Retained products of conception (RPOC) may necessitate invasive interventions, such as uterine artery embolization (UAE). Hysteroscopic surgery with a balloon catheter (BC) in the internal iliac artery may reduce the risk of fertility loss. However, its therapeutic efficacy and subsequent pregnancy outcome have not been studied.

With Ethics Committee approval and informed patient consent, we enrolled seven cases of RPOC managed with hysteroscopic surgery using a BC (BC group) between January 2019 and September 2023. These cases were retrospectively compared in terms of the treatment course and postoperative reproductive outcomes in 12 patients who underwent hysteroscopic procedures with UAE (UAE group).

No differences were observed between the BC and UAE groups in patient demographics, operative time, and intraoperative blood loss. The median hospital stay was significantly shorter in the BC group ( p < 0.05). In the UAE group, there was a higher percentage of patients with a fever above 38 °C on postoperative day 1 ( p < 0.044). The interval from RPOC diagnosis to interventional radiology was comparable between the groups (median [range]; BC:15 [1–29] vs UAE: 13 [1–25] days), as was the interval from IVR to subsequent pregnancy (325.5 [123–925] vs 312 [78–2253] days). After surgery, five women in the BC group experienced 8 pregnancies, of which two resulted in spontaneous abortion and six in live births. No differences were found in the rate of obstetric complications between the two groups.

Hysteroscopic surgery with BC demonstrated comparable safety to hysteroscopic surgery with UAE. Compared with UAE, hysteroscopic surgery with BC may shorten hospital stay and contribute to fertility preservation by transiently obstructing uterine blood perfusion.