Long-term results of hysteroscopic myomectomy for abnormal uterine bleeding

Objective: To analyze the efficacy of transcervical resection of submucous myomas and to identify prognostic factors for long-term results. Methods: Two-hundred eighty-five women were treated with transcervical rese ction of submucous myomas without endometrial ablation. In case of incomple te resection a repeat procedure was offered. Long-term follow-up was obtain ed. Recurrence was defined as the need for further surgery. The relation of several variables with the outcome was analyzed using Cox proportional haz ard regression analysis. Results: Seventeen cases (6%) were lost to follow-up. The median follow-up was 46 months (range 1-104. months); for cases without recurrence median fo llow-up was 42 months (range 16-104 months). Forty-one (14.5%) patients had repeat surgery. An independent prognostic value of uterine size (P < .001) and number of submucous myomas (P < .001) for recurrence was noted. Twenty of 41 patients who had repeat surgery subsequently had a hysterectomy. Non e of the variables investigated predicted the need for hysterectomy. The su rgery-free percentage of 165 patients with normal sized uteri and not more than two myomas was 94.3% (standard error +/- 1.8%) at 2 years and 90.3% (/- 3.0%) at 5 years. Conclusion: Transcervical resection of submucous myomas is a safe and effec tive treatment for patients with a normal sized uterus and not more than tw o myomas. It is an acceptable alternative for selected other patients. The need for a combined endometrial ablation is questionable. Transcervical res ection of submucous myomas will give patients a high chance of averting fur ther surgery and should modify the way patients are counseled. (C) 1999 by The American College of Obstetricians and Gynecologists.