Channel-like 360° Isthmocele Treatment with a 16F Mini-Resectoscope: A Step-by-step Technique

ConclusionThe presence of a uterine scar defect is usually asymptomatic or refers to postmenstrual spotting with dark red or brown discharge, dysmenorrhea, dyspareunia, chronic pelvic pain, infertility, or a dull sensation after menstruation. Several factors may play a role in isthmocele development such as a low uterine incision, a deficient suturing technique of the uterine incision, and patient-related factors that impair wound healing or increase inflammation or adhesion formation. Different techniques were used as reconstructive therapies of the cesarean scar defect including laparoscopic or robot-assisted laparoscopic excision, vaginal repair, or hysteroscopic treatment. All of these procedures remove or ablate the niche fibrotic tissue with the aim of relieving symptoms. Asymptomatic cases should not be treated. According to the most recent literature, hysteroscopic repair of a cesarean scar represents an effective and safe surgical option in cases of a symptomatic isthmocele. The persistence of symptoms has been reported in up to 18% of cases, so adequate counseling should be performed before the procedure.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research

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Uterine fibroids affect up to 80% of reproductive-aged women. Although many women are asymptomatic, fibroids can cause pelvic pain, abnormal uterine bleeding, anemia, urinary frequency, infertility, and adverse pregnancy outcomes that can impair quality of life. Fifty percent of women with symptomatic fibroids report a detrimental impact on their mental and physical health (1). Fibroids appear to have a greater impact on quality of life than other chronic conditions, including asthma, irritable bowel syndrome, and gastroesophageal reflux disease (2).
Source: Fertility and Sterility - Category: Reproduction Medicine Authors: Tags: Reflections Source Type: research
Conclusion(s)Office hysteroscopy is a well tolerated procedure and prior use of analgesic medication was not effective in decreasing pain. In selected patients with chronic pelvic pain the use prior analgesic medication may be beneficial.
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
ConclusionTraditionally only pathologies of the uterus and ovaries are assessed during a routine pelvic ultrasound. Here we demonstrate that the routine ultrasound examination can easily be extended beyond the uterus and ovaries into the posterior and anterior pelvic compartments to evaluate structural mobility and to look for deep infiltrating endometriotic nodules, so women suffering from deep infiltrating endometriosis can benefit from a pre-operative diagnosis and subsequently a single, well-planned procedure in the hands of a well-prepared team.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
SUMMARY An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic preg...
Source: Revista da Associacao Medica Brasileira - Category: General Medicine Source Type: research
ConclusionThe presence of a uterine scar defect is usually asymptomatic or refers to postmenstrual spotting with dark red or brown discharge, dysmenorrhea, dyspareunia, chronic pelvic pain, infertility or dull sensation following menstruation. Several factors may possibly play a role in isthmocele development such as low uterine incision, deficient suturing technique of the uterine incision, patient-related factors that impair wound healing or increase inflammation or adhesion formation. Different techniques were used as reconstructive therapies of the cesarean scar defect including laparoscopic or robot-assisted laparosco...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
ConclusionThe management of adenomyosis is quite complex and controversial. Complications after extensive uterine reconstruction, such as uterine rupture, should be considered and discussed with the patient. There are still limited data to support surgery effectiveness, especially for infertility, and further well-designed studies are required.
Source: Archives of Gynecology and Obstetrics - Category: OBGYN Source Type: research
Semin Reprod Med 2017; 35: 494-498 DOI: 10.1055/s-0037-1607240Uterine fibroids (UF; aka leiomyoma, myomas) are the most common benign tumors of female reproductive tract. They are highly prevalent, with 70 to 80% of women burdened by the end of their reproductive years. Fibroids are a leading cause of pelvic pain, abnormal vaginal bleeding, pelvic bulk symptoms, miscarriage, and infertility. They are the leading indication for hysterectomy, and costs exceed 34 billion dollars annually in the United States alone. Recently, somatic mutations in exons 1 and 2 of Med12 gene emerged as common UF driver mutations. Unfortunately,...
Source: Seminars in Reproductive Medicine - Category: Reproduction Medicine Authors: Tags: Review Article Source Type: research
When my first period came at age 13, it involved blood clots and extreme pain. I didn’t know what to expect or what was considered “normal,” but thankfully, my mother did. She recognized that my symptoms were unusual and immediately took me to see my pediatrician. I was first prescribed birth control pills, which seemed to help initially, but when my period remained heavy and painful, I was put on a different birth control pill that enabled me to have my period only four times a year. I thought my situation was normal – albeit uncomfortable and inconvenient. No one ever suggested that painful period...
Source: Thrive, Children's Hospital Boston - Category: Pediatrics Authors: Tags: Our Patients’ Stories Teen Health endometriosis Marc Laufer Source Type: news
Andrea Syrtash was first hospitalized at the age of 14 for painful and heavy menstrual cycles due to endometriosis. She had no idea her condition would affect her fertility â€• and even if she had known, she may not have thought to address it without guidance from her doctors. After six years of trying to conceive, Syrtash, who’s now in her 40s and works as a relationship and dating expert, recently founded pregnantish, a website for singles, couples and LGBTQ people who are trying to conceive.  “When you’re a teenager, it’s not on your mind,” she said. Had she known, “I migh...
Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
Abstract Endometriosis is a chronic disease of women during their reproductive age. The most typical symptoms are dysmenorrhoea, dyspareunia, dysuria, cyclical and acyclical pelvic pain, bleeding disorders and infertility. These symptoms lead to significant impairment of the quality of life and economic burden. The prevalence is estimated to be 2-20 % of all women in this age and due to this fact, it is one of the most frequently benign gynecological diseases. Not all women suffer from severe symptoms, but more than 50 % require ongoing treatment. Beside the severe physical impairment due to the...
Source: Schmerz - Category: Anesthesiology Authors: Tags: Schmerz Source Type: research
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