Intrauterine Adhesions

Hysteroscopic surgery is the treatment of choice for intrauterine adhesions. It allows to perform lysis of adhesions under direct vision and magnification. After the surgery, the adhesions recurrence rate is between 3,1 to 23,5% being the high recurrence rate one of the main problems of this entity. This recurrence rate is higher in severe cases. According to AAGL guidelines, the use of postoperative estrogen hormone therapy to promote endometrial overgrowth and a regrowth of the uterine lining may reduce recurrence of intrauterine adhesions (grade B).

Some physical barriers such as intrauterine device (IUD), Foley catheter, intrauterine balloon and hyaluronic acid gel are used as adjuvant therapy. In a retrospective study by Lin in 107 patients with intrauterine adhesions, they found that the intrauterine balloon was more effective in preventing intrauterine adhesion reformation than the use of IUD or hyaluronic acid gel.

A Foley catheter after hysteroscopic surgery for intrauterine adhesions was one of the first devices used to prevent the recurrence of adhesions. A Foley catheter (10-16 Fr) with 3`5 to 5 ml of fluid is used to separate the uterine walls. This catheter is left inside the cavity for 7-10 days.

Recently, a new triangular shape catheter balloon has been available (Cook medical Inc). This device, due to its more anatomic shape, fits better into the uterine cavity than the classical Foley catheter. This uterine balloon is filled with 5 ml of fluid and maintains separation of the lateral walls of the uterine cavity which is the area where the recurrence of adhesions is more frequent.

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