Hysteroscopic resection of submucous fibroids: clinical analysis of 99 cases

Objective To evaluate the efficacy of hysteroscopic resection of submucous fibroids. Design A retrospective study of 99 cases. Setting Shanghai Institute of Planned Parenthood Research, Shanghai First Maternity and Infant Health Hospital and the Shanghai Jiading Gynaecological Endoscopy Centre. Subjects The study included 99 patients with submucous fibroids. Out of these, 84 had menorrhagia, 13 had menorrhagia with irregular bleeding and two had postmenopausal bleeding. Interventions Transcervical hysteroscopic resection was used to treat submucous myoma in all patients on one or two occasions. All patients were followed up, for between 6 months and 6 years. Those patients who desired a child underwent hysteroscopic tubal catheterization and hydrotubations to check whether the shape of the uterine cavity recovered after surgery. Results In 94 out of 99 patients, the menstrual pattern became normal; five patients remained hypermenorrhoeic. Two patients were treated with endometrial ablation using a thermal balloon, because of retained myoma within the uterine wall and persistent hypermenorrhoea. Both of these patients experienced hypomenorrhoea for more than 12 months. Only one patient required hysterectomy after 34 months, because of a retained intramural myoma, which had enlarged and caused a recurrence of her menorrhagia. Seven out of the 12 women who desired a child became pregnant. Conclusion Hysteroscopic resection is an effective method for the treatment of submucous fibroids and could replace hysterectomy for some patients. It can shorten the operation time and patients can recover more quickly. For those patients who desire a child, this technique is not only organ-sparing, but also avoids the intra-abdominal adhesions induced by laparotomy.