Outcomes after rollerball endometrial ablation for menorrhagia.

OBJECTIVE: To evaluate the outcomes of women undergoing rollerball endometrial ablation for menorrhagia and to identify factors associated with those outcomes. METHODS: Data on the clinical history, operative technique, and follow-up status as of August 1998 were obtained by retrospective medical record review for 240 women undergoing rollerball endometrial ablation with or without resection of polyps or myomas from January 1991 through December 1996. The incidence of subsequent hysterectomy was calculated by survival analysis, and Cox proportional hazard models were used to identify the predictors of success or failure of the procedure. RESULTS: The mean follow-up time was 31.2 months. Twenty-nine women (31% of the available subjects) who had not undergone hysterectomy were still being monitored 5 years after the rollerball endometrial ablation. Overall, the probability of no hysterectomy in the first 5 years was 71%. Ablation was repeated in 10 patients, six of whom eventually underwent hysterectomy. Multivariate analysis identified previous tubal ligation as a statistically significant positive predictor of the risk of hysterectomy (hazard ratio 2.20, 95% confidence interval [CI] 1.18, 4.09). Women at least 45 years old had a lower risk of subsequent hysterectomy than those younger than 35 years of age (hazard ratio 0.28, 95% CI = 0.10, 0.75). CONCLUSION: The results of this study confirm the effectiveness of rollerball endometrial ablation for the treatment of menorrhagia for a longer duration of follow-up than in most previous reports. Repeated ablation and a younger age at the time of ablation increase the risk of requiring a subsequent hysterectomy.     

Improving results of hysteroscopic submucosal myomectomy for menorrhagia by concomitant endometrial ablation

STUDY OBJECTIVE: To evaluate the effect of endometrial ablation on the outcome of premenopausal patients undergoing hysteroscopic myomectomy for menorrhagia or menometrorrhagia DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Private practice. PATIENTS: One hundred seventy-seven women with one or more submucosal myomas experiencing menorrhagia or menometrorrhagia. INTERVENTION: Hysteroscopic myomectomy without endometrial ablation in 104 patients and with concomitant endometrial ablation in 73 patients. MEASUREMENTS AND MAIN RESULTS: Bleeding was controlled in 95.9% of patients with endometrial ablation and in 80.8% of patients without endometrial ablation (p = .003). Complete removal of the myoma led to better results (p = .039), which were further improved by endometrial ablation (p = .022). Endometrial ablation improved bleeding in patients whose myomas could not be completely removed, but the difference was not statistically significant (p = .23). Subsequent hysterectomies were not decreased by endometrial ablation (p = .48) or by complete removal of the myoma (p = .83). Hysterectomies for bleeding problems were decreased by endometrial ablation. Pain and dysmenorrhea were a frequent cause of hysterectomy. CONCLUSION: Endometrial ablation at the time of hysteroscopic myomectomy improves results in the control of bleeding.     

Polypectomy in premenopausal women with abnormal uterine bleeding: effectiveness of hysteroscopic removal

STUDY OBJECTIVE: To estimate the effectiveness of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding and to identify prognostic factors for persistence or recurrence of symptoms after polypectomy. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospital. PATIENTS: Premenopausal women with abnormal uterine bleeding. INTERVENTION: Hysteroscopic polypectomy, regardless of whether combined with endometrial ablation or insertion of a levonorgestrel-releasing intrauterine device. MEASUREMENTS AND MAIN RESULTS: Seventy-eight consecutive patients met the inclusion criteria and were followed over time. Data were retrieved from medical records or from additional questionnaires sent to the patients. Failure of treatment was defined as persistence or recurrence of abnormal uterine bleeding after polypectomy, requiring further treatment. The mean age was 44.2 years (SD 5.2, 95% CI 33.9-54.4 years). Intervention-free survival after polypectomy, as calculated by Kaplan-Meier survival analysis, was 41.1% (SE 8.3%, 95% CI 24.8%-57.4%) after 4 years for patients who underwent only hysteroscopic polypectomy and 54.7% (SE 13.6%, 95% CI 28.0%-81.4%) for patients who underwent a polypectomy combined with endometrial ablation or insertion of a levonorgestrel-releasing intrauterine device (p = .08). Cox regression analyses revealed no statistically significant predictors for persistence or recurrence of symptoms after polypectomy. CONCLUSION: Nearly 60% of patients required further treatment for persistence or recurrence of abnormal uterine bleeding 4 years after hysteroscopic polypectomy. Although not significant, outcome of treatment tended to improve by combining polypectomy with either an endometrial ablation or insertion of a levonorgestrel-releasing intrauterine device.     

Prognostic factors for the success of thermal balloon ablation in the treatment of menorrhagia

OBJECTIVE: To identify predictive factors that will ensure successful menorrhagia treatment using hot fluid balloon endometrial ablation. METHODS: This is a prospective study on patients referred for menorrhagia and treated with hot fluid thermal balloon ablation. Potential prognostic factors for assessing the success of treatment were recorded. Success was defined as patient satisfaction and no subsequent hysterectomy at 2-year follow-up. RESULTS: A total of 130 women were included in the final analysis. The cumulative rate of patients undergoing a hysterectomy after 2 years was 12%. After 2 years, 81% of the remaining patients were satisfied with the results of the treatment. Predictive factors for adverse outcome were a retroverted uterus (hazard rate ratio 3.3, 95% confidence interval [CI] 1.2, 8.6), pretreatment endometrial thickness of at least 4 mm (hazard rate ratio 3.6, 95% CI 1.3, 11), and the duration of menstruation (hazard rate ratio 1.2, 95% CI 1.0, 1.3, per day in excess of 9 days). The risk of an adverse outcome declined steadily with increasing age (hazard rate ratio 0.86, 95% CI 0.77, 0.96 per year over 42 years of age). Uterine depth and dysmenorrhea were not predictive factors, which significantly affected outcome. CONCLUSION: Young age, retroverted uterus, endometrial thickness of at least 4 mm, and prolonged duration of menstruation were associated with an increased risk of treatment failure. Uterine depth and dysmenorrhea had limited impact on the effectiveness of balloon ablation.     

The impact of endometrial ablation technique at a large university women's hospital

OBJECTIVE: To determine the effect of ThermaChoice uterine balloon system on the practice patterns of endometrial ablations performed at a large university-based teaching hospital. STUDY DESIGN: A retrospective chart review was conducted of 226 patients who underwent endometrial ablation. Data were analyzed to determine any change in the type and rate of ablations performed since the introduction of second-generation technologies. Multivariate logistic regression models were used to estimate adjusted risk factors for subsequent admission. RESULTS: A total of 72.1% of all cases were performed with the ThermaChoice uterine balloon. The postoperative admission rate was significantly higher after a balloon procedure (13.7% versus 3.1%, P=.02), with a 10.6% overall incidence of admission. Adjusting for confounding variables, more women were admitted after a balloon procedure, compared with women undergoing hysteroscopic ablation (odds ratio 5.0; 95% CI: 1.1, 22). CONCLUSION: Second-generation endometrial ablation technologies represent frequently utilized and proficient treatment modalities for dysfunctional uterine bleeding. Notwithstanding their facilitative design, clinicians should not lose sight of potential limitations of these new procedures.     

Prognostic factors for the success of endometrial ablation in the treatment of menorrhagia with special reference to previous cesarean section

Objective

To assess whether, among other prognostic factors, a history of Cesarean section is associated with endometrial ablation failure in the treatment of menorrhagia.Study design We compared women who had failed ablation to women who had successful ablation for menorrhagia in a case–control study. Failed ablation was defined as the need for hysterectomy due to persistent heavy menstrual bleeding after ablation. Successful ablation was defined as an ablation for menorrhagia not needing hysterectomy and the woman being satisfied with the result. Both cases and controls were identified from the surgery registration in the Máxima Medical Center between January 1999 and January 2009. Cases were women that had an endometrial ablation and a hysterectomy, whereas controls only had an endometrial ablation. From the medical files we collected for each patient clinical history, including the presence of a previous Cesarean section, baseline characteristics at the moment of initial ablation, data of the ablation technique and follow-up status. We used univariable and multivariable logistic regression to estimate the risk of failure of endometrial ablation.

Results

We compared 76 cases to 76 controls. Among the cases, 12 women had had a previous Cesarean section versus 15 in the control group (15.8% versus 19.7%; odds ratio (OR) 0.76; 95% CI 0.3–1.8). Factors predictive for failure of ablation were dysmenorrhea (OR 3.0; 95% CI 1.5–6.1), having a submucous myoma (OR 3.2; 95% CI 1.5–6.8) and uterine depth (per cm OR 1.3; 95% CI 1.0–1.6). Presence of intermenstrual bleeding, sterilization and age were not associated with failure of ablation.

Conclusion

A previous Cesarean delivery is not associated with an increased risk of failure of endometrial ablation, but dysmenorrhea, a submucous myoma and longer uterine depth are. This should be incorporated in the counseling of women considering endometrial ablation.     

Cavaterm thermal balloon endometrial ablation versus hysteroscopic endometrial resection to treat menorrhagia: the French, multicenter, randomized study

STUDY OBJECTIVE: To compare the efficacy and safety of Cavaterm thermal balloon endometrial ablation with hysteroscopic endometrial resection. DESIGN: Multicenter randomized trial (Canadian Task Force classification I). SETTING: Departments of obstetrics and gynecology in French university hospitals. PATIENTS: Fifty-one women with menorrhagia unresponsive to medical treatment. INTERVENTIONS: Women were randomized to thermal destruction of the endometrium or to hysteroscopic endometrial resection. Women completed preoperative, 6-, and 12-month postoperative pictorial charts to determine Higham blood loss scores and a satisfaction questionnaire. Operative time, discharge time, complication rate, and resumption of normal activities were evaluated for each group. MEASUREMENTS AND MAIN RESULTS: Amenorrhea rates were 36% (95% CI 19%-56%) and 29% (95% CI 8%-51%) in the Cavaterm and the endometrial resection groups at 12 months, respectively (ns). Both treatments significantly reduced uterine bleeding. The median decrease in Higham score at 12 months was significantly higher in women treated by Cavaterm (377, range 108-1300) than in women treated by resection (255, range -82 to 555) (p=.006). A subsequent hysterectomy for recurrent bleeding was performed in 2 women, both previously treated by resection. The rate of women reporting good or excellent satisfaction was 89% (95% CI 72%-98%) in the Cavaterm group and 79% (95% CI 54%-94%) in the resection group at 12 months. Discharge time was significantly lower in women treated by Cavaterm, although postoperative pain at 1 hour was higher. There were no major complications in either group. CONCLUSIONS: Cavaterm thermal balloon ablation was as effective as hysteroscopic endometrial resection to treat menorrhagia, both resulting in a significant reduction in menstrual blood loss and high patient satisfaction.     

The long-term effectiveness of endometrial laser ablation: a survival analysis

OBJECTIVES: To assess the long-term effectiveness of endometrial laser ablation and factors that predict long-term outcome. SETTING: A university teaching hospital. STUDY DESIGN: Postal questionnaires were sent to all women who underwent endometrial laser ablation between 1992 and 1998. RESULTS: Of 215 patients who underwent endometrial laser ablation, 174 (80.9%) returned the questionnaire. Duration of follow-up was 1.5-9 years. The procedure was reported as a success by 138 (79.3%) and a failure by 36 (20.7%). Twenty-four patients (13.8%) subsequently underwent hysterectomy for excessive bleeding. Using survival curve estimates the percentage that remained free of failure was 95.3% at 1 year and 76.2% at 4 years. Increasing patient age was significantly associated with reduced risk of failure (hazard ratio 0.91 for every year increase in age). An inexperienced operator significantly increased the hazard of failure. CONCLUSION: Endometrial laser ablation is effective in the long-term in the majority (76.2%) of patients. Older women can expect to have a lower risk of failure.     

Hysteroscopic myomectomy in postmenopausal women

STUDY OBJECTIVE: To review the findings in postmenopausal patients undergoing hysteroscopic myomectomy. DESIGN: Retrospective case-controlled study (Canadian Task Force classification II-2). SETTING: Private practice. PATIENTS: Eighteen women with postmenopausal bleeding and two asymptomatic women with abnormal ultrasounds. INTERVENTIONS: Hysteroscopic myomectomy in 19 patients, with concomitant destruction of the endometrium in 4 patients, and resectoscopic biopsy in 1 patient. MEASUREMENTS AND MAIN RESULTS: Three patients underwent subsequent gynecologic surgery. One had hysteroscopy to evaluate and remove an asymptomatic residual myoma found on ultrasound. A sarcoma was found in two of the symptomatic patients. Two patients underwent hysterectomy-one for a sarcoma and the other for a carcinoma of the cervix. One patient has had further postmenopausal bleeding. CONCLUSION: Women who have a submucosal myoma that becomes symptomatic in the menopausal period may be at increased risk for a sarcoma.     

Outcome of uterine clear cell carcinomas compared to endometrioid carcinomas and poorly-differentiated endometrioid carcinomas

OBJECTIVES: Our aim was to compare the survival between patients with clear cell carcinoma (CC) and patients with endometrioid carcinoma (EC). METHODS: Through the population-based Geneva Cancer Registry, we identified 1,380 resident women diagnosed with uterine cancer between 1970 and 2000. We excluded those with papillary serous endometrial carcinoma and uterine sarcomas. We categorized patients as CC (n = 32, 2.8%) or EC (n = 1,145, 97.2%). Uterine cancer-specific survival rates were calculated by Kaplan-Meier analysis. We used Cox proportional hazards analysis to compare uterine cancer mortality risks between groups, and adjusted these risks for other prognostic factors. RESULTS: CC patients presented with a more advanced stage at diagnosis than EC patients (p = 0.002). Compared to women with EC, women with CC had a significantly greater risk of dying from their disease (hazard ratio [HR] 2.9, 95% confidence interval (95% CI) 1.7-4.9). After adjustment for age, stage and adjuvant chemotherapy, the risk of dying from uterine cancer was still significantly higher for CC patients (HR 2.0, 95% CI 1.2-3.4). By univariate analysis, the risk of dying of endometrial cancer was not significantly higher in CC patients than in patients with poorly-differentiated EC (HR 1.3, 95% CI 0.7-2.3). CONCLUSION: This population-based investigation shows that patients with CC have a poorer outcome than those with EC. Studies to determine the role of adjuvant treatment in CC patients are needed.     

Incidence and predictors of failed second-generation endometrial ablation

Background

The need for any treatment following an endometrial ablation is frequently cited as “failed therapy,” with the two most common secondary interventions being repeat ablation and hysterectomy. Since second-generation devices have become standard of care, no large cohort study has assessed treatment outcomes with regard to only these newer devices. We sought to determine the incidence and predictors of failed second-generation endometrial ablation, defined as the need for surgical re-intervention.We performed a retrospective cohort study at a single academic-affiliated community hospital. Subjects included women undergoing second-generation endometrial ablation for benign indications between October 2003 and March 2016. Second-generation devices utilized during the study period included the radiofrequency ablation device (RFA), hydrothermal ablation device (HTA), and the uterine balloon ablation system (UBA).

Results

Five thousand nine hundred thirty-six women underwent endometrial ablation at a single institution (3757 RFA (63.3%), 1848 HTA (31.1%), and 331 UBA (5.6%)). The primary outcome assessed was surgical re-intervention, defined as hysterectomy or repeat endometrial ablation. Of the total 927 (15.6%) women who required re-intervention, 822 (13.9%) underwent hysterectomy and 105 (1.8%) underwent repeat endometrial ablation. Women who underwent re-intervention were younger (41.6 versus 42.9 years, p?<?.001), were more often African-American (21.8% versus 16.2%, p?<?.001), and were more likely to have had a primary radiofrequency ablation procedure (hazard ratio 1.37; 95%CI 1.01 to 1.86). Older age was associated with decreased risk for treatment failure with women older than 45 years of age having the lowest risk for failure (p?<?.001). Age between 35 and 40 years conferred the highest risk of treatment failure (HR 1.59, 95% CI 1.32–1.92). Indications for re-intervention following ablation included menorrhagia (81.8%), abnormal uterine bleeding (27.8%), polyps/fibroids (18.7%), and pain (9.5%).

Conclusion

Surgical re-intervention was required in 15.6% of women who underwent second-generation endometrial ablation. Age, ethnicity, and radiofrequency ablation were significant risk factors for failed endometrial ablation, and menorrhagia was the leading indication for re-intervention.

     

Leiomyoma characteristics and risk of subsequent surgery after myomectomy.

OBJECTIVE: Evaluate the association between leiomyoma characteristics at myomectomy with subsequent surgery risk. METHODS: A population-based nested case control study from a cohort of women at a large HMO, identified as having had a myomectomy was performed; 82 cases had subsequent uterine surgery; 82 controls, frequency matched for age and date of first surgery, did not. Medical records were abstracted; follow-up was 18-128months. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. RESULTS: Women without subserosal myomas were more likely to have a second surgery as compared to women with at least one subserosal myoma, aOR=4.1(95% CI 1.5-10.9). Size of myomas did not predict subsequent surgery in subanalyses by type of surgery. Number of leiomyomas was not predictive of a subsequent uterine surgery overall or in subgroup analyses. CONCLUSION: Myoma location, but not number or size, impacts the risk for subsequent leiomyoma uterine surgery.     

Risk of discovering endometrial carcinoma or atypical hyperplasia during hysteroscopic surgery in postmenopausal women.

STUDY OBJECTIVE: To assess the risk of diagnosing endometrial carcinoma or atypical hyperplasia in tissue resected during hysteroscopy performed for intrauterine pathology presumed benign in postmenopausal women. DESIGN: A single-center prospective study (Canadian Task Force classification II-2). SETTING: Department of Gynecology, La Conception Hospital, Marseille, France. PATIENTS: Three hundred twenty-five women with intrauterine pathology, presumed benign, causing postmenopausal bleeding or bleeding related to hormone replacement therapy. INTERVENTION: All women had an endometrial biopsy after diagnostic hysteroscopy to exclude endometrial carcinoma or atypical hyperplasia. Then they underwent hysteroscopic surgical resection (203, 62.5%) or endometrial ablation (122, 37.5%). MEASUREMENTS AND MAIN RESULTS: Two cases each (0.6%) of endometrial carcinoma and endometrial atypical hyperplasia were discovered that were missed by preoperative evaluations. CONCLUSION: Outpatient hysteroscopy and endometrial biopsy do not eliminate the finding of carcinoma or endometrial atypical hyperplasia, as these disorders may be discovered during hysteroscopic surgery.     

Does risk of endometrial cancer for women without a germline mutation in a DNA mismatch repair gene depend on family history of endometrial cancer or colorectal cancer?

Objective

To determine whether risk of endometrial cancer for women without a germline mutation in a DNA mismatch repair (MMR) gene depends on family history of endometrial or colorectal cancer.

Methods

We retrospectively followed a cohort of 79,166 women who were recruited to the Colon Cancer Family Registry, after exclusion of women who were relatives of a carrier of a MMR gene mutation. The Kaplan–Meier failure method was used to estimate the cumulative risk of endometrial cancer. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for association between family history of endometrial or colorectal cancer and risk of endometrial cancer.

Results

A total of 628 endometrial cancer cases were observed, with mean age at diagnosis of 54.4 (standard deviation: 15.7) years. The cumulative risk of endometrial cancer to age 70 years was estimated to be 0.94% (95% CI 0.83–1.05) for women with no family history of endometrial cancer, and 3.80% (95% CI 2.75–4.98) for women with at least one first- or second-degree relative with endometrial cancer. Compared with women without family history, we found an increased risk of endometrial cancer for women with at least one first- or second-degree relative with endometrial cancer (HR 3.66, 95% CI 2.63–5.08), and for women with one first-degree relative with colorectal cancer diagnosed at age < 50 years (HR 1.48, 95% CI 1.15–1.91).

Conclusion

An increased risk of endometrial cancer is associated with a family history of endometrial cancer or early-onset colorectal cancer for women without a MMR gene mutation, indicating for potential underlying genetic and environmental factors shared by colorectal and endometrial cancers other than caused by MMR gene mutations.     

Microwave endometrial ablation at a frequency of 2.45 GHz. A pilot study.

OBJECTIVE: To investigate the clinical application of a microwave tissue coagulator at 2.45 GHz with a needle electrode customized for endometrial ablation. STUDY DESIGN: In a pilot clinical study, endometrial ablation was performed under intravenous thiopental anesthesia on five women suffering from hypermenorrhea caused by aplastic anemia (3), von Willebrand's disease (1) and a submucosal myoma (1) using a microwave tissue coagulator at 2.45 GHz. RESULTS: Four patients were amenorrheic after endometrial ablation. The patient with the submucosal myoma experienced minor menstrual bleeding. No notable complications were observed during or after ablation. CONCLUSION: Endometrial ablation using a microwave tissue coagulator at 2.45 GHz is a simple and useful method of treating hypermenorrhea.     

Endocavitary surgical procedures, an alternative to myomectomy in patients with symptomatic fibroids

Endometrial ablation can be used in heavy menstrual bleeding due to symptomatic submucosal myomas in women without desire of pregnancy. Those methods used alone, lead to an improvement on bleeding but results are not as good as in women without myomas. They can be associated with hysteroscopic myomectomy and, then, the results on bleeding are better than myomectomy alone. Second generation endometrial ablation methods must be used preferentially as they present less surgical complications than first generation methods. As the pregnancies that may occur after endometrial ablation have high risk of complications, a contraceptive mean is highly recommended after surgery. Transcervical sterilisation by intratubal insert (Essure) can also be proposed, but for women with Essure placed before endometrial ablation, only Thermachoice and bipolar resection have proven their safety. Finally, economical outcomes of endometrial ablation in myomas haven't been assessed yet.     

Perioperative factors for predicting successful hysteroscopic endometrial ablation

OBJECTIVE: To investigate factors affecting the success of hysteroscopic endometrial ablation in order to improve patient counseling. STUDY DESIGN: Preoperative patient characteristics (age, parity, uterine length, and presence and location of myomas) and intraoperative factors (intracavitary findings, ablation or resection, and operator) were analyzed. Forty-three women with a uterine size of < or = 10 weeks underwent hysteroscopic endometrial ablation or resection and had a median follow-up of 20 months. All were treated with depot triptorelin, 3.75 mg, 1 month prior to the procedure. Alleviation of menorrhagia and amenorrhea was classified as treatment success. Comparative analyses were made between patients with failed vs. successful procedures and with reduced bleeding vs. those with amenorrhea following surgery. RESULTS: Thirty-seven women (86%) reported a decrease in menstrual flow or amenorrhea. In 6 patients (14%), bleeding persisted or became more severe. There were no statistically significant differences between women who had successful vs. failed procedures with regard to all preoperative and intraoperative parameters analyzed. Patients with amenorrhea were significantly older as compared to women with reduced bleeding (47.5 +/- SD 5.0) vs. 44.0 +/- SD 4.1 years, P = .03. CONCLUSION: Most women with uterine size of < or = 10 weeks may expect alleviation of menorrhagia or amenorrhea after surgery. Apart from age, all other preoparative and intraoperative factors examined had no predictive value for a successful procedure. These data are valuable for proper patient counseling before hysteroscopic endometrial ablation.     

Why Do Women Choose Endometrial Ablation Rather Than Hysterectomy?

Objective: To determine why women choose endometrial ablation rather than hysterectomy for the treatment of menorrhagia.

Design: Observational study based on postal questionnaires.

Setting: A university hospital.

Patient(s): One hundred eighty randomly selected patients from a cohort of 658 patients who underwent endometrial ablation for the treatment of menorrhagia during the past 7 years.

Intervention(s): None.

Main Outcome Measure(s): Patient attitude about endometrial ablation.

Result(s): One hundred six questionnaires (58.9%) were completed satisfactorily. The average postoperative follow-up period was 45.1 months (range, 3–80 months). Eleven women (10.4%) had undergone repeated endometrial ablation and 8 (7.5%) had undergone hysterectomy. More than half the women indicated that they would find endometrial ablation acceptable even if there was no chance of amenorrhea, if the probability of menstruation becoming lighter was ≥4:10, if the likelihood of menstrual pain decreasing was ≥3:10, if the chance of requiring repeated endometrial ablation or hysterectomy was ≤1:4, and if the risk of uterine cancer after surgery was ≤1:200. The three most important advantages of endometrial ablation over hysterectomy were perceived to be the avoidance of major surgery, the fast return to normal functioning, and the short hospitalization.

Conclusion(s): Most women who choose endometrial ablation rather than hysterectomy as therapy for menorrhagia are prepared to undergo hysteroscopic surgery even if the chance of success is relatively poor.     

Do risk factors for epithelial ovarian cancer have an impact on prognosis? Focus on previous pelvic surgery and reproductive variables

OBJECTIVES: The prognostic impact of risk factors for ovarian cancer development is sparsely explored, but previous sterilisation has been shown to have a negative impact on survival. METHODS: Ovarian cancer cases were from the Danish MALOVA study. Information on previous pelvic surgery as well as reproductive variables was obtained from a personal interview conducted closely after primary surgery. Cox regression models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for ovarian cancer specific death in relation to previous pelvic surgery and reproductive variables including lifetime number of ovulation years. RESULTS: A total of 295 women with Stage III ovarian carcinomas were identified and followed to death or for a median of 7.3 years (range 5.4-9.5 years). Previously sterilised or hysterectomised women seemed to have a slightly decreased risk of ovarian cancer death (HR = 0.62; 95% CI: 0.36-1.08 and HR = 0.82; 95% CI: 0.55-1.21), although none of these associations reached statistical significance. The prognostic impacts of the individual reproductive variables followed the same pattern as the impact of the variables on ovarian cancer development, although significance was only reached for age at menarche (HR = 0.91 per year; 95% CI: 0.84-0.99). By accumulation of the possible minor effects of the reproductive variables in calculation of the total lifetime number of ovulation years, we found that survival decreased significantly with increasing number of ovulations (HR = 1.53 per 10 years; 95% CI: 1.09-2.14). CONCLUSION: Increasing lifetime number of ovulations was a negative prognostic factor for ovarian cancer specific survival. Previous sterilisation or hysterectomy seemed to be associated with improved survival.     

Ultrasound-Guided Percutaneous Microwave Ablation for Submucosal Uterine Fibroids

Study ObjectiveTo prospectively evaluate the efficiency and safety of ultrasound-guided percutaneous microwave ablation (PMWA) in treating symptomatic submucosal uterine myomas.DesignSelf-controlled study (Canadian Task Force classification II-1).SettingSingle center.PatientsTwenty-two premenopausal women with 22 symptomatic submucosal uterine myomas.InterventionAll patients underwent ultrasound-guided PMWA.Measurements and Main ResultsPMWA was performed in 22 premenopausal women with 22 symptomatic submucosal uterine myomas. Mean (SD) patient age was 42 (4.60) years (95% confidence interval [CI], 39.96–44.04). Five symptomatic submucosal uterine myomas were identified as type 0, 7 as type 1, and 10 as type 2. Contrast-enhanced ultrasound and magnetic resonance imaging were performed before and after surgery. Myoma volume, hemoglobin concentration, and scores on the UFS-QOL (Uterine Fibroid Symptom and Quality of Life) questionnaire were recorded before and at 3 and 12 months after ablation. Complications were also recorded. In all patients, therapy was completed with a single ablation. The baseline diameter of the symptomatic submucosal uterine myomas was 4.90 (1.60) cm. Mean myoma volume reduction rate was 81.46% (16.33%) (95% CI, 73.06%–89.86%) at 3 months (p < .001) and reached 90.00% (9.79%) (95% CI, 85.07–95.13) at 12 months (p < .001). At 3 months after ablation, hemoglobin concentration increased from 88.64 (21.87) g/L (95% CI, 78.94–98.34) to 123.21 (15.77) g/L (95% CI, 115.10–131.32) (p < .001), and remained stable at 12 months, with a value of 125.92 (14.90) g/L (95% CI, 117.98–133.86). Scores on the UFS-QOL were comparable, with normal levels observed at 1 year. No major complications were observed. Nine patients were discharged with necrotic masses.ConclusionPMWA seems to be effective and safe for treatment of submucosal myomas.