Channel-Like 360° Isthmocele Treatment With 16 Fr Mini-Resectoscope: Step By Step Technique.

The presence of a uterine scar defect is usually asymptomatic or refers to postmenstrual spotting with dark red or brown discharge, dysmenorrhea, dyspareunia, chronic pelvic pain, infertility or dull sensation following menstruation. Several factors may possibly play a role in isthmocele development such as low uterine incision, deficient suturing technique of the uterine incision, patient-related factors that impair wound healing or increase inflammation or adhesion formation. Different techniques were used as reconstructive therapies of the cesarean scar defect including laparoscopic or robot-assisted laparoscopic excision, vaginal repair or hysteroscopic treatment. All these procedures remove or ablate the niche fibrotic tissue with the aim of relieving symptoms. Asymptomatic cases should not be treated. According to the most recent literature, hysteroscopic repair of cesarean scar represents an effective and safe surgical option in cases of symptomatic isthmocele. Persistence of symptoms has been reported in up to 18% of cases, so adequate counselling should be performed before the procedure.