Resectoscopic correction of the "isthmocele" in women with postmenstrual abnormal uterine bleeding and secondary infertility.
OBJECTIVE
The obstetric complications that a cesarean delivery may produce have been known and studied for a long time. In the last few years, new correlations with some gynecologic disturbances also emerged, such as postmenstrual abnormal uterine bleeding (PAUB), and with some cases of secondary infertility. This is due to the presence of a diverticulum on the anterior wall of the uterine isthmus or of the cervical canal at the site of a previous cesarean delivery scar. The aim of our study was to assess the effectiveness of a hysteroscopic surgical technique to correct this anatomic defect and therefore eliminate the symptoms.


METHODS
A prospective study (Canadian Task Force classification III).


METHODS
Private clinic and university hospital.


METHODS
Twenty-six patients who previously had 1 or more cesarean deliveries, were evaluated from 2001 to 2005 for postmenstrual uterine bleeding and secondary infertility in 9 patients. All patients had a "niche" (which we defined as "isthmocele") principally on the isthmus-superior third of cervical canal (18/26), but on the lower cervical tract too (8/26). All of them underwent resectoscopic correction of the "isthmocele."


METHODS
Hysteroscopic resection of the edges and the bottom of the defect until the complete removal of the fibrotic scar tissue showing the muscular tissue below, using a cutting loop and pure cutting current. Aimed electrocoagulation of the bottom of the pouch with a roller-ball to avoid the in situ production of blood.


RESULTS
The anatomic defect in 100% of patients treated (26/26) was repaired, thus solving the symptom. Seven of 9 patients with secondary infertility became pregnant.


CONCLUSIONS
The "isthmocele" represents a possible consequence of one or more cesarean deliveries and may be symptomatic in some women. It is a defect that can be easily diagnosed by hysteroscopy and successfully treated by resectoscopic technique.
Gubbini
Giampietro
G
"Madre Fortunata Toniolo" Clinic, Bologna, Italy.
Casadio
Paolo
P
Marra
Elena
E
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications*; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000601:surgery*; D008599:Menstruation Disturbances / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies