This document discusses uterine balloon therapy as an alternative to hysterectomy for treating heavy menstrual bleeding. It provides information on how the procedure is performed using a balloon catheter to ablate the endometrial lining in 8 minutes. Studies show uterine balloon therapy has success rates of 95% in reducing bleeding, requires only a brief hospital stay, and carries a low risk of complications compared to other procedures. It is presented as a minimally invasive treatment option especially for patients who are poor surgical candidates or wish to avoid hysterectomy.

1. Lecture 2
Uterine Balloon therapy
An alternatives to Hysterectomy
Dr. Sharda Jain
“Save
Uterus
Campaign”
Lecture Series
(1 to 4 )

2. Uterine Balloon therapy
An alternatives to Hysterectomy
Dr. Jyoti Agarwal
Dr. Sharda Jain
Dr. Jyoti Bhaskar

3. Hysterectomy is the choice

4. Alternatives should be probed

8. Dilemma!! of Treatment
Aim - Quality Personal life
- Family life
- Preserve the feminity of a women
- ↓ Frequent leave from office
Age
Severity
Fertility

9. 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

10. Present Practice
TVS/D&C
Drugs
Another D&C
Hysterectomy

11. Options Available
Drug therapy
Mirena /
Endometrial Ablation
Hysterectomy

12. Options available
Alternatives to Hysterectomy

13. 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

14. Uterine balloon
therapy

15. 10 minute
Solution
for
‘Heavy
Periods’

16. 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

17. 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

18. Ideal global endometrial
ablation technique
• SAFE
• SUCCESFULL
• SIMPLE
• SAVING

19. SEAT
Second generation endometrial ablation
techniques

20. UTERINE BALLOON THERAPY
SYSTEM
“UBT”
(GynecareThermachoiceR)
First global ablation technology to
receive FDA approval 1997
1997

21. 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.

22. 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

23. Pre-Ablation

24. Post-Ablation

25. 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

26. 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

27. Patient Selection
•
•
•
•
•
Unresponsive to medical therapy
Completed family
Normal pap smear
Negative endometrial biopsy
Cavity depth 6-12 cm

28. Not fully Evaluated
•
•
•
•
Large uterus (> 30 cc, >12 cm)
Previously failed TCRE
Repeat Endometrial Ablation
Post Menopausal Bleeding

29. Factors Affecting
Failure Rate Increases
•
•
•
•
↓40 years
Prolonged duration (↑ 10 years)
RV uterus (6 fold)
< Intrauterine pressure during therapy
(ideal > 160)

30. 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%)

31. 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%

32. > OVER 20,00,000
procedures worldwide
We Have Largest
No. of Cases of UBT in India
Updated on 1/9/2013,N - 1304

33. 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

34. 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

35. Hysterectomy needed in – 2
(Both with fibroids)
Repeat Balloon Therapy – 3

36. UBT’s
Biggest Use
Is for patients who are
high risk for surgery

37. Our Experience
UBT v/s Mirena
Great
Great
Great
4th Month
Jaan Nikaal
Deta Hai
Really
troublesome
But one should TRY

38. HYSTERECTOMY
as Treatment
Should be last resort
KJ Carlson, NEJM 328:856,
1993

39. 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

40. Thank You