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The effectiveness of endometrial ablation with the Hydro ThermAblator (HTA) for abnormal uterine bleeding

Published:April 29, 2010DOI:https://doi.org/10.1016/j.ajog.2010.03.010

      Objective

      We sought to determine the overall effectiveness and risk factors for failure of hydrothermal ablation in the management of abnormal uterine bleeding.

      Study Design

      We performed a retrospective cohort analysis of patients who underwent hydrothermal ablation for abnormal uterine bleeding at our institution from July 2005 through February 2008. Variables analyzed included patient demographics, insurance status, body mass index, bleeding pattern, obstetric history, prior medical therapy and duration, uterine characteristics, and tobacco use history.

      Results

      In all, 159 patients were identified and 142 charts were eligible for evaluation. A total of 45 patients (31.6%) had return of preablation vaginal bleeding. Menometrorrhagia was a significant predictor for failure (P = .027) and subsequent hysterectomy (P = .0025). Younger age (P = .044), tobacco use (P = .042), and Medicaid/Medicare insurance status (P = .039) were also associated with a higher risk of failure.

      Conclusion

      Women who are younger, use tobacco products, and have menometrorrhagia are more likely to fail hydrothermal ablation.

      Key words

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      References

        • El-Hemaidi I.
        • Gharaibeh A.
        • Shehata H.
        Menorrhagia and bleeding disorders.
        Curr Opin Obstet Gynecol. 2007; 19: 513-520
        • O'Connor H.
        • Magos A.
        Endometrial resection for the treatment of menorrhagia.
        N Engl J Med. 1996; 335: 151-156
        • Lethaby A.
        • Shepperd S.
        • Farquhar C.
        • Cooke I.
        Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding.
        Cochrane Database Syst Rev. 2002; 2 (CD000329)
        • Lethaby A.
        • Hickey M.
        • Garry R.
        Endometrial destruction techniques for heavy menstrual bleeding.
        Cochrane Database Syst Rev. 2005; 4 (CD001501)
        • Goldrath M.
        Evaluation of HydroThermAblator and rollerball endometrial ablation for menorrhagia 3 years after treatment.
        J Am Assoc Gynecol Laparosc. 2003; 10: 505-511
        • Gemer O.
        • Kapustian V.
        • Kroll D.
        • Tur-Kaspa I.
        • Segal S.
        Perioperative factors for predicting successful hysteroscopic endometrial ablation.
        J Reprod Med. 2003; 48: 677-680
        • Seidman D.S.
        • Bitman G.
        • Mashiach S.
        • Hart S.
        • Goldenberg M.
        The effect of increasing age on the outcome of hysteroscopic endometrial resection for management of dysfunctional uterine bleeding.
        J Am Assoc Gynecol Laparosc. 2000; 7: 115-119
        • Longinotti M.K.
        • Jacobson G.F.
        • Hung Y.Y.
        • Learman L.A.
        Probability of hysterectomy after endometrial ablation.
        Obstet Gynecol. 2008; 112: 1214-1220
        • Phillips G.
        • Chien P.F.
        • Garry R.
        Risk of hysterectomy after 1000 consecutive endometrial laser ablations.
        Br J Obstet Gynaecol. 1999; 105: 897-903
        • Shamonki M.I.
        • Ziegler W.F.
        • Badger G.J.
        • Sites C.K.
        Prediction of endometrial ablation success according to perioperative findings.
        Am J Obstet Gynecol. 2000; 182: 1005-1007
        • Glasser M.H.
        • Zimmerman J.D.
        The HydroThermAblator system for management of menorrhagia in women with submucous myomas: 12- to 20-month follow-up.
        J Am Assoc Gynecol Laparosc. 2003; 10: 521-527
        • Rosenbaum S.P.
        • Fried M.
        • Munro M.
        Endometrial hydrothermablation: a comparison of short-term clinical effectiveness in patients with normal endometrial cavities and those with intracavitary pathology.
        J Minim Invasive Gynecol. 2005; 12: 144-149
        • Richart R.
        • das Dores G.B.
        • Nicolau S.M.
        • Focchi G.R.
        • Cordeiro V.C.
        Histologic studies of the effects of circulating hot saline on the uterus before hysterectomy.
        J Am Assoc Gynecol Laparosc. 1999; 6: 269-273
        • Wood C.
        Surgical and medical treatment of adenomyosis.
        Hum Reprod Update. 1998; 4: 323-336
        • Levgur M.
        Therapeutic options for adenomyosis: a review.
        Arch Gynecol Obstet. 2007; 276: 1-15
        • Windham G.C.
        • Elkin E.P.
        • Swan S.H.
        • Waller K.O.
        • Fenster L.
        Cigarette smoking and effects on menstrual function.
        Obstet Gynecol. 1999; 93: 59-65