title: Impact of myomas on the results of transcervical resection of the endometrium.
abstract: OBJECTIVE
  To investigate long-term hysterectomy rates after transcervical resection of the endometrium (TCRE) performed by experienced surgeons in the presence and absence of intracavitary myomas.
  
  
  METHODS
  Multicenter case-control study (Canadian Task Force classification II-2).
  
  
  METHODS
  The study group comprised 456 women with myomas who met the inclusion criteria, and of these, 82 (17.98%) later underwent hysterectomy. The control group comprised 1438 women without myomas, and of these, 284 (19.75%) later underwent hysterectomy.
  
  
  METHODS
  From 2001 to 2004, standardized results were extracted from Hyskobase on the basis of a total of 1894 women aged 23 to 59 years. The women were identified as having or not having myomas, and data from both groups were statistically analyzed. Detailed information on myoma size and intramural involvement (type 0, 1, and 2) was collected.
  
  
  RESULTS
  After TCRE, women with type 2 myomas, compared with those with type 0 myomas, were found to have a significantly higher risk of undergoing hysterectomy (p = .04), and women, including controls, with myomas >3.6 cm in greatest diameter were found to have a significantly higher risk of undergoing hysterectomy than were those with smaller myomas (p = .01). There was no statistically significant difference in risk of hysterectomy between type 0 and type 1 myomas or between type 1 and type 2 myomas. When hysterectomy rates between the myoma and control groups were compared, there was an increased risk of hysterectomy in the control group (p = .008). Multiple-step multivariate regression analysis of uterine and procedural characteristics of TCRE demonstrated that factors that were positive predictors of hysterectomy within 66 months after resection were younger age, inaccessible uterine corners, enlarged uterus, and pretreatment using gonadotropin-releasing hormone agonists.
  
  
  CONCLUSIONS
  When performing TCRE in women with intracavitary myomas, the chance of treatment success is worsened if they are of type 2 or their diameter is >3.5 cm. In addition, younger age increases the risk of hysterectomy and the need for pretreatment with gonadotropin-releasing hormone agonists, or if the uterus is enlarged or the uterine corners are difficult to access during the procedure.
authors.affiliation: Department of Pediatrics, Hospital of Norther Zealand, Hilleroed, Denmark. Electronic address: Christianvech@icloud.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Christoffersen
authors.affiliation: Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Henriette Strøm
authors.initials: HS
authors.lastname: Kahr
authors.affiliation: Department of Obstetrics and Gynaecology, Herlev Hospital, Herlev, Denmark.
authors.forename: Søren Stampe
authors.initials: SS
authors.lastname: Sørensen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002584:Cervix Uteri; D003718:Denmark / Q000453:epidemiology; D004717:Endometrium / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007889:Leiomyoma / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000601:surgery*
keywords: Endometrium; Hysterectomy; Transcervical resection; Uterine myomas