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Lecture 2
Uterine Balloon therapy
An alternatives to Hysterectomy
Dr. Sharda Jain

“Save
Uterus
Campaign”
Lecture Series
(1 to 4 )
Uterine Balloon therapy
An alternatives to Hysterectomy

Dr. Jyoti Agarwal
Dr. Sharda Jain
Dr. Jyoti Bhaskar
Hysterectomy is the choice
Alternatives should be probed
Uterine balloon therapy   an alternatives to hysterectomy dr. sharda jain  lecture 2
Uterine balloon therapy   an alternatives to hysterectomy dr. sharda jain  lecture 2
Uterine balloon therapy   an alternatives to hysterectomy dr. sharda jain  lecture 2
Dilemma!! of Treatment
Aim - Quality Personal life
- Family life
- Preserve the feminity of a women
- ↓ Frequent leave from office
Age
Severity
Fertility
Treatment of Heavy Periods

Individualized
•
•
•
•
•
•
•
•

age
need for contraception
desire to retain uterus
Nature and severity of complaints
presence of any pelvic pathology
outcome of previous treatment
cost of treatment
time away from work
Present Practice
TVS/D&C
Drugs
Another D&C
Hysterectomy
Options Available
Drug therapy
Mirena /
Endometrial Ablation
Hysterectomy
Options available

Alternatives to Hysterectomy
NICE guideline (Jan 2007)
management of heavy menstrual bleeding

• If future childbearing is desired
LNG – IUS is the first line intervention

• If future child bearing is not
desired
Endometrial ablation
Uterine balloon
therapy
10 minute
Solution
for
‘Heavy
Periods’
Day Care Procedure
• Definitive solution for patients

• Minimally Invasive
• High safety profile
• Requires minimal training
• Clinically proven (90-97%)
• Can be performed under LA
• Cost Effective

See to Believe it
FEAT
FIRST GENERATION ENDOMETRIAL ABLATION
TECHNIQUES

(Hysteroscopic Techniques)

• Long learning curve

•Succes rate 85%
• Re-surgery up to 30% .
•LO

Given up by most experts
Ideal global endometrial
ablation technique

• SAFE
• SUCCESFULL
• SIMPLE
• SAVING
SEAT
Second generation endometrial ablation
techniques
UTERINE BALLOON THERAPY
SYSTEM

“UBT”
(GynecareThermachoiceR)
First global ablation technology to
receive FDA approval 1997
1997
Therma choice
• A balloon tipped
catheter is positioned
into the uterine cavity
and filled with fluid
that is heated to 87
degrees centigrade
• Ablation cycle takes
8 minutes.
Extensive Safety/Feasibility Study:
In-Vivo +2 Million
• Mean peak serosal temperature: 36.1 + 1.6
• Deep endometrial and superficial myometrial
injury in all areas
• Deepest myometrial injury: 3.4 mm
• In no uterine cornu was depth > 2.0 mm
Pre-Ablation
Post-Ablation
Uterine Balloon Therapy
• 95 % success rate
• 50 % amenorrhic at 1
year
• Affects fertility

Pre-Ablation

Post Ablation

Use of effective contraception
following procedure is must
Uterine Balloon Therapy
Requires hospital stay only
hours
• Crampy feeling- 2-8 hours

• Mild pain – 2-14 days
• Vaginal discharge
( watery or blood stained – 2-14 days)

4
Patient Selection
•
•
•
•
•

Unresponsive to medical therapy
Completed family
Normal pap smear
Negative endometrial biopsy
Cavity depth 6-12 cm
Not fully Evaluated
•
•
•
•

Large uterus (> 30 cc, >12 cm)
Previously failed TCRE
Repeat Endometrial Ablation
Post Menopausal Bleeding
Factors Affecting

Failure Rate Increases
•
•
•
•

↓40 years
Prolonged duration (↑ 10 years)
RV uterus (6 fold)
< Intrauterine pressure during therapy
(ideal > 160)
Factors Affecting

Failure Rate decreases
• Pre- operative medical therapy
Danazol /gnRH - G
• Post Operative therapy with injection
Depo-provera 3 monthly for 4-6 injections
(95 to 99%)
INTERNATIONAL MULTI-CENTER STUDY
INTERNATIONAL MULTI-CENTER STUDY
PATIENTS WITH AT LEAST 24 MONTH FOLLOW-UP
PATIENTS WITH AT LEAST 24 MONTH FOLLOW-UP
8 min treatment; >150 mmHg Start Pressure
Amenorrhea /spotting
36%

22%
Normalperiods

Hypomenorrhea
38%
Minimal or no
reduction in
menses 4.0%
> OVER 20,00,000
procedures worldwide

We Have Largest

No. of Cases of UBT in India
Updated on 1/9/2013,N - 1304
N – 1304
•
•
•
•

(Success Rate – 99%)

Updated on 1/9/2013
Proliferative Endometrium – 156
Disorderd Secretory Endometrium – 37
Simple Hyperplasia – 618
Complex Hyperplasia without Atypia- 27

Post Menopausal Bleeding – 209
• Proliferative Endometrium
• Simple Hyperplasia

Poor surgical risk - 257
UTERINE BALLOON THERAPY IN
POOR SURGICAL RISK CASES
I.E.PALLIATIVE TREATMENT

N-257 Cases

• Morbid Obesity, Diabetic, Hypertensive, Fibroids
(95-126 kg)
• Chronic Renal failure
• Poor Cardiac Reserve
• I.T.P. For BM Transpant
(Pancytopenia & CML)
• RHD (valve replacement)

Compiled on 1/9/2013
Hysterectomy needed in – 2
(Both with fibroids)
Repeat Balloon Therapy – 3
UBT’s
Biggest Use
Is for patients who are
high risk for surgery
Our Experience
UBT v/s Mirena
Great
Great
Great

4th Month
Jaan Nikaal
Deta Hai

Really
troublesome

But one should TRY
HYSTERECTOMY
as Treatment
Should be last resort
KJ Carlson, NEJM 328:856,
1993
Uterine Balloon Therapy is thus a new
horizon to your patient and yourself.
Once family is completed

BE BOLD, WALK ALONG NEW
PATHS
EXPERIENCE IT YOURSELF
Thank You

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Uterine balloon therapy an alternatives to hysterectomy dr. sharda jain lecture 2

Hinweis der Redaktion

  1. Mirena
  2. Benefits of hysterectomy. There are women out there who want amenorrhea and will be satisfied with nothing less. After understanding and accepting the balanced risks, benefits, and alternatives, those patients may be more appropriate candidates for hysterectomy than for any type of endometrial ablation, since no type of ablation can guarantee amenorrhea.
  3. WHY SHOULD’NT A HYSTERECTOMY BE AVOIDED IF THE BENEFIT CAN BE PROVIDED TO A GOOD NO, OF PATIENTS BY A SAFER ALTERNATIVE TT MODALITY COZ HYSTERECTOMY DOES CARRY RISKS OF ANAESTHESIA ETC