Modified thermal balloon endometrial ablation (MTBEA) is an effective alternative to hysterectomy for treating intractable menorrhagia. In a study of 33 patients treated with MTBEA, 18% experienced amenorrhea, 39% experienced hypomenorrhea, 30% experienced normal menses, and 13% experienced persistent menorrhagia requiring hysterectomy. MTBEA is a safe, simple, cheap, available, and minimally invasive procedure for endometrial ablation with minimal risks. It provides benefits over hysterectomy by preserving the uterus and over hysteroscopic ablation by using a simpler, cheaper method. Long term follow up is still needed to fully evaluate MTBEA.

1. Dr Muhammad El HennawyDr Muhammad El Hennawy
Ob/gyn ConsultantOb/gyn Consultant
Rass el barr central hospitalRass el barr central hospital
DumyattDumyatt –– EGYPTEGYPT
www.mmhennawy.co.nrwww.mmhennawy.co.nr
Balloon in uterus
Instead of Hysterectomy
)MTBEA(

2. MTBEAMTBEA
 Modified Thermal BalloonModified Thermal Balloon
Endometrial AblationEndometrial Ablation
 In Teatment of intractableIn Teatment of intractable
menorrhagia instead ofmenorrhagia instead of
HysterectomyHysterectomy

3. Endometrial AblationEndometrial Ablation
 It is destruction of endometriumIt is destruction of endometrium
to sufficient depthto sufficient depth
 to prevent regenerationto prevent regeneration
 and to increase adhesion betweenand to increase adhesion between
anterior and posterior endometriumanterior and posterior endometrium
 to decrease menstrual flow sufficientto decrease menstrual flow sufficient
to avoid Hysterectomyto avoid Hysterectomy

4. Methods of Endometrial AblationMethods of Endometrial Ablation
ResectoscopeResectoscope
 LaserLaser
 Circulating hot waterCirculating hot water
 CryotherapyCryotherapy
 Intracavitary radiumIntracavitary radium

5. AIMAIM
 To evaluate clinical effect ofTo evaluate clinical effect of
Modified thermal Balloon System inModified thermal Balloon System in
ablation of endometrium in cases ofablation of endometrium in cases of
Menorrhagia as alternative toMenorrhagia as alternative to
HysterectomyHysterectomy

6. 3333CasesCases
during 2004during 2004 –– 20052005
 33 cases33 cases
 with menorrhagia more than 8 days more than 80 mlwith menorrhagia more than 8 days more than 80 ml
in day or affect general condition of womanin day or affect general condition of woman
 failed treatment ( medical and hormonal treatment forfailed treatment ( medical and hormonal treatment for
6 months or d & c ) or not tolerate it6 months or d & c ) or not tolerate it
 age ( 42age ( 42 –– 50 y )50 y )
 complete her familycomplete her family
 uterus length less than 12 weeks , uterine cavity lessuterus length less than 12 weeks , uterine cavity less
than 12 cm , more than 4 cm ( U/S )than 12 cm , more than 4 cm ( U/S )
 Myometrial thichness more than 10 mm ( U/S )Myometrial thichness more than 10 mm ( U/S )
 no uterine or pelvic pathology ( U/S )no uterine or pelvic pathology ( U/S )
 informed consentinformed consent

7. preoperativepreoperative
patient after menses ( lowpatient after menses ( low
thickness of endometiumthickness of endometium((
 testing of silicon foley cathetertesting of silicon foley catheter
size 18size 18 –– 2020
 by inflation of balloon with 20 mlby inflation of balloon with 20 ml
boiled waterboiled water
 also cut its tip above balloonalso cut its tip above balloon
 boil water in cup with electricboil water in cup with electric
apparatus to 90 degreeapparatus to 90 degree

8.  lithotomy positionlithotomy position
 under general anaesthesia (ampoule valium +under general anaesthesia (ampoule valium +
1/2 to 1 gram intraval )1/2 to 1 gram intraval )
 vaginal speculumvaginal speculum
 volsellum to anterior lip of cervixvolsellum to anterior lip of cervix
 measure length of uterine cavity by soundmeasure length of uterine cavity by sound
 dilate cervix to 9 hegardilate cervix to 9 hegar
 + or - diagnostic hysteroscopy ( not done )+ or - diagnostic hysteroscopy ( not done )
 do curettage of endometrium and preservedo curettage of endometrium and preserve
specimen to histopathology to diagnose anyspecimen to histopathology to diagnose any
abnormality and also to decrease thickness ofabnormality and also to decrease thickness of
endometriumendometrium

9.  insert silicon foley catheterinsert silicon foley catheter
to the same length measured byto the same length measured by
soundsound
 put a towel in vagina around foleyput a towel in vagina around foley
cathetercatheter
( 18( 18 –– 20 size ) to avoid burn of20 size ) to avoid burn of
vagina if balloon rupturevagina if balloon rupture

10.  inflate balloon of catheter by boiled waterinflate balloon of catheter by boiled water
( boiled saline ) till feel resistance( boiled saline ) till feel resistance
(20(20 –– 40 ml ) with large syringe ( 840 ml ) with large syringe ( 8 –– 1010
ml still in catheter itself )ml still in catheter itself )
 for 3 minutesfor 3 minutes
 you can sure from its site under sonaryou can sure from its site under sonar
( NOT DONE )( NOT DONE )
 deflate cooled water from balloon anddeflate cooled water from balloon and
repeat 3 times ( maximum 9 minutes )repeat 3 times ( maximum 9 minutes )
 then deflate balloon , remove vaginalthen deflate balloon , remove vaginal
towel , remove volsellumtowel , remove volsellum

11.  follow up every monthfollow up every month

12. results after 3monthresults after 3month
 6 cases6 cases 18%18% amenorrheaamenorrhea
 13 cases13 cases 39%39% hypomenorrheahypomenorrhea
 10 cases10 cases 30%30% normal mensesnormal menses
 4 cases4 cases 13%13% persistantpersistant
menorrhagiamenorrhagia
( failure )( failure )

13. in 4 cases of failurein 4 cases of failure
We do hysterectomyWe do hysterectomy
 1 -- diffuse adenomyosis1 -- diffuse adenomyosis
 2 --- localized adenomyosis2 --- localized adenomyosis
 1 --- intramural fibroid 2 X 2 cm1 --- intramural fibroid 2 X 2 cm

14. benefitsbenefits
 safesafe
 simplesimple
 CheapCheap
 avaliableavaliable
 effectiveeffective
 minimally invasiveminimally invasive
 with minimal riskswith minimal risks

15. complicationcomplication
 rupture of balloon with boiled waterrupture of balloon with boiled water
--- nothing occur--- nothing occur
 ( vaginal towel( vaginal towel –– no burn to vagina)no burn to vagina)
alsoalso
 ( boiled water coming quickly( boiled water coming quickly
through catheter from passage ofthrough catheter from passage of
urineurine ((

16. benefits over Hysterectomybenefits over Hysterectomy
 preservation of uteruspreservation of uterus
 avoid surgical incisionavoid surgical incision

17. benefits over Hysteroscopicbenefits over Hysteroscopic
ablationablation
 similar results with simple cheapsimilar results with simple cheap
methodsmethods

18. conclusionconclusion
 MTBEAMTBEA
 safesafe
 simplesimple
 CheapCheap
 avaliableavaliable
 effectiveeffective
 minimally invasiveminimally invasive
 with minimal riskswith minimal risks
 But need long follow upBut need long follow up

19. With my best wishes
muhammad El hennawy