Objective: The evaluation of the effect of both transcervical resection of submucous myoma/s and endometrial ablation during the same procedure in patients with abnormal uterine bleeding. Design: Prospective clinical study. Setting: Department of Obstetrics and Gynaecology, 1st Medical Faculty, Charles University and General Faculty Hospital in Prague, Czech Republic. Methods: 34 patients with submucous myoma/s were selected for both transcervical myoma/s resection and endometrial ablation as treatment for abnormal uterine bleeding. The average age of the cohort was 44,3 years (29-66). Hysteroscopy, ultrasound scan or both techniques were used to diagnose and classify myomas. In 34 patients were resected 52 myomas. In 21 (62%) patients 1 myoma was resected, in 8 (34%) 2 and in 5 (14%) patients 3 submucous myomas were resected. The highest ESH (Eur. Society of Hysteroscopy) myomas classification was 0° in 29 (85%) patients and I° in 5 (15%) patients. The maximal size of resected myoma in cases with endometrial ablation was 3 cm. Surgery was performed in early proliferative phase of menstrual cycle but in 2 (6%) cases the endometrium was prepared with short term Danol administration. Purisol (sorbitol and mannitol) was used as a distention medium. Myomas were resected using loop high frequency electroendoresection technique, endometrium ablation was performed in 28 (82%) cases using the combination of loop high frequency electroendoresection and "roller ballie coagulation" but 6 (18%) cases using loop technique only. "Follow upil" of the study is 51-2 months. Results: The hysteroscopical procedures were successfully performed in all cases without perioperative complications. The average operative time was 45 min. (15-60). We have not repeated the procedure in any case. The bleeding was controlled in terms of amenorrhoea 7 (21%), hypomenorrhoea 18 (53%) or eumenorrhoea 9 (26%) in all 34 (100%) patients. In 2 (6%) patients we performed hysterectomy in the postoperative period (the indication for hysterectomy was the growing subserous myoma in both cases). Also in prevention of hysterectomy we were successfull in only 32 (94%) patients. Conclusion: Hysteroscopic resection of submucous myoma/s in connection with endometrial ablation could be a modality of surgical management, an alternative of hysterectomy in cases of uterine abnormal bleeding and where the small uterine myoma/s of the ESH 0° or I° classification is found.

        Key words: uterus, bleeding, hysteroscopy, myoma, endometrium, resection