Cesarean Scar Defects: Hysteroscopic Treatment of Isthmocele in Menstrual Disorders and Infertility

Surgical deliveries may lead, as a consequence, the formation of cesarean scar defects (CSD), also called isthmocele. This pathology can cause symptoms, such as abnormal uterine bleeding, pelvic pain and infertility. Surgical correction should be performed using hsiteroscopic procedure for its efficacy and low invasiveness.The increasing incidence of surgical deliveries has resulted in a greater number of cesarean scar defects (CSD). This disorder is also known as isthmocele and is responsible for symptoms like post-menstrual abnormal uterine bleeding (PAUB), infertility, chronic pelvic pain, and possible obstetric complications in subsequent pregnancies. Diagnostic investigation for this disorder should be carried out by transvaginal ultrasound and hysteroscopy (imaging methods that allow identification of the defect and guide the surgical program). Surgical treatment is effective. Of the developed techniques, the hysteroscopic technique is the most used because of its low invasiveness and satisfactory results. Currently, mini resectoscopy (of 16-Fr diameter) is the most suitable technique because it is technically simpler and safer. This study includes 412 patients with a cesarean delivery history and confirmed diagnosis of isthmocele treated surgically by vaginal resectoscope. Results showed a correction of anatomical defects in 100 % of cases, with persistent symptoms in only 9 % of patients. While there is not a broad awareness of the correct indication for caesarean sections amongst gynecologists, the diagnosis and treatment of isthmocele will continue to feature in modern gynecological practice.