Hysteroscopic management of a juvenile cystic adenomyosis

Hysteroscopic management of juvenile cystic adenomyosis on a virgin patient with non-touch technique. Juvenile cystic adenomyosis of uterus is a cyst which is surrounded by myometrium and inside of this cyst is filled with hemorrhagic fluid. A 23-year-old virgin patient admitted to endometriosis outpatient clinic. The patient complained of dysmenorrhea, chronic pelvic pain, and abnormal uterine bleeding. A submucosal adenomyotic cyst was, sized 40 mm approximately, determined at posterior wall of uterus by transrectal ultrasonography. She received daily 2？mg dienogest (Visanne？) for 6？months. At the end of 6？months of treatment, the cyst size was still 35？mm. Hysteroscopy was performed with the use of the non-touch technique (vaginoscopic approach). A rigid 2.9-mm hysteroscope with a 12° oblique lens and an outer sheath diameter of 4？mm was used. When the cystic wall was ruptured by bipolar instrument, a chocolate-colored fluid was drained. The operation lasted 10？min. Her postoperative course was uncomplicated. Postoperatively, two dose of leuprolide acetate 11.25？mg (Lucrin depot？—3M; Abbot, Istanbul, Turkey) was prescribed (6？months total). On her sixth month, there was no cyst on transrectal ultrasonography examination. The patient did not exhibit any symptoms. Because the disease affects adolescent girls, fertility issues should be kept in mind during the workup and when operating on these patients. Hysteroscopy is a mini-invasive, safe, and effective option for the treatment of juvenile cystic adenomyosis