Longterm Results of Hysteroscopic Myomectomy for Abnormal Uterine Bleeding

EMANUEL, MARK H. MD, PhD; WAMSTEKER, KEES MD, PhD; HART, AUGUSTINUS A. M. MSc; METZ, GODFRIED MD; LAMMES, FRITS B. MD, PhD

Obstetrics & Gynecology:
Original Research
Abstract

Objective: To analyze the efficacy of transcervical resection of submucous myomas and to identify prognostic factors for long-term results.

Methods: Two-hundred eighty-five women were treated with transcervical resection of submucous myomas without endometrial ablation. In case of incomplete resection a repeat procedure was offered. Long-term follow-up was obtained. Recurrence was defined as the need for further surgery. The relation of several variables with the outcome was analyzed using Cox proportional hazard regression analysis.

Results: Seventeen cases (6%) were lost to follow-up. The median follow-up was 46 months (range 1–104 months); for cases without recurrence median follow-up was 42 months (range 16–104 months). Forty-one (14.5%) patients had repeat surgery. An independent prognostic value of uterine size (P < .001) and number of submucous myomas (P < .001) for recurrence was noted. Twenty of 41 patients who had repeat surgery subsequently had a hysterectomy. None of the variables investigated predicted the need for hysterectomy. The surgery-free percentage of 165 patients with normal sized uteri and not more than two myomas was 94.3% (standard error ± 1.8%) at 2 years and 90.3% (± 3.0%) at 5 years.

Conclusion: Transcervical resection of submucous myomas is a safe and effective treatment for patients with a normal sized uterus and not more than two myomas. It is an acceptable alternative for selected other patients. The need for a combined endometrial ablation is questionable. Transcervical resection of submucous myomas will give patients a high chance of averting further surgery and should modify the way patients are counseled.

Modern resectoscopic techniques have expanded treatment options for patients with submucous myomas.1,2 However, less is known about the efficacy of transcervical resection of submucous myomas when applied on a larger scale. Classification of different types of submucous myomas was shown to be indispensible, because their intramural extension varies considerably and determines the chance of a complete resection.3 Although many authors have published their results,3–7 long-term outcomes of transcervical resection of submucous myomas are still to be elucidated. It is necessary to know which factors influence success, failure, and recurrence for appropriate treatment and counseling of patients. In the present study we analyzed the efficacy of transcervical resection of submucous myomas and the prognostic effect of several variables on the rate of recurrence after long-term follow-up.

In Brief

The long-term results of resection of myomas demonstrate that this technique is effective and gives patients a high chance of averting further gynecologic surgery.

Author Information

Department of Obstetrics and Gynecology, Spaarne Hospital, Haarlem, and the Departments of Clinical Epidemiology and Biostatistics and Obstetrics and Gynecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

Address reprint requests to: Mark H. Emanuel, MD, PhD, Department of Obstetrics and Gynecology, Spaarne Hospital, PO Box 1644, 2003 BR Haarlem, The Netherlands. E-mail: memanuel@knmg.nl

Received May 26, 1998. Received in revised form November 3, 1998. Accepted November 12, 1998.

© 1999 The American College of Obstetricians and Gynecologists