title: Fertility and pregnancy outcomes following resectoscopic septum division with and without intrauterine balloon stenting: a randomized pilot study.
abstract: OBJECTIVE
  Although uterine stenting is performed routinely following hysteroscopic metroplasty, we were unable to find any evidence documenting its value with regards to septum reformation and/or obstetrical performance. To evaluate the benefits of intrauterine Foley catheter/balloon splinting after resectoscopic septum division on septum reformation, fertility, and pregnancy outcomes.
  
  
  METHODS
  Prospective, randomized controlled pilot study (Canadian Task Force Classification I) conducted in university affiliated teaching hospital.
  
  
  METHODS
  Twenty-eight women with infertility and/or adverse pregnancy outcomes diagnosed with intrauterine septum were randomized into having a No. 14 pediatric Foley catheter/balloon for 5 days (n=13) vs. no balloon (n=15) following resectoscopic septum division. None of the patients received preoperative endometrial thinning, antibiotic prophylaxis or adjuvant postoperative hormone therapy. All uterine septa were divided under general anaesthesia using a 26 F (9 mm) resectoscope with a monopolar electrical knife using glycine irrigant solution (1.5%) and 120 watts of power of low voltage (cut) waveform.
  
  
  RESULTS
  The median age (range) was 29 years (23-38) and 32 years (22-40), respectively (P=.59). The groups were comparable by age, past obstetrical performance and comorbidities including endometriosis stage I-IV in 3 and 4 women, in the catheter/balloon and balloon group, respectively, and one in each group of polycystic ovarian syndrome and Crohn disease and one case of tubal obstruction in the balloon group. There were no intra- or postoperative complications. At 3 months, a hysterosalpingogram was done in 10 (77%) and 13 (87%) women, respectively, the results of which were normal. At 12-18 months, 1 woman in the balloon and 3 in the control group were not trying to conceive and 1 in each group had not conceived. Of the remaining women, 11 (92%) in each group had conceived and pregnancy outcomes included spontaneous abortion 3 (25%) and 4 (33.3%), ectopic pregnancy 0 and 1, second trimester loss 1 (8.3%) and 0 and term pregnancy 8 (66.6%) in both groups. Conception through assisted reproductive technology occurred in 2 and 1 woman, respectively.
  
  
  CONCLUSIONS
  Following resectoscopic septum division with monopolar knife electrode, splinting the uterine cavity with Foley catheter provided no advantage in septum reformation, clinical pregnancy rate, and pregnancy outcomes.
authors: Obstetrics and Gynecology Department, King Saud University, Riyadh, Saudi Arabia. baburafea@ksu.edu.sa
authors: Basim Fouad
authors: BF
authors: Abu Rafea
authors: George Angelos
authors: GA
authors: Vilos
authors: Ayman Mohamad
authors: AM
authors: Oraif
authors: Stephen George
authors: SG
authors: Power
authors: Jackie Hollet
authors: JH
authors: Cains
authors: Angelos George
authors: AG
authors: Vilos
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007047:Hysterosalpingography; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D015607:Stents; D014546:Urinary Catheterization / Q000295:instrumentation; D014599:Uterus / Q000002:abnormalities* / Q000601:surgery; D055815:Young Adult