title: Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility.
abstract: OBJECTIVE
  To review the treatments of the cesarean-induced isthmocele in restoring infertility, associated techniques, and the risks of complications associated with their use.
  
  
  RESULTS
  Isthmocele is a reservoir-like pouch defect on the anterior wall of the uterine isthmus located at the site of a previous cesarean delivery scar. The flow of menstrual blood through the cervix may be slowed by the presence of isthmocele, as the blood may accumulate in the niche because of the presence of fibrotic tissue, causing pelvic pain in the suprapubic area. Moreover, persistence of the menstrual blood after menstruation in the cervix may negatively influence the mucus quality and sperm quality, obstruct sperm transport through the cervical canal, interfere with embryo implantation, leading to secondary infertility. The removal of the local inflamed tissue may be performed by laparoscopic, combined laparoscopic-vaginal, or vaginal surgery, and operative hysteroscopy, a minimally invasive approach to improve symptoms and restore fertility.
  
  
  CONCLUSIONS
  Isthmocele occurs after cesarean section, a common method of delivery and one of the most frequent surgical procedures, so that its upward incidence appears likely to continue in the near future. Because of its minimal invasiveness, resectoscopy may be the better choice for treatment, yielding good therapeutic results.
authors.affiliation: Department of Pediatrics, Obstetrics and Reproductive Medicine, Section of Obstetrics and Gynecology, University of Siena, Siena, Italy. florio@unisi.it
authors.forename: Pasquale
authors.initials: P
authors.lastname: Florio
authors.forename: Marco
authors.initials: M
authors.lastname: Filippeschi
authors.forename: Irene
authors.initials: I
authors.lastname: Moncini
authors.forename: Elena
authors.initials: E
authors.lastname: Marra
authors.forename: Mario
authors.initials: M
authors.lastname: Franchini
authors.forename: Giampietro
authors.initials: G
authors.lastname: Gubbini
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D014599:Uterus / Q000473:pathology / Q000601:surgery*