The impact of major uterine wall resection and reconstruction of the uterus (MURU) on uterine hemodynamics and ovarian function in patients with adenomyosis: a clinical study

Abstract

Background: Previous studies had shown that major uterine wall resection and reconstruction of the uterus (MURU) was safe and effective in the treatment of adenomyosis. However, MURU results in loss of a significant amount of myometrial and some endometrial tissues, which may have an impact on uterine hemodynamics and ovarian function. Therefore, it is necessary to study the changes of uterine hemodynamics and ovarian function in patients after MURU, in order to provide an evidence-base for its clinical application. Objective: To explore the effects of major uterine wall resection and reconstruction of the uterus (MURU) on uterine hemodynamics and ovarian function in patients with adenomyosis. Study design: The maximum thickness of unilateral uterine muscle wall or the maximum diameters of adenomyosis focus were measured by ultrasonography. Patients with adenomyosis were divided into three groups: mild, moderate or severe. Fifty cases of adenomyosis without fertility requirement were treated with MURU (observation group), and levonorgestrel-releasing system (LNG-IUS) was placed in uterine cavity during the operation. Fifty patients with intramural myoma of the uterus were selected for hysteromyomectomy (control group). The changes of arterial pulsation index (PI) and resistance index (RI) of uterine artery, as well as antral follicle count (AFC) and serum antimullerian hormone (AMH) were observed before operation and 1 month, 3 months, 6 months, 12 months and 18 months post-operation. Results: No complications were observed in both groups, no significant difference in uterine hemodynamics and ovarian function were found between the two groups (P > 0.05). During intragroup comparison, there were no significant changes in PI and RI before and after operation in the two groups, and no significant changes in AFC and AMH were detected in both groups before and after operation (P > 0.05). Conclusions: MURU did not significantly affect the uterine hemodynamics and ovarian function in patients with adenomyosis, but the long-term effects need to be further investigated.