89: Development of a Highly Successful Novel Comprehensive Diagnostic, Intraoperative, & Postoperative Treatment for Asherman′s Syndrome

Abstract

Study ObjectiveWe previously reported clinical features and treatment results from an international registry of patients with Asherman′s Syndrome - AS and documented 1) no consensus exists regarding optimal treatment regimens 2) worldwide treatment outcomes are very poor with standard treatment methods. This study presents results of a novel comprehensive diagnostic, intraoperative, and postoperative management plan designed to address limitations revealed in our previous study and yield patent uteri with low complications.DesignRetrospective analysis of patients treated with identical diagnostic, operative and postoperative management algorithm.SettingPrivate infertility practice with large referral base of severe Asherman′s Syndrome.PatientsForty patients with intrauterine synechiae, hypo/amenorrhea, and infertility.InterventionPatients underwent preoperative 2D+3D coronal plane sonohysterographic mapping of intrauterine adhesions. Under ultrasound adhesions were partially lysed with saline and SHG balloon followed by short-interval hysteroscopy. LOA was performed under ultrasound guidance (with full bladder) in the midcoronal-midsaggital plane using semiflexible scissors without intrauterine energy. An 8–12 French Foley catheter with distal tip cut flush to balloon was inflated in cavity under ultrasound to 2 cm average diameter. Patients received broad spectrum antibiotics, estradiol, and activity restriction for 2 weeks with serial exams/balloon adjustment until removal. Treatment results were assessed by SHG 6 weeks postoperatively.Measurements and Main ResultsThe majority of patients had severe intrauterine scarring (ESH stage III/IV). All had involvement of uterine cavity/fundus beyond cervix. This approach prevented perforations, vessel injuries, and infections despite aggressive LOA. All patients had a patent significantly increased size cavity at postoperative SHG. Less than 10% of cases required a second hysteroscopy for residual adhesions. Days of menstrual flow increased significantly postoperatively. Data on endometrial thickness and pregnancy rates will be presented.ConclusionThis systematic approach yielded significantly better outcomes for AS than standard methods. We were able to successfully restore partial or full patency to despite the severity of disease without intraoperative or postoperative complications. Study ObjectiveWe previously reported clinical features and treatment results from an international registry of patients with Asherman′s Syndrome - AS and documented 1) no consensus exists regarding optimal treatment regimens 2) worldwide treatment outcomes are very poor with standard treatment methods. This study presents results of a novel comprehensive diagnostic, intraoperative, and postoperative management plan designed to address limitations revealed in our previous study and yield patent uteri with low complications. We previously reported clinical features and treatment results from an international registry of patients with Asherman′s Syndrome - AS and documented 1) no consensus exists regarding optimal treatment regimens 2) worldwide treatment outcomes are very poor with standard treatment methods. This study presents results of a novel comprehensive diagnostic, intraoperative, and postoperative management plan designed to address limitations revealed in our previous study and yield patent uteri with low complications. DesignRetrospective analysis of patients treated with identical diagnostic, operative and postoperative management algorithm. Retrospective analysis of patients treated with identical diagnostic, operative and postoperative management algorithm. SettingPrivate infertility practice with large referral base of severe Asherman′s Syndrome. Private infertility practice with large referral base of severe Asherman′s Syndrome. PatientsForty patients with intrauterine synechiae, hypo/amenorrhea, and infertility. Forty patients with intrauterine synechiae, hypo/amenorrhea, and infertility. InterventionPatients underwent preoperative 2D+3D coronal plane sonohysterographic mapping of intrauterine adhesions. Under ultrasound adhesions were partially lysed with saline and SHG balloon followed by short-interval hysteroscopy. LOA was performed under ultrasound guidance (with full bladder) in the midcoronal-midsaggital plane using semiflexible scissors without intrauterine energy. An 8–12 French Foley catheter with distal tip cut flush to balloon was inflated in cavity under ultrasound to 2 cm average diameter. Patients received broad spectrum antibiotics, estradiol, and activity restriction for 2 weeks with serial exams/balloon adjustment until removal. Treatment results were assessed by SHG 6 weeks postoperatively. Patients underwent preoperative 2D+3D coronal plane sonohysterographic mapping of intrauterine adhesions. Under ultrasound adhesions were partially lysed with saline and SHG balloon followed by short-interval hysteroscopy. LOA was performed under ultrasound guidance (with full bladder) in the midcoronal-midsaggital plane using semiflexible scissors without intrauterine energy. An 8–12 French Foley catheter with distal tip cut flush to balloon was inflated in cavity under ultrasound to 2 cm average diameter. Patients received broad spectrum antibiotics, estradiol, and activity restriction for 2 weeks with serial exams/balloon adjustment until removal. Treatment results were assessed by SHG 6 weeks postoperatively. Measurements and Main ResultsThe majority of patients had severe intrauterine scarring (ESH stage III/IV). All had involvement of uterine cavity/fundus beyond cervix. This approach prevented perforations, vessel injuries, and infections despite aggressive LOA. All patients had a patent significantly increased size cavity at postoperative SHG. Less than 10% of cases required a second hysteroscopy for residual adhesions. Days of menstrual flow increased significantly postoperatively. Data on endometrial thickness and pregnancy rates will be presented. The majority of patients had severe intrauterine scarring (ESH stage III/IV). All had involvement of uterine cavity/fundus beyond cervix. This approach prevented perforations, vessel injuries, and infections despite aggressive LOA. All patients had a patent significantly increased size cavity at postoperative SHG. Less than 10% of cases required a second hysteroscopy for residual adhesions. Days of menstrual flow increased significantly postoperatively. Data on endometrial thickness and pregnancy rates will be presented. ConclusionThis systematic approach yielded significantly better outcomes for AS than standard methods. We were able to successfully restore partial or full patency to despite the severity of disease without intraoperative or postoperative complications. This systematic approach yielded significantly better outcomes for AS than standard methods. We were able to successfully restore partial or full patency to despite the severity of disease without intraoperative or postoperative complications.