LYSIS OF INTRAUTERINE ADHESIONS USING GYNECORADIOLOGIC TECHNIQUES

Objective: To present further experience with in-office lysis of intra uterine adhesions under fluoroscopic control using a specially designe d catheter. Design: Prospective study. Setting: Medical school-affilia ted infertility center. Patient(s): Seventeen infertile patients under going routine gynecoradiologic investigation as part of an initial inf ertility workup. Intervention(s): The initial hysterosalpingography wa s performed with a commercially available uterine catheter that seals off the uterine cavity before injection of contrast. If intrauterine a dhesions were diagnosed, an immediate attempt at lysis was made using the catheter's balloon tip or hysteroscopic scissors, which were inser ted through the main port of the catheter. The procedures were carried out using a paracervical block or IV analgesia. Main Outcome Measure( s): Normal uterine cavity after lysis of intrauterine adhesions. Resul t(s): Seventeen patients underwent lysis of intrauterine adhesions. In 13 patients (9 mild, 3 moderate, and 1 severe), the adhesions were ly sed successfully (81.2%). Among those, nine procedures were performed with the balloon and four with scissors. In 4 cases (2 moderate and 2 severe), lysis of adhesions was only partially successful. These proce dures had to be abandoned prematurely because of patient discomfort be fore attempting the use of scissors (n = 1), extravasation of dye into the myometrium making visualization difficult (n = 1), and thick, fib rotic adhesions that were resistant to scissors (n = 2). Conclusion(s) : In-office lysis of intrauterine adhesions under gynecoradiologic con trol can be carried out safely in the majority of patients, using mini mally invasive techniques. The potential cost savings in comparison wi th endoscopic procedures, which require utilization of expensive opera ting room time, are especially relevant in today's cost-conscious mana ged care environment. Only failures of in-office procedures would reac h the operating room under the algorithm proposed here. (C) 1997 by Am erican Society for Reproductive Medicine.