Isthmocele - To Treat or Not to Treat? |Biomedgrid

Due to the growing number of Cesarean section deliveries, the uterine scar defect is becoming a common problem in gynecology and in obstetrical care. The symptoms of the niche include abnormal uterine bleeding (AUB, 65%), spotting between menses (76%), dysmenorrhea (53.1%), chronic pelvic pain (46.2%), infertility (71.5%) and dyspareunia (24.2%). The diagnosis of isthmocele is based on the imaging methods performed during the early proliferative phase of the menstrual cycle: transvaginal ultrasound (TVUS), saline infusion sonography (SIS), magnetic resonance imaging or hysteroscopy. The treatment of niche includes conservative procedures like management with expectant, oral contraceptive or hormonal IUD (levonorgestrel-releasing device). In case of incidental diagnosis of isthmocele (asymptomatic) there is no indication for any treatment. Surgical treatments include endoscopic (hysteroscopy, laparoscopy) procedures, repair by laparotomy, transvaginal or combined abdominal/transvaginal operations. The decision to treat and how to treat is made individually, considering the severity of the condition and the patients' desire for future fertility. Hysteroscopic treatment should be considered as a first line surgical treatment in fertility desire women, because of minimally invasive and beneficial therapeutic results. It is associated with nearly 100% of efficacy in reducing the AUB symptoms and in restoring fertility. The laparoscopic, laparotomic or vaginal repair techniques are dedicated to fertility desire women with residual myometrial thickness <5mm. According to literature data about 90% of the patients had resolution of their symptoms and the percentage of patients with restoring fertility after treatment was about 44%. However, there is no data available to confirm the effectiveness of treatment in preventing the obstetrical complications like uterine rupture or pregnancy in the scar.