Ultrasound-guided repeat intrauterine balloon dilatation for prevention of adhesions.

Abstract

Intrauterine adhesions (IUAs) can occur following an invasive intrauterine procedure as a result of the normal healing process of the damaged endometrium/myometrium1. Although several interventions have been proposed for preventing the occurrence of IUAs, such as use of hyaluronic acid gel or polyethylene oxide-sodium carboxymethylcellulose gel, estrogen therapy and use of an intrauterine balloon or intrauterine device, their effectiveness is still uncertain2. The idea of using intrauterine pressure, through injection of saline solution into the uterine cavity, under ultrasound guidance for treating IUAs was first introduced in 20013. Subsequently, the potential therapeutic effect on mild adhesions of intrauterine insertion of a balloon and infusion of a distending medium was reported in 20144. More recently, ultrasound-guided balloon therapy for the treatment of mild IUAs in the outpatient setting was described5, 6. Here, we present a technique for adhesion prophylaxis following intrauterine surgery, based on the hypothesis that use of a balloon for dilatation of the uterine cavity and/or adhesiolysis might be effective using short repeated sequences in the most pivotal period. Before introducing the intrauterine balloon approach, we used hyaluronic acid gel routinely for prevention of IUAs. In our experience, repeat intrauterine balloon therapy can achieve better anatomic results and reduce the need for repeat intervention compared with use of hyaluronic acid gel (Figure 3 and Figure S2). The main disadvantages of the technique are the need for additional appointments and the pain associated with uterine-cavity distension. Although we are optimistic about the value of the method, well-designed studies are needed to evaluate its effectiveness and safety. A randomized controlled trial (RCT) completed recently found that intermittent intrauterine balloon therapy can prevent reformation of IUAs after hysteroscopic adhesiolysis8. Another RCT from the same group, evaluating the efficacy of intrauterine balloon dilatation therapy in adhesion prevention following hysteroscopic myomectomy, is ongoing9. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.