KMS-GQ intrauterine stent vs. conventional intrauterine device after hysteroscopic treatment of moderate-to-severe intrauterine adhesions: a propensity score–matched comparative study

Objective Moderate-to-severe intrauterine adhesions (IUAs) significantly impair female fertility and quality of life, with high recurrence rates following transcervical resection of adhesions (TCRA). Effective postoperative barrier strategies are therefore essential. This study aimed to compare the clinical outcomes of the KMS-GQ intrauterine stent and the conventional heart-shaped copper intrauterine device (IUD) in the management of moderate-to-severe IUAs following TCRA. Methods A retrospective analysis was conducted on patients with moderate-to-severe IUAs who underwent TCRA at our institution between January 2019 and February 2024. Of the 190 patients assessed for eligibility, 186 were enrolled after excluding 4 patients (incomplete septate uterus, n = 2; hydrosalpinx, n = 2). To minimize selection bias, propensity score matching (PSM) was performed using a 1:1 nearest-neighbor matching algorithm with a caliper of 0.2, including age, BMI, baseline AFS score, cervical adhesion, and chronic endometritis (CE) as covariates. This resulted in 76 matched pairs ( n = 152). Demographic characteristics and perioperative data were collected and statistically analyzed. Results After PSM, baseline characteristics were well-balanced between the two groups, residual differences in cervical adhesion and CE were additionally adjusted for in multivariable analyses. The KMS-GQ stent group demonstrated significantly higher cure rates for cervical canal adhesions [95.0% [38/40] vs. 50.0% [14/28], p < 0.001] and chronic endometritis [62.2% [23/37] vs. 25.0% [5/20], p = 0.012] compared to the IUD group. The stent group also showed significantly lower rates of new-onset cervical adhesions [0.0% [0/36] vs. 16.7% [8/48], p = 0.009] and 1-year adhesion recurrence [1.3% [1/76] vs. 11.8% [9/76], p = 0.009]. The 1-year pregnancy rate was numerically higher in the stent group, though this difference was not statistically significant [50.0% [38/76] vs. 46.1% [35/76], p = 0.626]. Conclusion After adjusting for baseline differences through PSM, the KMS-GQ intrauterine stent demonstrated significantly superior outcomes in resolving cervical canal adhesions and chronic endometritis, as well as reducing new-onset cervical adhesions and 1-year recurrence rates compared to conventional IUDs. Pregnancy outcomes were similar between the two groups within the first postoperative year. Given the retrospective, non-randomized design, these findings should be considered hypothesis-generating. Prospective randomized controlled trials are warranted to confirm these observations and evaluate long-term reproductive outcomes including live birth rates.