterine leiomyomas. Indications were: menometrorrhagia (n = 159), postmenopausal metrorrhagia (n = 22), infertility (n = 19) as sole etiology. Sixteen patients had infertility and menometrorrhagia.


RESULTS
The mean follow-up was 33.4 +/- 19.2 months. Twenty-three patients were lost to follow-up. Due to the large size of the leiomyomas, 35 patients had 2 or 3 resections and a total of 241 hysteroscopic resections were performed. Twelve complications (5%) occurred without death or need for intensive care. An improvement of clinical symptoms was observed in 74% of patients. The predictive factors of failure were: size (> 5 cm), number of intracavitary leiomyomas (> 3), hysterometry (> 12 cm), intramural myoma class 2 and association of leiomyomas. Eight of the 35 infertile patients subsequently became pregnant, but with only two live births (5.8%).


CONCLUSIONS
Hysteroscopic myomectomy appears to be safe, effective and reproducible for the treatment of menstrual disorders. Intramural class 2 and larger leiomyomas constitute the limits of the endoscopic technique.
Service de gynécologie-obstétrique, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France. herve.fernandez@abc.ap-hop-paris.fr
H
H
Fernandez
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O
Kadoch
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S
Capella-Allouc
A
A
Gervaise
S
S
Taylor
R
R
Frydman
D000328:Adult; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods*; D007247:Infertility, Female / Q000209:etiology; D007889:Leiomyoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008595:Menorrhagia / Q000209:etiology; D008796:Metrorrhagia / Q000209:etiology; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*