Hysteroscopy in daily practice (original) (raw)
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Indications of diagnostic hysteroscopy, a brief review of the literature
Gynecological Surgery, 2012
Plenty of authors propose outpatient hysteroscopy as the gold standard diagnostic method for the evaluation of endometrial pathology. This statement has been strengthened in the recent years due to the wide use of smaller diameter hysteroscopic devices, which have made the dilation of the cervix and the use of anesthesia unnecessary. The main purpose of this paper is to summarize the indications of diagnostic hysteroscopy. In this review, we used the most recent publications in MEDLINE and Cochrane Library in order to specify the indications of diagnostic hysteroscopy and the experience that have been obtained till today in the management of certain pathological uterine conditions. The key words we used were diagnostic hysteroscopy, abnormal uterine bleeding, infertility, endometrial cancer. Hysteroscopy provides an accurate method of evaluation and direct visualization of the endometrial cavity and moreover directed biopsy and sampling of suspected lesions. Last years with the continuous development in the hysteroscopy devices, plenty of women benefit surgical hysteroscopy techniques for uterine abnormalities. Hysteroscopy is useful for the diagnosis in patients with abnormal uterine bleeding, with endometrial cancer and in infertile women. Hysteroscopy has the unique advantage of combining a thorough procedure with great diagnostic accuracy. The only disadvantage is that hysteroscopy requires specific teaching and training and has a long learning curve.
Diagnostic hysteroscopy - a retrospective study of 1545 cases
Mædica, 2012
The development of hysteroscopy has provided a minimally invasive approach to common gynecologic problems, such as abnormal uterine bleeding. Diagnostic hysteroscopy is considered now "the gold standard" by the Association of Professors of Gynecology and Obstetrics (2002) in investigation of abnormal uterine bleeding (AUB) in order to rule out organic endouterine causes of AUB. Although the World Health Organization (WHO) recommends hysterosapingography (HSG) alone for management of infertile women many specialists use hysteroscopy as a first-line routine exam for infertility patients regardless of guidelines. This paper is a retrospective study of 1545 diagnostic hysteroscopies performed in the "Prof. Dr. Panait Sirbu" Obstetrics and Gynecology Hospital between January 1, 2008 and June 30, 2011. The following parameters were studied: diagnostic hysteroscopy indications, type of anesthesia used, correlation between pre-and postoperative diagnoses. Of 1545 diagnos...
Role of Hysteroscopy in Gynecological Conditions
World Journal of Laparoscopic Surgery with DVD, 2014
Introduction: Hysteroscopy offers a valuable extension of the gynecologist armamentarium, as uterine cavity can be explored in detail for making exact diagnosis. Hysteroscopy can be used for diagnosis as well as management of various gynecological problems. A study was conducted to evaluate the role of hysteroscopy in gynecological conditions. Materials and methods: A prospective clinical study was conducted in the Department of Gynecology, Hindu Rao Hospital. Total 69 patients with abnormal uterine bleeding attending gynecology outpatient department were selected and subjected to hysteroscopic exami nation after detail history, examination and consent. Subjects were divided into six groups as per their history and examination. Observation: In group I (DUB) 40.5%, in group II (infertility) 21.7%, in group III (postmenopausal bleeding) 11.6%, in group IV (suspected leiomyoma) 11.6%, in group V (lost IUCD) 7.3% and in group VI (secondary amenorrhea) 7.3% patients were there. Abnormal hysteroscopic findings were observed as follows, in group I: 85.71%, group II: 80%, group III: 80%, group IV: 62.5%, group V: 60%, group VI: 60% had. Out of 69 patients, in 73.91% patient's intrauterine pathology was seen on hysteroscopic examination. In our study commonest cause of abnormal bleeding was endometrial hyperplasia (28.5%), endometrial polyp (18%), proliferative endometrium (28.59%), endocervical polyp (3.6%), submucous myoma (3.6%) and atrophic endometrium (3.6%) patients. In patients with lost IUCD, removal of IUCD was done and adhesionolysis was performed in patient with secondary amenorrhea. Conclusion: Hysteroscopy is simple, safe, quick, and economical technique which allows exploration of uterine cavity in precise manner with speed and safety. Diagnostic and operative procedures can be performed in the same time.
Journal of Obstetrics and Gynaecology Research, 2003
Aim: To investigate the accuracy of hysterosalpingography (HSG) in comparison to hysteroscopy in the detection of intrauterine pathology in patients with infertility, where hysteroscopy is the gold standard. Methods: A prospective, comparative study included 336 patients undergoing both HSG and diagnostic hysteroscopy. Main outcome measures were sensitivity, specificity, positive and negative predictive value, and accuracy rate of HSG. Results: Intrauterine abnormalities were shown on HSG in 286 patients and confirmed in 200 at hysteroscopy. Contrarily intrauterine lesions were detected by hysteroscopy in 4 out of 50 patients in whom HSG were normal. The most common intrauterine finding of 336 patients on hysteroscopy were intrauterine adhesions (IUA) (74), followed by endometrial polyps (56), and submucous myoma, 26 patients. Statistical analysis revealed that HSG in the detection of intrauterine pathology had a sensitivity of 98.0%, specificity of 34.9%, positive predictive value of 69.9%, negative predictive value of 92.0%, and accuracy rate of 73.2% with falsepositive and false-negative rates of 30.1% and 8.0%, respectively. The common incorrect diagnoses of HSG were misdiagnosing a condition of cervical stenosis as severe IUA in 24 patients, endometrial polyps as submucous myoma in 22 out of 50 patients, and submucous myoma as endometrial polyps in 12 out of 72 patients. Conclusions: Hysterosalpingography is still a useful screening test for the evaluation of the uterine cavity. If a hysterogram demonstrates intrauterine abnormalities, hysteroscopy should be considered to make a definite diagnosis and treatment. Both procedures should be complementary to each other.
Hysteroscopy and female infertility: a fresh look to a busy corner
Human Fertility, 2020
Hysteroscopy has evolved from the traditional art of examining the uterine cavity for diagnostic purposes to an invaluable modality to concomitantly diagnose and (see and) treat a multitude of intrauterine pathologies, especially in the field and clinics specialising in female reproduction. This article reviews the literature on the most common cervical, endometrial, uterine and tubal pathologies such as chronic endometritis, endometrial polyps, adenomyosis, endometriosis, endometrial atrophy, adhesions, endometrial hyperplasia, cancer, and uterine malformations. The aim is to determine the efficiency of hysteroscopy compared with other available techniques as a diagnostic and treatment tool and its association with the success of in vitro fertilisation procedures. Although hysteroscopy requires an experienced operator for optimal results and is still an invasive procedure, it has the unique advantage of combining great diagnostic and treatment opportunities before and after ART procedures. In conclusion, hysteroscopy should be recommended as a first-line procedure in all cases with female infertility, and a special effort should be made for its implementation in the development of new high-tech procedures for identification and treatment infertility-associated conditions.
The efficacy of hysteroscopy in diagnosis and treatment of endometrial pathology
Gynecological Surgery, 2011
Hysteroscopy has become the first choice approach for patients with suspicion for intrauterine lesions. The one-stop approach in which diagnosis and hysteroscopic treatment is performed in one session has been described as being highly appreciated by the patient, has a low risk profile, and is a costefficient approach. This study addresses the value of hysteroscopy on diagnostic accuracy and its effectiveness to the onestop therapeutic approach. This is a prospective study of patients admitted in the ambulatory surgery unit of the Sto. André-Leiria Hospital (Portugal) from February 2005 to February 2008 for a one-stop diagnostic and therapeutic approach. Patient selection was done on transvaginal ultrasound findings or on clinical pathology. Depending on the transvaginal ultrasound report and the clinical data, the instrumentation and analgesia for the one-stop approach was defined. The average age was 54 years (range24-87 years). The majority of patients (96.2%) presented with a transvaginal ultrasonographic lesion. The hysteroscopic evaluation characterized the hysteroscopic findings in two groups: the "uterine cavity lesions" (endometrial and cervical polyps, myomas, malignant smooth muscle tumor, placenta or first trimester debris, bone, adhesions or septum, lost IUD, or no lesion) and "the endometrial characterization" (which include functional atrophic or thin endometrium, dysfunctional, endometritis, cystic atrophy, hyperplasia, polypoid, and carcinoma). We concluded that the ambulatory performance of direct visualization of uterine cavity by hysteroscopy guarantees a high diagnostic accuracy, allowing the simultaneous accomplishment of biopsies and surgical treatment of the visualized lesions.
Hysteroscopic Management of Intrauterine Pathologies: A Case Series of 296 Patients
The Journal of South Asian Federation of Menopause Societies, 2017
Aim: To discuss the incidence of various hysteroscopic findings in patients of infertility, abnormal uterine bleeding (AUB), and postmenopausal bleeding and to compare the prevalence of various uterine pathologies in patients of primary and secondary infertility. Materials and methods: This is a retrospective observational study, which evaluated 296 patients who underwent diagnostic hysteroscopy for evaluation of primary or secondary infertility, AUB, and postmenopausal bleeding over a period of 18 months in a Gynae-endoscopy Unit. Detailed hysteroscopic evaluation of the endocervical canal and uterine cavity in all recruited cases was done by the same surgeon and the data were collected by reviewing the case records. Results: Among the 296 cases analyzed, 157 cases were of primary infertility, 81 cases were of secondary infertility, 45 cases were of AUB, and 13 cases presented with postmenopausal bleeding. Among the primary infertility patients, 58.6% had abnormal findings on hysteroscopy, while among the secondary infertility patients, hysteroscopy revealed abnormalities in as high as 72.5% cases. In the present study, uterine synechiae was the most common abnormality detected among the infertile patients. Endometrial polyps were the most common pathology detected among patients with AUB and postmenopausal bleeding. Conclusion: Hysteroscopy is a minimally invasive and highly safe technique to directly visualize the endocervical canal, uterine cavity, and tubal ostia. It has an added advantage of treating the pathology in the same sitting, thus improving the clinical outcomes. Based on our findings, we conclude that uterine pathologies are a major contributor in causing infertility and menstrual irregularities, which are missed on blind modalities like hysterosalpingography and dilatation and curettage. Clinical significance: This article stresses on the use of hysteroscopy as a primary diagnostic modality in evaluating patients of infertility, AUB, and postmenopausal bleeding in order to increase the detection rates of uterine pathologies.
Results of 2500 office-based diagnostic hysteroscopies before IVF
Reproductive biomedicine online, 2010
The aim of the study is to assess the diagnostic accuracy, findings and feasibility of office-based diagnostic hysteroscopy in an IVF population. A total of 2500 consecutive infertile patients were enrolled prospectively prior to IVF treatment. Diagnostic hysteroscopy was performed on each subject in an office setting in the study IVF centre. A total of 1927 patients (77.1%) had a normal uterine cavity, while the remainder of the sample (n=573) demonstrated endometrial pathology on hysteroscopy (22.9%). Of the patients with endometrial pathology, 192 patients had endometrial polyps (7.68%), 96 patients had submucosal fibroids (3.84%), 31 patients had polypoid endometria (1.24%), 27 patients had intrauterine adhesions (1.08%) and 73 patients had uterine septa (2.92%). Diagnostic office-based hysteroscopy is routinely performed in the IVF clinic to assess the endometrial cavity. In such an unselected population, a significant percentage of patients had evidence of uterine pathology th...
Facts, views & vision in ObGyn, 2014
Magnetic Resonant Imaging (MRI) has demonstrated that we can differentiate the uterus in 3 important functional areas. Exploration of the uterus in the infertile patient should implement the evaluation of the endometrium, the Junctional zone myometrium (JZ), the outer myometrium and the cervical canal. Especially the JZ myometrium should receive our close attention in the exploration and treatment of the infertile patient. MRI cannot be implemented as a screening examination but also limiting the imaging of the womb to a 2 or 3 D ultrasound exam only does not meet the scientific requirements of sensitivity and specificity. Modern ambulatory uterine diagnosis in a one-stop approach includes transvaginal ultrasound, fluid mini Hysteroscopy, contrast sonography and endomyometrial tissue sampling. Transvaginal Ultrasound being the gold standard for global uterine screening has a cardinal importance for diagnosis of myometrial disorders and uterine congenital malformations whereas hyster...