title: Characteristics of patients undergoing hysterectomy for failed endometrial ablation.
abstract: OBJECTIVE
  Endometrial ablation is a minimally invasive procedure for menorrhagia. High success rates are documented with >90% of patients experiencing satisfaction. However, adequate relief after endometrial ablation is not obtained in a cohort of patients. The purpose of this study is to identify the characteristics of patients for whom endometrial ablation fails due to persistent symptoms, causing them to choose hysterectomy for definitive treatment.
  
  
  METHODS
  We conducted a retrospective chart review of patients who underwent hysterectomy for persistent menorrhagia, pain, or both, who previously had endometrial ablation. We reviewed medical records including pathology reports from hysterectomy. We compared demographics to a group previously studied at our institution that were identified as satisfied 5 years after ablation.
  
  
  RESULTS
  The number of patients in our study group was 51 (n = 51). Median age of patients was 39 (range 29-50) years. Average body mass index was 31 (range 19-47) kg/m(2). Average parity was 1.9. Sixty-nine percent underwent tubal ligation. The majority were nonsmokers (75%). Ninety-six percent were Caucasian. Compared with the previously studied satisfied group, the only statistically significant difference was age. Of 51 patients, 11 (22%) noted pelvic pain as their chief concern. Menorrhagia was the chief concern in 22 (43%). Eighteen patients (35%) complained of both. The most common diagnosis was endometriosis, which was identified in 35 patients (68%). Leiomyomata were present in 33 patients (64%). Adenomyosis was identified in 22 patients (43%).
  
  
  CONCLUSIONS
  Patients who present for hysterectomy after endometrial ablation have a high rate of endometriosis, adenomyosis, and leiomyomata, with endometriosis being the most common finding.
authors.affiliation: Department of Obstetrics and Gynecology, The Milton S. Hershey Medical Center, The Pennsylvania State College of Medicine, Hershey, 500 University Drive, P.O. Box 850, MC H103, Hershey, PA 17033, USA. Kriley1@hmc.psu.edu.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Riley
authors.affiliation: Department of Obstetrics and Gynecology, The Milton S. Hershey Medical Center, The Pennsylvania State College of Medicine, Hershey, PA, USA; Speaker for Boston Scientific.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Davies
authors.affiliation: Department of Obstetrics and Gynecology, The Milton S. Hershey Medical Center, The Pennsylvania State College of Medicine, Hershey, PA, USA; Speaker/proctor for Intuitive and Ethicon.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Harkins
mesh_terms: D000328:Adult; D000368:Aged; D055356:Endometrial Ablation Techniques; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008595:Menorrhagia / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure