Abnormal uterine bleeding (AUB) is any alteration in the pattern or volume of menstrual blood flow and heavy menstrual bleeding affects up to 30% of women at some time during their reproductive years. Abnormal menstruation can be due to conditions such as pregnancy complication uterine fibroids and adenomyosis, but in a large proportion of cases, the etiology is unclear, a condition generally referred to as dysfunctional uterine bleeding (DUB). Treatment options for DUB include symptomatic medical treatment or surgery, traditionally hysterectomy. Hysteroscopically guided endometrial ablation methods have been shown to be effective and safe alternatives to hysterectomy for management of DUB. These methods require particular skills and experience and a long learning curve to be performed effectively and safely. Through the past three decades DUB patients in Assiut university hospital were treated with either electrosurgical ablation or hysterectomy. When faced with hysteroscopic challenges during transcervical resection of the endometrium or rollerball coagulation, we used to shift to thermal balloon as backup method . However, expensive uterine balloon could not infrequently be afforded because of financial constrains and limited health resources . Therefore, another method was used as backup for hysteroscopic failures. It was first tried via insulating the conventional double-ended uterine curette then through a specially designed tactile electrosurgical ablation (TEA) probe.The technique of TEA is largely similar to the dilatation and curettage procedure both principally and practically. Hence, the basic requirements for its performance are the general awareness with electrosurgical principles and adequate experience in performing dilatation and curettage. TEA is done by specially designed tactile diathermy probe that carried the job of electrosurgical ablation without hysteroscopy or distension media first in an experimental session that clearly clarified the reproducibility of the depth of thermal damage and safety of the tactile electrosurgical ablator . Thereafter, TEA was successfully performed with satisfactory short and medium term outcomes for ten cases with DUB during an active, relentless bleeding attack. TEA is done under laparoscopic monitoring. The aim of the present work is to present TEA as a simple, inexpensive, novel backup approach for treatment of DUB.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
108
Woman's Health Hospital-Assiut University.
Asyut, Egypt
Satisfaction with the treatment at 12 month follow up
Satisfaction with the treatment will be measured at 1 year post procedure on 3-point scale-very satisfied, satisfied, and not satisfied.
Time frame: 12 moth
Change in menstrual status.
Menstrual status will be reported as * Normal menstrual flow. * Light menstrual bleeding. * Heavy menstrual bleeding. * The need for hysterectomy.
Time frame: At 3, 6, 9, and12 months pot operatve.
Acceptability of treatment
Acceptability of the procedure will be assessed in 3- point scale as cure or acceptable improvement in symptoms, treatment acceptable and would recommend treatment to others or not acceptable
Time frame: 4 weeks
Changes in health related quality of life
Health-related quality of life parameters will be completed using * Short form-12 (SF12). * Life style questionnaires including Work affection will be measured by the number of days absence from the work due to menses as following, non ,non but work suffer, 1 day and \>2 days. * sexual life affection will be measured in two point as no or yes.
Time frame: At 3, 6, 9, and 12 months post operative.
Difference in operative time between the two groups in minutes.
Difference in operative time is calculated using a stop watch.The zero minute is the time of starting the procedure. The stop watch is on at the zero minute then sopped at the end of the procedure.time of anesthesia is not included.
Time frame: 0-60 minutes
Reporting of any intro-operative complications.
Intro-operative complications includes * Cervical laceration. * Perforation of the uterus. * Hemorrhage * Fluid overload.
Time frame: 0-60 minutes.
Reporting of any technical complications.
Technical complications for transcervical resection of the endometrium (TCRE) includes * Poor uterine distention. * Slow clearance of the debris. * Inefficient cutting. * Poor visualization. * problem of diathermy. * Problems with the camera. * problems with light source. Technical complications for tactile electrosurgical ablation (TEA) includes * Insulation problem. * Connection problem. * Inefficient diathermy power.
Time frame: 0-60 minutes
Difference in post-operative pain score using visual analogue scale between the two groups.
Difference in post-operative pain score using visual analogue scale from 1-10.
Time frame: 4 hours.
Time needed for post operative recovery (days) of pain, vaginal bleeding, vaginal discharge, till full recovery and till return to work.
Time frame: 28 days post operative
Length of hospital stay in days
Length of hospital stay in days is calculated from the day of operation till day of discharge.
Time frame: up to 2 days
Difference in the cost of the two surgical procedure.
Direct cost of the surgical procedure itself is calculated.The cost of the TCRE procedure will include the cost paid for the hysteroscopic unit and the cost of glycine used as distension media.The cost of the TEA procedure will include the cost of laparoscopy, the cost of TEA probe, and the cost of diagnostic hysteroscopy. The cost of the investigations, anesthesia, pre and post operative treatments will be excluded from analysis as they are the same for both groups.
Time frame: up to one hour.
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