The role of transvaginal ultrasonography in pre-operative case selection and post-operative follow up of endometrial resection

Abstract

50 patients undergoing transcervical endometrial resection (TCRE) for abnormal uterine bleeding underwent transvaginal ultrasonography (TVUS) before danazol therapy, immediately pre-operatively, and 3 months post-operatively. There were no significant changes in the uterine dimensions but as expected the endometrium became thinner (p < 0.0005) after treatment with danazol facilitating endometrial resection. 12 cases (24%) continued to have menstrual problems. In those cases TVUS showed unchanged endometrium (4), minimum residual endometrium (5), irregular uterine cavity (5), and fibroids (2) as probable causes of failure. These findings guided the choice of further management as follows: conservative for minimum residual endometrium, repeat TCRE for unchanged endometrium, and hysterectomy for irregular uterine cavity and fibroids. The value of TVUS in diagnosing the cause of post-operative pain was limited to the cases (2) of haematometra. The smaller transverse (< 6 cm) and anteroposterior (AP) (< 4.5 cm) dimensions of the uterus (p < 0.05, < 0.05), a significant reduction in these dimensions after the operation (p < 0.0005, p < 0.01) along with the absence of endometrium (p < 0.0001), fibroids and irregular uterine cavity (p < 0.005) predicted a favourable outcome of TCRE. This study substantiates the role of TVUS in TCRE for proper selection of cases, determination of the causes of failure and their subsequent management, leading to an improved outcome.