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Isthmocele Repair

An isthmocele is a defect in the wall of a woman's uterus, which can result from incomplete healing of the uterus after a cesarean section.   This incomplete healing leads to a 'nook' in the front wall of the uterine muscle, near the transition from the uterine body (corpus) and the cervix, in the same location where the uterus was opened to deliver the infant in the cesarean delivery.  While this is uncommon, over the last decade physicians have developed greater understanding of this phenomenon, and what problems can occur because of it.

What are the symptoms?

The most common symptom of an isthmocele is irregular menstrual bleeding.  This often presents as irregular bleeding that lingers on for a long period of time after the onset of the menstrual cycle, or bleeding that may last the entire month.  It is believed that this is the result of menstrual blood collecting within the isthmocele, and then leaking out over time.   

Isthmocele may also be associated with pelvic pain, painful menstrual cycles, and secondary infertility (meaning a woman that is able to achieve pregnancy normally but later in life, or after childbirth, is unable 

I have irregular bleeding... do I have an isthmocele?

The reality is that abnormal or dysfunctional bleeding can come from a lot of different things, including ovulatory dysfunction, fibroids, and uterine polyps.  Isthmoceles are actually relatively uncommon, and are not a common reason for abnormal bleeding.   But in a woman who has had a cesarean delivery, it is appropriate to evaluate for an isthmocele.  If one is present and there is no other good reason for the irregular bleeding, repair can be considered.

How is an isthmocele diagnosed?

The best way to see an isthmocele is via transvaginal ultrasound.  Infusing fluid into the uterus via sonohysterography can augment the transvaginal ultrasound by providing fluid contrast, allowing the physician to better see the edges and size of the isthmocele.  MRI can also be an effective way of diagnosing and characterizing an isthmocele.

How is an isthmocele treated?

Our primary technique for repairing an isthmocele is via laparoscopic repair.  This involves dissecting out the uterine defect, cutting out the scar tissue in the wall of the uterus, and repairing the defect with absorbable suture.  This technique has a high success rate in resolving the abnormal bleeding that can be associated with isthmocele.

An alternate technique for repairing an isthmocele is via Hysteroscopy.  This technique does not actually repair the defect, but rather makes it somewhat larger so that blood does not easily collect within the defect.  This is an option in some cases, depending on characteristics of the case.

My doctor has seen an isthmocele on my ultrasound.  Should I have it repaired?

Many women have isthmoceles that do not seem to cause them problems.  For example, they are unlikely to cause problems after menopause.  Furthermore, the shape of a given isthmocele may be such that it does not collect blood during menses, and thus not cause symptoms.  An isthmocele that does not cause problems such as bleeding, pain, or secondary infertility does not need to be repaired.


Dr. Fogelson is one of the most experienced gynecologic surgeons on the West Coast, seeing patients from Oregon, Washington, California, and around the country.  He is sought out for his high level of surgical skills in management of all types of gynecologic issues.   After having performed over 1,000 minimally invasive hysterectomies as well as many other gynecologic procedures, Dr. Fogelson is able to almost guarantee a minimally invasive approach to any gynecologic surgery, no matter how complex.  While the possibility of complications in surgery cannot be completely eliminated, Dr. Fogelson's experience leads to a dramatically lower rate of issues than the national average.  Whether you have severe endometriosis and require surgery or just have very heavy bleeding from fibroids or adenomyosis, Dr. Fogelson will provide you with world class surgical care.  Dr. Fogelson is also happy to see you about non-surgical management of your bleeding issues, and can give you all the time required to thoroughly evaluate your issue and find the best possible solution.

This seem like me!  How can I be evaluated for this?

If you think you may have this condition, please give us a call to schedule a consultation in office, or setup a free phone consult.  Our phone # is 503-715-1377.


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