cesarean scar defect isthmocele

The use Resectoscope to treat Cesarean Scar Defects

The healing process of the cesarean section scar can be incomplete. In that situation there is a disruption of the myometrium at the site of the uterine scar. This “gap” in the anterior lower uterine segment receives different names, being the terms “niche” or isthmocele the most commonly used. This defect and the relation with some clinical symptoms such as menorrhagia, abdominal pain, dyspareunia and dysmenorrhea was first described by Morris using the term “cesarean scar syndrome”.

The estimated incidence of cesarean scar defect (CSD) ranges between 24% and 56%. This incidence varies considerably depending on the reports. This is due to variation on definitions and the differences in the methods used for the diagnosis of the defect.

There is a clear relationship between the anatomic defect and the existence of different degrees of postmenstrual bleeding disorders and other gynecological symptoms as dysmenorrhea, chronic pelvic pain and infertility.

Various surgical options have been proposed to treat the CSD. On one hand, a reparative treatment with laparoscopic repair of the dehiscence, On the other the resectoscopy correction in order to improve the symptoms. Other alternatives are the vaginal repair of the CSD and the use of oral contraceptives to reduce menstrual blood. The surgical treatment should only be reserved for symptomatic patients with postmentrual bleeding, chronic pelvic pain or secondary infertility. The first two options are the commonly used and the election of any of them is usually related with anatomical conditions of the CSD

The first reference about the use of the resectoscope in the treatment os a CSD was made by Fernandez who performed the resection of the fibrotic tissue of the inferior part of the scar to facilitate the drainage of the menstrual blood collected in the scar, improving the postmenstrual bleeding. Since then multiple articles have been published and the resectoscopy have become most reported approach for the treatment of symptomatics CSD.

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