The Effect of Uterine Size on the Failure Rate of NovaSure Radiofrequency Endometrial Ablation [11D

Abstract

INTRODUCTION: Utilization of NovaSure endometrial ablation has been shown to be successful in treating menorrhagia. Little data exists describing NovaSure ablation failure. The purpose of this research is to determine variables most predictive of failure with NovaSure endometrial ablation. METHODS: A retrospective case-control study included 224 women who received NovaSure ablation between 2003-2014 at Memorial University Medical Center. 112 of these patients were identified as failures receiving a subsequent hysterectomy and the other 112 women were identified as control patients without a need for subsequent hysterectomy. Patient charts were accessed and reviewed to determine uterine measurements and the preoperative status of each woman including pre-operative pain and prior bilateral tubal ligation. Using SPSS Statistical software, the data was analyzed. RESULTS: Mean uterine sound (p= 0.043) and mean cervical length (p= 0.049) were predictive of failure. Secondary analyses determined women with prior bilateral tubal ligation (p= 0.009) predicted failure with NovaSure ablation. Women who experienced preoperative pelvic pain trended toward failure requiring subsequent hysterectomy, but no statistically significant difference was noted (p= 0.073). CONCLUSION: Within the limitations of this study, a NovaSure ablation in women with a longer uterus and a longer cervix yields higher failure rates with subsequent hysterectomy. The data also supports the hypothesis that the presence of tubal sterilization is associated with increased risk of subsequent hysterectomy. Determining the significance of pre-operative pain will require further chart investigation. This study can help physicians better identify NovaSure ablation candidates that will be successful thereby improving cost efficacy.