Study of histopathological changes in endometriumand myometrium of uteri treated with thermalablation using foley's catheter

ABSTRACT

Dysfunctional uterine bleeding is a disabling condition for which many women seek medicaladvice. Medical treatment is often initiated and is only effective in around 50% ofwomen.For those intolerantor unresponsive to medical therapy, and/or for whom fertility is no longer desired and/or for whom hysterectomy isan unaccepted choice, a number of minimally invasive surgical options now exist and are collectively termedendometrial ablation. Endometrial ablation may be performed with or without hysteroscopic guidance.This work is designed to evaluate the possible safety and efficacy of the use of Foley's catheter as anew method of endometrial thermal ablation in the treatment of DUB through the study of immediatehistopathological changes occurring in endometrium and myometrium of uteri treated with thermal ablation usingFoley's catheter with its balloon filled with boiling saline just before hysterectomy. The study included twenty pre-menopausal women with DUB, selected from the outpatient clinic ofShatby Maternity Hospital. Foley's catheter was inserted into the uterine cavity up to thefundus, its balloon was inflated by boilingsaline by a 20 ml syringe through a three way cannula till the point when the side tube just started to bulge at thetip of the syringe and as the cavity could accommodate. The catheter was left inside the uterine cavity for 9minutes. Then hysterectomy was done and the uterus was sent immediately to the histopathology laboratory tostudy histopathologlical changes in the endometrium and myometrium. On the basis of inclusion criteria of this study, and to select twenty patients fulfilling those criteria, thestudy started with a number of 149 patients complaining of abnormally excessive uterine bleeding, and afterevaluation of the cause of their bleeding we found that ninety seven patients had DUB twenty five patients hadfibroids, two patients had cervical polyps, three patients had cervical ulcers, five patients had ovarian cysts, onepatient had solid ovarian tumour, two patients were on anticoagulant therapy due to medical conditions. Twopatients had hepatic dysfunction, one patient had Von- Willbrand diease, one patient had chronic renal failure, onepatient was thyrotoxic, and nine patients were dropped out from the study.On gross cut section of specimens, there was a zone ot hyperaemia in 19 out of 20 cases [95%]. The depth of thiszone ranged from 2 to 7 mm, the corresponding histological picture of the hyperaemic zone was fragmentation ofglands and heamorrhage in the endometrium extending into the underlying myometrium at places.Fragmentationof endometrial glands involving the entire endometrium was seen in 75% of specimens. The rest showed onlypatchy fragmentation. The myometrium was also affected in 60% of biopsies by foci of haemorrhage, and in 55%of biopsies by dilated blood vessels. Thermal endometrial ablation using hot saline in balloon of Foley's catheter is simple, safe and easy.The level of difficulty of performing the balloon procedure is similar to that required for inserting an intrauterinecontraceptive device.The technique does not require the direct use of endometrial visualization, distending solutions and high energysources with their possible dangerous complications met with hysteroscopy