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Fermin F. Barrueto, M.D., director of The Division of Endoscopy and Pelvic Reconstruction, a division of The Gynecology Center at Mercy as well as, his associate, Kevin M. Audlin, M.D., have specialized skill in the diagnosis and treatment of abnormal uterine bleeding, infertility, chronic pelvic pain, and other reproductive system disorders. Dr. Barrueto is a recognized expert in microsurgery, gynecology, laparoscopy, endoscopy, hysteroscopy, and other fields related to women's health care. He has extensive experience utilizing microwave endometrial ablation to treat abnormal uterine bleeding. Resectoscopic myomectomy is another treatment plan that Dr. Barrueto has particular expertise in performing, often used to improve the quality of life for women experiencing abnormal uterine bleeding or uncomfortable fibroid symptoms. A condition called Asherman's Syndrome caused by scar tissue in the uterus can cause infertility and can be treated with great success by Dr. Barrueto. Abnormal Uterine Bleeding Dr. Barrueto seeks to provide his patients with a thorough clinical diagnosis and the best treatment plan for abnormal uterine bleeding. According to Dr. Barrueto, "nearly all women, at some time in their life, experience heavy bleeding during a period. As many as 2 million women each year see their doctors about menorrhagia. It is the most common gynecologic complaint and the reason for two-thirds of all hysterectomies." Dr. Barrueto has particular expertise in treatment options available for this very common condition.
Hysteroscopy can be performed diagnostically in the office, without anesthesia, or in an operating room as a way to remove lesions. Diagnostic hysteroscopy is used to examine the uterus and cervical canal. Hysteroscopy provides patients with a viable alternative to hysterectomy, thus preserving the genital tract. Using a thin telescope (hysteroscope) to look inside the uterus and cervical canal, hysteroscopy can be used to locate polyps, cysts, fibroids and other pathology (diagnostic hysteroscopy) or to treat and/or remove pathology (operative hysteroscopy). In the United States, a tremendous number of hysterectomies are performed each year, of which 20% are due to abnormal uterine bleeding. Many of these hysterectomies were not necessary. A less invasive, targeted treatment, hysteroscopy, which does not require hospitalization, an OR setting or general anesthesia is often a viable alternative. Hysteroscopy has proven to be an essential investigation technique in the assessment of the following:
A hysteroscopy is an invaluable diagnostic tool for our patients. Reasons would include:
Microwave endometrial ablation is minimally invasive surgery that uses microwave energy to treat excessive menstrual bleeding by destroying tissue lining the uterus (womb). A long slender tube that delivers microwave energy is inserted into the uterus to destroy tissue. Treatment typically lasts 3 ½ minutes and is most often painless. In a retrospective study of 660 women over a six year period, 87% of patients were satisfied with the procedure. Overall, 80% of women were able to avoid hysterectomy. After endometrial ablation, the ovaries continue to make normal amounts of hormone, but without lining cells, bleeding cannot occur. In 50% percent of patients, all the lining cells have been destroyed, and these women never have another menstrual period again. In an additional 40% percent of women, a few lining cells have been left behind, and these women will experience a light flow for a few days each month. For 10% of women, no improvement is noted. Still, 90% of the women who have this procedure are extremely happy not to have to tolerate the severe and debilitating monthly bleeding they had previously. Fermin F. Barrueto, M.D. is a highly experienced physician with the protocols demanded for a successful outcome when this procedure is recommended.
Resectoscopic myomectomy is a technique that can be performed if a woman needs treatment for fibroids within the uterine cavity. It involves the use of a small telescope, called a resectoscope, which is placed through the vagina and cervix into the uterine cavity. Electricity is passed through a thin wire attachment of the telescope allowing the instrument to remove fibroids located within the cavity of the uterus and within the endometrial cavity itself. No abdominal incision is necessary and it is considered an outpatient procedure. When resectoscope myomectomy is performed for heavy bleeding, nearly 90% of patients return to normal menstrual flow. When fibroids are the cause of infertility, pregnancy rates following this procedure have been about 50%. Only a few years ago, treatment for fibroids in the cavity of the uterus involved major surgery - an abdominal incision and either cutting open the entire uterus to remove the fibroid, or performing a hysterectomy. Resectoscope myomectomy has been a major advance in the treatment of women who have fibroids protruding into the uterine cavity.
Asherman's Syndrome is an acquired uterine disease, characterized by the formation of scar tissue or adhesions in the uterus. This occurs most often after uterine surgery, particularly a dilation and curettage done after a birth, miscarriage or abortion. The extent of the adhesions defines whether the case is mild, moderate or severe. The adhesions can be thin or thick, can be spotty in location, or can cause the walls of the uterus to adhere to one another. They are usually not vascular, an important characteristic that helps in treatment. When the condition is severe, a woman usually does not have a period and it can cause infertility or miscarriages. Some infections can also cause Asherman's Syndrome such as tuberculosis or schistosomiasis, but this problem is rare in the USA. The treatment of Asherman's Syndrome requires a highly specialized team with experience in Operative hysteroscopy (Resectoscopic Surgery) that is perform under laparoscopic control which is necessary for a successful outcome. Fermin F. Barrueto, M.D. has been treating Asherman's Syndrome since the early 1990's with good pregnancy rates for many women. For more information on diagnosis or treatment, please call, 410-321-8452. To create your personal iHealthRecord and to access physician selected articles, please click here. Please call for an appointment.
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