Endometrial polyps are some of the widespread intrauterine lesions in girls of childbearing age. Most sufferers are handled for irregular uterine bleeding, irregular vaginal bleeding, infertility or different causes. Remedy for endometrial polyps consists of conservative administration, medical administration and surgical elimination. Expectant administration is appropriate for useful polyps, which may shed with menstrual blood. Medical administration consists of the appliance of hormonal therapies, comparable to utilizing oral progesterone in the course of the second half of the menstrual cycle or taking oral contraceptives, however on the similar time, unwanted side effects associated to the long-term use of hormonal medication, comparable to endocrine issues, shouldn’t be ignored. For cervical polyps, utilizing merely medical remedy is unlikely to realize a radical treatment. Hysteroscopy and electrosurgical elimination of polys are advisable for sufferers with giant polyps or those that, after ineffective therapy with hormonal medication or who’ve achieved efficient therapy, expertise recurrence inside a brief time frame. Nonetheless, for ladies with out sexual exercise, performing hysteroscopic electropolypectomy may be very troublesome. Just a few circumstances have mentioned the safety of hymen integrity throughout surgical procedure . Victoria reported a case of hysteroscopic resection of endometrial polyps in a twelve-year-old woman. Polyp tissue was utterly eliminated after the second surgical procedure, and at last, the symptom of irregular uterine bleeding was relieved . Cheong carried out hysteroscopic resection of a cervical polyp that protruded from the vagina in a virgin . We began hysteroscopic resection of intrauterine lesions in girls with out sexual exercise in 2003 and have achieved a lot expertise .
MyoSure has achieved nice efficacy since its utility in 2014 for benign intrauterine lesions in girls with intact hymens in our hospital. MyoSure has distinctive benefits. The exterior diameter of the electroresectoscope is 9–10 mm, and the cervix is softened earlier than the process. Moreover, the operation requires excessive technical necessities of the surgeon. Nonetheless, the exterior diameter of the MyoSure instrument is 6.25 mm, and there’s no want to melt the cervix earlier than surgical procedure. Throughout surgical procedure, lesions have been resected with a high-speed rotating blade contained in the sidewall of the instrument, and solely high quality adjustment of the lens physique was wanted to finish the operation, which significantly diminished the likelihood of damaging the hymen. On the similar time, the suction gadget is hooked up after the working deal with of MyoSure. After polypectomy, polyp fragments may be eliminated and saved within the specimen storage tank on the similar time, making certain readability of the surgical area and lowering the variety of instances that the mirror physique enters and leaves the uterine cavity, preserving the intact hymen. As well as, MyoSure’s reducing window is positioned on the sidewall of the instrument, which limits the surgical area. Moreover, it makes use of mechanical power to keep away from electrical and warmth injury, which protects the membrane of the conventional components across the lesion and reduces the incidence of long-term postoperative problems, comparable to intrauterine adhesion. Moreover, the reducing depth of the electrosurgical ring is troublesome to manage, which will increase the chance of cervical trauma and uterine perforation. Nonetheless, the reducing window of MyoSure is parallel to the bottom of polyps, which avoids cervical injury. In our research, all endometrial polyps or cervical polyps within the 32 sufferers have been efficiently eliminated. Intraoperative blood loss and operative period have been minimized. No intraoperative problems, comparable to cervical damage, uterine perforation or TURP syndrome, occurred. Hymen integrity was preserved, and signs of irregular uterine bleeding have been relieved. MyoSure resection of endometrial polyps and cervical polyps is secure and environment friendly, permitting preservation of the intact hymen.
Prognosis and therapy of intrauterine lesions in girls with out sexual habits has particularities. Nonetheless, if the indications for surgical procedure are strictly grasped and the perioperative possibility is taken into account, passable results may be obtained. First, girls with intact hymens are liable to resistance and worry transvaginal uterine operations. Sufferers ought to be totally knowledgeable of the need and threat of surgical procedure earlier than surgical procedure. Normal anesthesia is advisable in the course of the surgical procedure, and the operation ought to be carried out after a passable anesthesia impact to keep away from hymen damage attributable to repeated motion by the affected person. Second, the advanced iodine rinse for disinfection of the vagina may be rejected by way of a catheter. The distension fluid may also be used for increasing and flushing the vagina to forestall micro organism from retrograding into the uterine cavity and even inflicting pelvic irritation. As well as, though there isn’t any want to melt the cervix earlier than surgical procedure, motion of the instrument ought to be managed. Warning ought to be taken concerning each the entry and exit of the instrument to keep away from problems and shield the integrity of the hymen.
Research strengths included the dialogue of the benefits of MyoSure hysteroscopic tissue elimination system as a brand new try within the therapy of endometrial and cervical polyps in girls with an intact hymen. Major limitations of this research included the truth that information have been retrospectively collected and the pattern dimension was comparatively small. Additionally, this can be a single-center research, which limits the choice to generalize its conclusions. Additional research are wanted to substantiate the benefits of MyoSure tissue elimination system in these explicit forms of circumstances, and to discover extra choices for therapy of intrauterine lesions in girls with an intact hymen.
In conclusion, MyoSure tissue elimination system generally is a secure and environment friendly possibility for the therapy of endometrial polyps in girls with an intact hymen. Beneath the situation of strictly greedy the surgical indications and issues needing consideration, MyoSure can successfully take away the intrauterine lesions, and protect the integrity of the hymen.