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Title: Hysteroscopic surgery as an alternative to hysterectomy in the treatment of dysfunctional uterine bleeding
Author: Pinion, Sheena Barbara
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1994
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The basis of this thesis is a prospective randomised trial comparing hysterectomy (n=99) with two methods of hysteroscopic surgery, endometrial laser ablation (n=53) and transcervical resection of the endometrium (n=52), in the treatment of dysfunctional uterine bleeding. The main outcome measures were efficacy in the relief of menstrual and related symptoms, operative complication rates, postoperative recovery, the effect of treatment on other symptoms, on psychosocial morbidity, and patient satisfaction. In the hysterectomy group, all women were amenorrhoeic at 12 months; in the hysteroscopy group, 93 (97%) were either amenorrhoeic or had light menstrual loss, although 32 women required a second procedure to achieve this status. At 12 months 13 (15%) of the hysterectomy group and 46 (58%) of the hysteroscopy group had continuing cyclical abdominal pain, although dysmenorrhoea improved in the majority. Major operative complications were rare in all groups, but minor morbidity, principally infection, was significantly more common following hysterectomy (difference 32%, 95% CI 20-44%, P<.001). There were major differences in postoperative recovery, with median time to self-reported recovery being two to three months in the hysterectomy group compared with two to four weeks in the hysteroscopy group (P<.0.001). Premenstrual symptoms improved in both groups and, although significantly less common in the hysterectomy group at six months, differences were no longer present at 12 months. Similarly there were no differences between the group in the incidence of urinary or bowel symptoms, dyspareunia or menopausal symptoms. Anxiety and depression were common preoperatively, but improved significantly postoperatively, with no difference between the groups at 12 months. Other aspects of psychosocial functioning were studied and found to be no different between the two groups. In conclusion, all but five women were satisfied with their outcome at 12 months.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available