Aim: Asses the effectiveness of three steps resection method of an isthmocele using hysteroscopy in patients complained of postmenstrual bleeding with confirmed presence of isthmocele.
Study Design: Prospective interventional cohort study.  Materials and Methods: 50 patients complained of postmenstrual bleeding with confirmed presence of an isthmocele. After written consent, the patients have been subjected to three steps hysteroscopic resection of an isthmocele by removing the distal edge of the niche then the proximal edge and lastly ball cauterization of the floor of the pouch of the isthmocele. Postoperative transvaginal ultrasound and follow up for 2 menstrual cycles were performed for all patients. Results: The median duration of menstruation shortened from 13 days to 7days after surgery (p < 0.01). The median duration of postmenstrual spotting improved from 6 days (range 5-7 days) to 2 day (range 0–3 days) at follow-up (p < 0.01). Follow up transvaginal ultrasound showed significant reduction of the niche depth from 5.2±1.1 mm to 2.3±1.3 (p < 0.01).  Conclusion: Hysteroscopic repair of post caesarean isthmocele in patients with post menstrual spotting is considered an effectiveness minimally invasive choice of treatment.