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

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

    1. 1. Lecture 2 Uterine Balloon therapy An alternatives to Hysterectomy Dr. Sharda Jain “Save Uterus Campaign” Lecture Series (1 to 4 )
    2. 2. Uterine Balloon therapy An alternatives to Hysterectomy Dr. Jyoti Agarwal Dr. Sharda Jain Dr. Jyoti Bhaskar
    3. 3. Hysterectomy is the choice
    4. 4. Alternatives should be probed
    5. 5. Dilemma!! of Treatment Aim - Quality Personal life - Family life - Preserve the feminity of a women - ↓ Frequent leave from office Age Severity Fertility
    6. 6. 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
    7. 7. Present Practice TVS/D&C Drugs Another D&C Hysterectomy
    8. 8. Options Available Drug therapy Mirena / Endometrial Ablation Hysterectomy
    9. 9. Options available Alternatives to Hysterectomy
    10. 10. 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
    11. 11. Uterine balloon therapy
    12. 12. 10 minute Solution for ‘Heavy Periods’
    13. 13. 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
    14. 14. 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
    15. 15. Ideal global endometrial ablation technique • SAFE • SUCCESFULL • SIMPLE • SAVING
    16. 16. SEAT Second generation endometrial ablation techniques
    17. 17. UTERINE BALLOON THERAPY SYSTEM “UBT” (GynecareThermachoiceR) First global ablation technology to receive FDA approval 1997 1997
    18. 18. 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.
    19. 19. 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
    20. 20. Pre-Ablation
    21. 21. Post-Ablation
    22. 22. 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
    23. 23. 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
    24. 24. Patient Selection • • • • • Unresponsive to medical therapy Completed family Normal pap smear Negative endometrial biopsy Cavity depth 6-12 cm
    25. 25. Not fully Evaluated • • • • Large uterus (> 30 cc, >12 cm) Previously failed TCRE Repeat Endometrial Ablation Post Menopausal Bleeding
    26. 26. Factors Affecting Failure Rate Increases • • • • ↓40 years Prolonged duration (↑ 10 years) RV uterus (6 fold) < Intrauterine pressure during therapy (ideal > 160)
    27. 27. 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%)
    28. 28. 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%
    29. 29. > OVER 20,00,000 procedures worldwide We Have Largest No. of Cases of UBT in India Updated on 1/9/2013,N - 1304
    30. 30. 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
    31. 31. 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
    32. 32. Hysterectomy needed in – 2 (Both with fibroids) Repeat Balloon Therapy – 3
    33. 33. UBT’s Biggest Use Is for patients who are high risk for surgery
    34. 34. Our Experience UBT v/s Mirena Great Great Great 4th Month Jaan Nikaal Deta Hai Really troublesome But one should TRY
    35. 35. HYSTERECTOMY as Treatment Should be last resort KJ Carlson, NEJM 328:856, 1993
    36. 36. 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
    37. 37. Thank You

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