Abstract:

Objective: To compare the short-term outcomes of intrauterine cavity reconstruction and menstrual function recovery after hysteroscopic adhesiolysis between patients with intrauterine adhesions (IUAs) caused by endometrial tuberculosis (ETB) and those with trauma-induced IUAs. Methods: A retrospective matched cohort study was conducted on patients with IUAs who underwent hysteroscopic adhesiolysis at Fuxing Hospital Affiliated Capital Medical University between July 2012 and January 2023. The study group included 54 patients with pathologically confirmed ETB who had completed anti-tuberculosis treatment, while the control group consisted of 108 patients with non-infectious, trauma-induced IUAs. The 1 ∶ 2 matching was performed based on age and preoperative American Fertility Society (AFS) scores. Changes in AFS scores before and one month after surgery, as well as improvements in menstrual patterns, were compared between the two groups. Subgroup analysis was conducted based on the severity of adhesions (moderate and severe). Results: No significant differences were observed between the two groups in terms of age, preoperative AFS scores, postoperative AFS scores, or the magnitude of score reduction (all P>0.05). The overall menstrual improvement rates were 68.5% (37/54) in the study group and 76.8% (83/108) in the control group, with no significant difference (P>0.05). Among patients with preoperative moderate IUAs, no statistically significant difference was observed in postoperative AFS scores between the two groups (P>0.05). In contrast, among those with severe IUAs, the study group had significantly higher postoperative AFS scores (P=0.031). Nevertheless, postoperative menstrual improvement rates did not differ significantly between the two groups in either the moderate or severe IUA subgroups (both P>0.05). Conclusions: Patients with ETB-related IUAs can achieve comparable short-term recovery in menstrual function to those with trauma-induced IUAs after standardized anti-tuberculosis treatment and hysteroscopic adhesiolysis. Moderate adhesions demonstrate promising potential for anatomical restoration, while severe adhesions present more limited recovery. Early identification and timely intervention are essential, and future strategies may benefit from severity-based stratified management and the integration of regenerative treatment for severe cases.

Key words: Tuberculosis, female genital, Endometrium, Tissue adhesions, Hysteroscope, Menstruation, Treatment outcome, Endometrial tuberculosis, Intrauterine adhesions