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Isthmocele: Diagnosis and Treatment Insights

Isthmocele, a condition resulting from cesarean section scars, affects approximately 60% of women and can lead to various symptoms including infertility and chronic pain. Recent literature reviews highlight new diagnostic criteria and management options, including surgical interventions like hysteroscopic resection and robotic-assisted approaches. There is currently no consensus on the best surgical management, which varies based on individual patient characteristics.

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14 views2 pages

Isthmocele: Diagnosis and Treatment Insights

Isthmocele, a condition resulting from cesarean section scars, affects approximately 60% of women and can lead to various symptoms including infertility and chronic pain. Recent literature reviews highlight new diagnostic criteria and management options, including surgical interventions like hysteroscopic resection and robotic-assisted approaches. There is currently no consensus on the best surgical management, which varies based on individual patient characteristics.

Uploaded by

faurflaviuionut
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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The 4th National Congress of Minimally

Invasive Surgery in Gynecology


The 17th Annual Conference of the Egon and
Ann Diczfalusy Foundation
12-15 November 2025

Isthmocele - an update of existing literature regarding diagnosis,


clinical relevance and treatment
Ioana-Adelina Clim1, Name Surname2, Name Surname3,...
1
University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania.

Background: Isthmocele, also know as cesarean scar defect or uterine


niche, is characterized by a defect within the myometrium due to defective
healing and is defined sonographically as a identation at the site of the
cesarean section scar with a depth of at least 2 mm. The prevalence of
isthmocele has risen in parallel with the increasing rate cesarean section,
affecting about 60% of women. Symptoms such as postmenstrual spotting,
dysmenorrhea, chronic pelvic pain, infertility or poor quality of life are
frequently reported. More than this, in 2023 a Delphi Consensus evaluated
the definition, diagnostic and uniforme nomenclature of this condition,
categorizing the symptomatic niche as Cesarean Scar Disorder (CSD).
Diagnosis can be made through transvaginal ultrasound, sonohysterography,
hysteroscopy or magnetic resonance imaging. Management of isthmocele
may involve pharmacological or surgical interventions.

Material and Methods: This literature review aims to provide an analysis of the new diagnostic
criteria, impact on clinical conditions such as infertility, cesarian scar pregnancy and placenta
accreta spectrum and also on surgical management options.
A comprehensive PubMed research of observational studies from recent years was performed.
Results: Regarding the impact on reproductive outcomes, niche appears to be an intermediate
risk factor for infertility and is also a risk factor for cesarean scar disorder, cesarean scar
pregnancy and placenta accreta spectrum.
Surgical treatment includes hysteroscopic resection, laparoscopic approaches or vaginal
procedures. The robotic-assisted approach shows promising results, but lacks extensive data.
The 4th National Congress of Minimally
Invasive Surgery in Gynecology
The 17th Annual Conference of the Egon and
Ann Diczfalusy Foundation
12-15 November 2025

Conclusion: Isthmocele is a very common pathology affecting many patients, with an increasing
prevalence. Symptoms can range from asymptomatic patiens to impaired quality of life.
Regarding the surgical managemnt, there in no consensus yet, but is based on individual patient
characteristics.

Keywords: isthmocele, cesarean scar disorder, surgical treatment

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