Outcomes after Hysteroscopic Treatment of Symptomatic Isthmoceles in Patients with Abnormal Uterine Bleeding and Pelvic Pain: A Prospective Case Series

Objective Isthmoceles have been described as complications associated to caesarean section (CS). Only symptomatic isthmoceles should be treated. The main symptoms are abnormal uterine bleeding (AUB) in abscense of any other causes, pelvic pain and secondary infertility. There are several techniques described for the correction of isthmoceles. Isthmoplasty can be performed by hysteroscopy, laparoscopy or vaginal surgery. The aim of this study is to assess the effectiveness of hysteroscopic surgical treatment of isthmoceles in women with associated symptoms such as pelvic pain and abnormal uterine bleeding. MaterialsAndMethods A prospective, case series study was performed including all women with AUB, pelvic pain and US diagnosis of isthmocele, who had undergone hysteroscopic correction between June 2014 and December 2017 in our Hospital. Results 38 women underwent surgical hysteroscopy to correct symptomatic isthmoceles. All patients presented AUB, 42.1% experienced pelvic pain and 28.9% secondary infertility. Ultrasonographic evaluation of isthmoceles was performed with 2D ultrasound. The residual miometrial thickness above the isthmocele was measured in women who expected future pregnancy, if it was less than 2,5mm patients were not included in the study because the correction was performed laparoscopically. Follow up was performed one and two months after surgery. In all cases pelvic pain had resolved the first month after the surgery. In 87.5% of patients AUB had disappeared within the first month, 96.8% in the second month and one needed further to alleviate her symptoms. Secondary infertility was assessed at the follow up one year after surgical isthmoplasty. Seven women have completed the first year of follow up, and three of them reported pregnancy after treatment (42.8%) between the first six and eight months after surgery. Conclusion Hysteroscopic correction of symptomatic isthmoceles may constitute a safe and effective technique for those patients who present AUB and pelvic pain.