title: Long-term clinical outcomes following resectoscopic endometrial ablation of non-atypical endometrial hyperplasia in women with abnormal uterine bleeding.
abstract: OBJECTIVE
  To determine the feasibility, efficacy, and long-term clinical outcomes of resectoscopic endometrial ablation as primary treatment of simple endometrial hyperplasia (SH) and complex endometrial hyperplasia (CH) without atypia in women with abnormal uterine bleeding (AUB).
  
  
  METHODS
  Prospective follow-up study (Canadian Task Force classification II-2).
  
  
  METHODS
  Teaching hospital.
  
  
  METHODS
  One hundred sixty-one women with hyperplasia, either SH (n = 107) or CH (n = 54).
  
  
  METHODS
  From January 1990 through December 2012, one of us performed 4729 primary resectoscopic endometrial ablation procedures in women with AUB. This group included 161 women with endometrial hyperplasia, identified either at office biopsy (n = 62) or incidentally during routine hysteroscopic endometrial ablation (n = 99). Endometrial tissue obtained at dilation and curettage and/or resected during resectoscopic surgery enabled identification of atypical hyperplasia in 6 patients (4 CH, 2 SH) and 1 patient with adenosarcoma. One patient with atypical CH and the patient with adenosarcoma underwent hysterectomy. The remaining 159 women, including 5 with atypical hyperplasia (3 CH, 2 SH), underwent resectoscopic endometrial ablation (102 SH, 52 CH) as primary treatment. Patient median age was 50 years (range, 30-87 years), and body mass index was 32 (range, 17-59). Comorbidities included hypertension in 25 patients, diabetes in 14, cerebrovascular disease in 3, cardiovascular disease in 7, and hypothyroidism in 8. Office biopsy demonstrated proliferative endometrium in 68 patients, SH in 43, CH in 19, and inadequate findings in 13. In 18 women, we were unable to perform biopsy because of cervical stenosis, morbid obesity, or patient intolerance. Endometrium was resected in 120 patients, electrocoagulated in 34, and a combination of procedures in 5, using a 9-mm (26F) resectoscope, 1.5% glycine, and 120W power. Patients were followed up annually. Three patients were lost to follow-up, and 1 died of an unrelated cause 5 years after surgery.
  
  
  RESULTS
  One uterine perforation occurred, which required no additional treatment. After endometrial ablation, SH was identified in 70 patients, and CH in 35 patients. At a median follow-up of 7 years (range, 1.5-18), 12 patients underwent hysterectomy to treat persistent bleeding (n = 6), benign ovarian cyst (n = 2), pelvic organ prolapse (n = 1), chronic pelvic pain (n = 2), or myomas (n = 1). Uterine histopathology in 11 patients demonstrated no residual endometrial hyperplasia. We were unable to obtain a pathology report for 1 patient. The remaining 138 women were satisfied with the treatment, with no further bleeding or pain in 132 (95.7%). Six patients (4.3%) had monthly spotting.
  
  
  CONCLUSIONS
  When performed by surgeons experienced in hysteroscopy, resectoscopic endometrial ablation is feasible, safe, and effective for treatment of SH and CH without atypia in women with AUB.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada. Electronic address: george.vilos@lhsc.on.ca.
authors.forename: George A
authors.initials: GA
authors.lastname: Vilos
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada.
authors.forename: Ayman
authors.initials: A
authors.lastname: Oraif
authors.affiliation: Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Ontario, Canada.
authors.forename: Angelos G
authors.initials: AG
authors.lastname: Vilos
authors.affiliation: Department of Pathology, Western University, London, Ontario, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Ettler
authors.affiliation: Department of Obstetrics and Gynecology, Umm Al-Qura University, Makkah, Saudi Arabia.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Edris
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Basim
authors.initials: B
authors.lastname: Abu-Rafea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055356:Endometrial Ablation Techniques / Q000379:methods*; D004714:Endometrial Hyperplasia / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D008796:Metrorrhagia / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Abnormal uterine bleeding; Complex endometrial hyperplasia; Heavy menstrual bleeding; Resectoscopic surgery; Simple endometrial hyperplasia