Ablation, hysterectomy short-term results similar.

SAN DIEGO -- Both hysterectomy and endometrial ablation were highly effective short-term treatments for dysfunctional uterine bleeding in a randomized, multi-center trial, but about one-third of women who underwent endometrial ablation eventually needed more surgery.

The Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB) research group enrolled 237 women with DUB at 25 study sites between January 1998 and June 2001 in a trial to compare three forms of hysterectomy (vaginal, laparoscopic, and abdominal low approach) under general or regional anesthesia, to two forms of endometrial ablation (rectoscopic ablation using radiofrequency electrodesiccation/coagulation or vaporization, and nonrectoscopic endometrial ablation with a thermal balloon), Dr. Malcolm G. Munro said at the annual meeting of the American College of Obstetricians and Gynecologists.

Once patients were assigned to a category--hysterectomy or endometrial ablation--the choice of technique was left to the discretion of the treating gynecologist, although supracervical hysterectomy was not permitted. Most hysterectomies were performed vaginally, said Dr. Munro of the University of California, Los Angeles.

To be eligible, patients had to have failed medical therapy for DUB. They could be anovulatory, ovulatory, or of indeterminate ovulatory status, and were required to have a normal endometrial cavity of limited size. Leiomyomas could be intramural or subserosal, but not submucosal. Among the 237 eligible patients, 41 entered the trial after being in an observational arm, either when they decided to pursue treatment or their condition changed to make them eligible for treatment.

Among the 103 women who underwent hysterectomy and the 107 who had endometrial ablation and answered the question, 96 and 94, respectively, said their major problem had been solved. This beneficial effect persisted in the majority of women out to 48 months of follow-up.

Other symptoms cited by women, such as bleeding, pain, and fatigue, also were effectively resolved by 12 months in most women in both groups. Hysterectomy was more effective in resolving bleeding.

Five major adverse events were reported. Two cystotomies, both of which occurred during vaginal hysterectomy, were diagnosed and treated intraoperatively. Three uterine perforations occurred during endometrial ablation and required treatment.

Institutional length of stay was significantly longer for women assigned to hysterectomy (1-2 days), particularly among women who underwent abdominal hysterectomy (3 days), compared with those who underwent endometrial ablation, an outpatient procedure.

Of note, by 48 months, 32 of 110 women who initially underwent endometrial ablation required reoperation, usually hysterectomy.

The authors noted that both techniques are safe and effective, but both have relative disadvantages-hysterectomy's longer length of stay and greater perioperative morbidity, and endometrial ablation's lack of long-term durable effect in some women.

"It is reasonable to recommend that women select the type of surgery they receive for treatment of DUB based on their individual preferences and situations," they concluded.

BY BETSY BATES

Los Angeles Bureau