Hysteroscopic isthmocele resection: evaluating quality of life and symptom improvements based on isthmocele volume

To investigate grade 3 isthmocele resection performed via hysteroscopy and the impact of isthmocele size on symptoms caused by isthmocele and quality of life.

This retrospective study included patients with grade 3 isthmocele who underwent hysteroscopy between January 2014 and June 2022. Age, body mass index, obstetric & gynecologic characteristics, operation duration, complications, and pre- and postoperative hemoglobin levels were recorded. Quality of life was assessed using the 36-Item Short Form Survey (SF-36). Patients were divided into two groups based on isthmocele volume: < 36 mm² and ≥ 36 mm².

A total of 47 women with a mean age of 36.6 ± 4.7 were included in the study. Twenty-two (46.81%) had an isthmocele size of < 36 mm² while 25 (53.19%) were in the ≥ 36 mm² group. There were no significant differences between the groups in terms of demographic and surgical characteristics, and there were no complications. Both groups demonstrated significant improvements in menstrual bleeding length, severity of postmenstrual spotting, frequency of postcoital bleeding, dyspareunia and dysmenorrhea, analgesic use, and quality of life. Compared to the < 36 mm² group, the ≥ 36 mm² group had significantly higher frequency of preoperative analgesic use (p = 0.041), better postoperative quality of life (p = 0.031), and greater improvement in quality of life (p = 0.028).

Hysteroscopic isthmocele resection is an effective and safe method for treating isthmocele and achieves considerable improvements in symptoms and quality of life. Patients with larger isthmoceles experience greater improvements in several parameters, suggesting the inclusion of isthmocele volume in treatment decisions.