Long-term outcomes after intrauterine morcellation vs hysteroscopic resection of endometrial polyps

Abstract

Study objective: To compare the long-term outcomes of intrauterine morcellation (IUM) of endometrial polyps vs a traditional operative polypectomy technique, hysteroscopic resection (HSR), and to identify factors predictive of recurrent abnormal uterine bleeding (AUB) after operative polypectomy.

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: Minimally invasive gynecologic surgery practice in a tertiary care center.

Patients: Women who underwent operative hysteroscopic polypectomy between January 1, 2004 and December 31, 2009.

Interventions: Intrauterine morcellation or HSR with evaluation and/or treatment of recurrent AUB after operative polypectomy.

Measurements and main results: Of 311 patients (IUM group, 139; HSR group, 172), 167 (53.7%) had at least 1 gynecologic follow-up visit and 57 (18.4%) had recurrent AUB. Subsequent gynecologic clinic visit rates were similar between the 2 groups (HSR, 58.1%, vs IUM, 48.2%; p = .08). Recurrence of AUB within the first 4 years of follow-up was similar between the IUM and HSR groups (hazard ratio for HSR vs IUM, 1.12; 95% confidence interval, 0.64-1.98; p = .59). However, recurrence of endometrial polyps approached statistical significance (hazard ratio, 3.3; 95% confidence interval, 0.94-11.49; p = .06). Premenopausal status, history of hormone replacement therapy, multiparity, and polycystic ovarian syndrome were independently associated with AUB recurrence. There were no reports of inability to establish a histopathologic diagnosis among all pathology specimens evaluated.

Conclusion: Compared with HSR, intrauterine morcellation may be associated with lower recurrence of endometrial polyps. However, the incidence of recurrent AUB is independent of polypectomy method.