Letters to the editor |
Possibility of hidden damages with temporary uterine artery occlusion device
J.J. Naón Institute, School of Medicine, University of Buenos, Paraguay 2155 1°P, C1121ABG, Ciudad Autónoma de Buenos Aires, Argentina E-mail: jpalacios{at}fmed.uba.ar
Sir,
I read the article of Vilos et al. (2006)
with interest, but I need to give some opinions about the use of this Doppler-guided transvaginal clamp. First, it is possible that the pelvic ureter will be occluded (Al-Awadi et al., 2005) when the transvaginal clamp closes. In this case, the ureter could be damaged, and the effects of this lesion could be fibrosis or stenosis. Probably, if the control could be made at the same moment as the clamp placement, the clamp could be relocated before causing occlusion. In this way, the ultrasound control referred by the authors does not result in a secondary structural injury after 6 h compression. Second, The authors stated that with this procedure the effect of ovarian dysfunction may be avoided, but this phenomenon seems be multiple. In approximately 10% of cases, the ovary circulation depends mainly on the uterine artery. If the uterine artery compression is performed in this circumstance, the lack of ovary irrigation could produce an ovary dysfunction, as embolization or hysterectomy cases were seen (Ryu et al., 2003). Cases of ovary dysfunction were reported after gross haemorrhages or uterine devascularization (Roman et al., 2005). In both examples, the lack of ovary irrigation could have been the main cause of secondary ovary failure. Regardless of this point, the authors have not considered that the deficient ovary irrigation after 6 h uterine artery occlusion will be the cause of secondary ovary failure. This is particularly important in patients over 35 years old who have more possibility of ovarian failure, and also those patients who consider a future pregnancy. In order to establish the risk on this point, it would be useful to measure FSH and estradiol after and before the utilization of transvaginal clamp. I completely agree with the authors that further studies are needed; maybe these comments will be useful to complement this novel study.
References
Al-Awadi K, Kehinde EO, Al-Hunayan A, Al-Khayat A. (2005) Iatrogenical ureteric injuries: incidente, aetiological factors and effect of early management on subsequent outcome. Int Urol Nephrol 37:235–241.[CrossRef][Medline]
Roman H, Sentilhes L, Cingotti M, Verspyck E, Marpeau L. (2005) Uterine devascularization and subsecuent major intrauterine synechiae and ovarian failure. Fertil Steril 83:755–757.[CrossRef][Web of Science][Medline]
Ryu RK, Siddiqi A, Omary RA, Chrisman HB, Nemcek AA Jr, Sichlau MJ, Vogelzang RL. (2003) Sonography of delayed effects of uterine artery embolization on ovarian arterial perfusion and function. AJR Am J Roentgenol 181:89–92.
Vilos GA, Vilos EC, Romano W, Rafea A. (2006) Temporary uterine artery occlusion for treatment of menorrhagia and uterine fibroids using an incisionaless Doppler-guided transvaginal clamp: Case report. Hum Reprod 21:269–271.
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