Is the hysteroscopic surgery of isthmocele related to the niche dimensions?

The aim of this study was to evaluate the impact of preoperative niche size on the success of hysteroscopic surgery in symptomatic isthmocele patients.

All patients who underwent hysteroscopic surgery for symptomatic isthmocele were recruited for this retrospective study. The dimensions of the niche, the apex of the niche to the uterine serosa (residual myometrial thickness), the depth of the wedge-shaped niche, and the width of the niche were measured before hysteroscopic repair of the isthmocele by ultrasonography. The present study assessed the correlation between preoperative niche dimensions and postoperative symptom resolution in a cohort of patients diagnosed with symptomatic isthmocele.

Of the 29 patients evaluated, 72.4% (n=21) complained of postmenstrual spotting, while 27.5% (n=8) had both postmenstrual spotting and pelvic pain. Myometrial thickness was thinner in the postmenstrual spotting+pelvic pain group than in the postmenstrual spotting-only group (9.76±1.87 and 6.25±1.28, respectively, p≤0.001). After surgery, 75.8% of the patients were cured: 79.3% in the postmenstrual spotting-only group and 17.24% in the pelvic pain group were symptom-free. The residual myometrial thickness was greater both in the group that achieved total cure (9.50±2.02, p=0.002) and in the group with only postmenstrual spotting (9.39±2.04, p=0.005).

This study demonstrated that patients with greater residual myometrial thickness had a higher success rate in hysteroscopic surgery for isthmocele-related symptoms. Preoperative niche measurements were considered a potential predictor of surgical outcomes.