Evaluation of hydrothermal endometrial ablation in comparison with hysteroscopic electrosurgical endometrial ablation for treatment of dysfunctional uterine bleeding in premenopausal women

الملخص EN

Objective: To evaluate and compare the efficacy, safety and effect on ovarian function of hydrothermal endometrial ablation and hysteroscopic electrosurgical endometrial ablation in cases of premenopausal dysfunctional uterine bleeding.

Patients and Methods: In this prospective randomized clinical study, after obtaining written and fully informed consents, 56 women with premenopausal dysfunctional uterine bleeding were randomized into two equal groups and were treated with either hydrothermal endometrial ablation (hydrothermal group) or hysteroscopic electrosurgical endometrial ablation (hysteroscopic group).

The main outcome measures were menstrual status, patient's satisfaction with the procedure and effect on ovarian function at 6 months after the procedures.

Results: The rates of amenorrhea, hypomenorrhea, eumenorrhea, vaginal blood spotting and patient's satisfaction at 6months postoperatively were 37.5% (9/24), 33.3%(8/24), 20.8%(5/24), 8.3%(2/24) and 91.7%(22/24) respectively, in the hysteroscopic group and 40%(10/25), 32% (8/25), 28%(7/25), 0%(0) and 84% (21/25) respectively, in the hydrothermal group, without significant differences between both groups.

There were no significant differences in complications of the procedure between both groups; uterine perforation and cervical laceration were developed only in the hysteroscopic group with rates of 7.1% and 3.6%, respectively, vaginal burns were developed only in the hydrothermal group with a rate of 7.7%, while endometritis was developed in 3.8% of the hysteroscopic group and in 7.7% of the hydrothermal group and post-operative pelvic pain was developed in 30.8 % of hysteroscopic group and in 38.5% of hydrothermal group .

There were no significant changes in FSH levels between before operation and at 6 months after operation in both groups (7.96  2.49 Vs 8.91  2.02 IU/L, respectively, in hysteroscopic group and 8.02  2.83 Vs 8.48  2.68 IU/L, respectively in hydrothermal group).

Similarly, there were no significant changes in LH levels between before operation and at 6 months after operation in both groups (4.74  1.49 Vs 5.16  1.39 IU/L, respectively in hysteroscopic group and 5.56  1.82 Vs 5.9  2.01 IU/L, respectively in hydrothermal group).

Also, there were no significant changes in E2 levels between before operation and at 6 months after operation in both groups (112.33  31.05 Vs 129.42  43.78 pg/ml, respectively in hysteroscopic group and 108.74  31.69 Vs 119.24  35.89 Pg/ml, respectively in hydrothermal group).

There were no significant changes in ovarian volumes between before operation and at 6 months after operation in both groups (5.92  0.72 Vs 5.90  0.73 cm3, respectively, in hysteroscopic group and 6.12  1.17 Vs 6.07  1.21 cm3, respectively, in hydrothermal group).

Conclusion: Hydrothermal endometrial ablation (HTA) is comparable with hysteroscopic electrosurgical endometrial ablation in efficacy, safety, and absence of deleterious effect on ovarian function, for treatment of premenopausal dysfunctional uterine bleeding.

HTA offers advantages over hysteroscopic electrosurgical endometrial ablation by being more easily learned, and of low cost.