Comprehensive therapy for the prevention of intrauterine adhesion recurrence in patients with Asherman’s syndrome

Introduction. Asherman’s syndrome (AS) is an acquired condition characterized by the formation of intrauterine adhesions, leading to impaired reproductive function. The high recurrence rate following hysteroscopic adhesiolysis necessitates the development of effective methods for secondary prevention.
Aim. To evaluate the clinical efficacy of a combined method, comprising hysteroscopic adhesiolysis followed by a course of non-contact ultrasonic cavitation (NUC) with solutions of an antiseptic and an enzymatic agent, in comparison with standard surgical treatment.
Materials and methods. A prospective comparative study was conducted, involving 47 reproductive-age patients with verified AS. The main group (n = 22) received a course of 15 NUC procedures with sequential application of 0.05% chlorhexidine digluconate solution and Longidaza (3000 IU) after hysteroscopy. The control group (n = 25) received only standard surgical treatment. Efficacy was assessed after 3 months via control hysteroscopy with evaluation of the uterine cavity status according to the modified American Fertility Society (AFS) classification, ultrasound examination, and assessment of menstrual function using a pictogram.
Results. In Group 1, complete restoration of the normal uterine cavity (AFS score 0) was achieved in 19 patients (86.4%) vs 13 patients (52.0%) in Group 2. The patients showed an increase in endometrial thickness during the proliferative phase (6.8 ± 0.9 mm in Group 1 and 5.1 ± 1.2 mm in Group 2). The recurrence rate of adhesions was 13.6% in Group 1 vs 48.0% in Group 2.
Conclusion. The proposed comprehensive treatment regimen utilizing NUC demonstrates significant superiority over isolated hysteroscopic adhesiolysis in preventing AS recurrence, promoting effective restoration of the morpho-functional state of the endometrium.

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