title: Sonohysterographic predictors of successful hysteroscopic myomectomies.
abstract: OBJECTIVE
  The purpose of this study is to assess the rate of persistent submucosal myomas and intrauterine scarring after hysteroscopic myomectomy, as well as to evaluate the preoperative and intraoperative sonohysterographic findings that will predict persistence of myomas, scarring, and the need for repeat surgery.
  
  
  METHODS
  Charts from all hysteroscopic myomectomies performed by a single surgeon between 2003 and 2011 were reviewed for preoperative, intraoperative, and postoperative sonohysterographic findings. Predictors included myoma number, diameter and percent extension into the cavity of the largest fibroid, and percent surgically resected. These predictors were assessed with postoperative sonohysterography. Statistics included t test, logistic regression, χ(2) test, and Fisher exact test.
  
  
  RESULTS
  Among the 79 cases with postoperative sonohysterograms, 17 (21.5%) had persistent submucosal myoma, and 9 (11.4%) had intrauterine scarring on postoperative sonohysterogram. Repeat hysteroscopic myomectomy was required in 11 (13.9%), but none required lysis of adhesions. The myoma number was not a significant predictor. A higher percentage of myoma within the cavity (63.35% vs 44.89%, P < .05) and smaller myoma size (2.22 cm vs 3.31 cm, P < .01) were significant predictors of a complete resection, a normal postoperative sonohysterogram, and avoidance of repeat surgery. On regression analysis, the percent of the myoma resected was the most significant outcome predictor (P < .001).
  
  
  CONCLUSIONS
  Larger myomas with a lower percent found within the uterine cavity are less likely to be completely resected. Percent resection at the time of surgery is the most significant predictor of a normal postoperative sonohysterogram, as well as the best predictor of the need for repeat surgery.
authors.affiliation: Department of Obstetrics & Gynecology, St. Luke's Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Keltz
authors.affiliation: Department of Obstetrics & Gynecology, St. Luke's Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Alexis D
authors.initials: AD
authors.lastname: Greene
authors.affiliation: Department of Obstetrics & Gynecology, St. Luke's Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Mary Breda
authors.initials: MB
authors.lastname: Morrissey
authors.affiliation: Department of Obstetrics & Gynecology, St. Luke's Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Vega
authors.affiliation: Department of Obstetrics & Gynecology, St. Luke's Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Moshier
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007889:Leiomyoma / Q000601:surgery*; D016015:Logistic Models; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Hysteroscopic myomectomy; Sonohysterography; Submucosal fibroid
references.citation: Obstet Gynecol. 1999 Aug;94(2):168-71
references.pmid: 10432121
references.citation: Br J Obstet Gynaecol. 1999 Jul;106(7):700-5
references.pmid: 10428527
references.citation: Obstet Gynecol. 1993 Nov;82(5):736-40
references.pmid: 8414318
references.citation: Obstet Gynecol. 1983 Oct;62(4):509-11
references.pmid: 6888829
references.citation: Eur J Obstet Gynecol Reprod Biol. 2004 Mar 15;113(1):78-82
references.pmid: 15036716
references.citation: Fertil Steril. 2003 Apr;79(4):998-1002
references.pmid: 12749444
references.citation: Hum Reprod. 2002 Jan;17(1):195-200
references.pmid: 11756387
references.citation: Ultrasound Obstet Gynecol. 2011 Sep;38(3):350-4
references.pmid: 21584888
references.citation: Fertil Steril. 2011 Apr;95(5):1764-8.e1
references.pmid: 21315334
references.citation: J Obstet Gynaecol. 2011;31(1):54-8
references.pmid: 21280995
references.citation: Fertil Steril. 2009 Nov;92(5):1690-3
references.pmid: 18937941
references.citation: Eur J Obstet Gynecol Reprod Biol. 2009 Feb;142(2):154-9
references.pmid: 19036492
references.citation: Obstet Gynecol. 2008 Aug;112(2 Pt 1):387-400
references.pmid: 18669742
references.citation: Clin Obstet Gynecol. 2006 Dec;49(4):811-20
references.pmid: 17082675
references.citation: Acta Obstet Gynecol Scand. 2006;85(1):82-7
references.pmid: 16521686