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At least 19 recordsLinked to original sources
PubMed2003

Office hysteroscopy and compliance: mini-hysteroscopy versus traditional hysteroscopy in a randomized trial.

BACKGROUND: Diagnostic hysteroscopy has not yet been generally accepted as a well-tolerated office procedure. The aim of our study was to verify compliance, side-effects and haemodynamic variations when a mini-hysteroscope is used. METHODS: A prospective randomized trial on office hysteroscopy was performed by comparing the use of a traditional 5 mm hysteroscope (group A) and of a 3.3 mm mini-hysteroscope (group B). Two patient groups (A and B), each comprising 100 cases, were formed on the basis of a randomized computer-generated list. RESULTS: A marked reduction in the mean (+/- SD) pelvic pain score during office hysteroscopy was seen in group B (2.3 +/- 2.1) as compared with group A (4.6 +/- 2.2) (P < 0.0001, Mann-Whitney test). This result was also confirmed when using an alternative approach: four classes of pelvic pain at the visual analogue score (VAS). A significant reduction was observed in the incidence of moderate and severe pelvic pain in group B at the end of the examination (P = 0.001) and 5-10 min later (P < 0.05). CONCLUSIONS: The use of mini-hysteroscopes (3.3 mm with diagnostic sheath) lowers considerably the level of pelvic pain the patients feel: it is halved in comparison with traditional calibre hysteroscopes (2.3 +/- 2.1, on a 0-10 VAS). Furthermore the outpatient hysteroscopy failure rate is less than half (2%) with the mini-hysteroscope compared with the traditional 5 mm hysteroscope (5%). As for side-effects and haemodynamic parameters, no differences were observed except for an increase (P < 0.05) in bradycardia in group B. The advantage of this technique is self-evident, if the patients' compliance is taken into account: in many cases the introduction or withdrawal of the vaginal speculum was reported as the greatest discomfort.

Adult↗
PubMed2000

[Can hysteroscopy reliably detect malignancy? Analysis of 1200 hysteroscopy findings].

OBJECTIVE: The aim of this study was retrospective analysis of how accurate was per-operational visual evaluation of malign process in an uterus cavity during hysteroscopy. And to evaluate whether increasing experience of hysteroscopiers leads to significant accuracy considering the neoplasm of an uterus cavity. SETTING: Department of Gynaecology and Obstetrics, Havírov. METHOD: In Havírov Hospital, 1,200 hysteroscopies altogether were performed in the period from December 1995 to March 1999. In this group, there were 26 cases of histologically verified endometrial cancer. The authors retrospectively attempted to evaluate how accurately the suspected disorder was already stated during the per-operational hysteroscopy. The advantage of comparing the sub-group was taken in the first 690 hysteroscopies, of which the complex analysis was published in Cs. Gynekologie 5/98, and in the sub-group of 510 hysteroscopies performed in the following period, to state whether experience can more precisely define the per-operational malignity recognition. The statistical analysis was performed by means of the Fischer exact test of numerical charts. Among other things, the MEDLINE database was used during discussion. RESULTS: The endometrial cancer was encountered 26 times altogether, it means in 2.2% cases of hysteroscopies. Carcinoma in situ occurred three times, the stage IA three times, IB 17 times, IC three times. A hysteroscopier described the negative finding incorrectly 13 times altogether, it means 50% of all cases. The sensitivity and the specificity of hysteroscopy for endometrial cancer prediction was 50% and 99.5% (P < 0.01). The comparison of the first sub-group results (16 cases of endometrial cancer, sensitivity 75%, specificity 99.7%, (P < 0.01) and the second sub-group (10 cases of endometrial cancer, sensitivity 10%, specificity 99.2%, P = 0.09%) indicates that even increasing experience of a hysteroscopier does not more precisely define per-operation malign consideration. CONCLUSION: The authors have come to the conclusion that the pre-operation consideration of intrauteral pathology during hysteroscopy does not allow to assess precisely whether there is a neoprocess of an uterus cavity, or not. Even growing experience does not define with more precision verification of malign disorders especially at early stages of this illness. Hysteroscopy always has to be supplemented with endometrium biopsy.

Adult↗
PubMed2000

Patient satisfaction with outpatient hysteroscopy versus day case hysteroscopy: randomised controlled trial.

OBJECTIVE: To compare outpatient hysteroscopy with day case hysteroscopy in terms of patient satisfaction and acceptability. SETTING: Gynaecology clinic of a teaching hospital. PARTICIPANTS: 100 women. DESIGN AND INTERVENTIONS: Patients were randomly allocated to outpatient hysteroscopy or day case hysteroscopy provided they had no preference for either procedure. MAIN OUTCOME MEASURES: Satisfaction rate, requirements for postoperative analgesia, speed of recovery, time away from home, and time off work. RESULTS: The outpatient group recovered preoperative fitness more quickly than the day case group (2 days (range 1-2.7) versus 3 days (2-4), P<0.05). After the procedure, the outpatient group were also fully mobile more quickly than the day case group (0 minutes (0-5) versus 105 minutes (80-120), P<0.001). Requirements for postoperative analgesia were similar in both groups. Overall, 78% of patients considered that the pain from outpatient hysteroscopy was less than that usually experienced during menstruation. Patient satisfaction was similar in both groups (83.6% in the outpatient group versus 77.0% in the day case group). CONCLUSIONS: Outpatient hysteroscopy and day case hysteroscopy were equally acceptable to patients. Patients recovered significantly more quickly from outpatient hysteroscopy than from day case hysteroscopy.

Adult↗
PubMed1999

A randomised controlled trial comparing transvaginal ultrasound, outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage.

OBJECTIVE: To compare the use of outpatient and inpatient procedures in the investigation of abnormal uterine bleeding. DESIGN: A randomised controlled trial. SETTING: Two university teaching hospitals. PARTICIPANTS: Four hundred women with abnormal uterine bleeding (postmenopausal bleeding, menorrhagia, intermenstrual bleeding, postcoital bleeding, or irregular periods) above the age of 35 years, between June 1993 and January 1995. MAIN OUTCOME MEASURES: 1. Incidence of detection of abnormal pathology by vaginal ultrasound, outpatient hysteroscopy and endometrial biopsy compared with inpatient hysteroscopy and curettage; 2. Number of 'lesions' (e.g. fibroids, polyps, endometrial hyperplasia or malignancy) found by hysteroscopy that would have been missed by the combination of endometrial sampling and ultrasound; 3. Comparison of the quality of tissue obtained for histology by outpatient endometrial sampling and inpatient curettage; and 4. An evaluation of patient acceptability of outpatient and inpatient procedures. RESULTS: 1. A combination of transvaginal sonography, Pipelle endometrial biopsy and outpatient hysteroscopy has similar efficacy to inpatient hysteroscopy and curettage for the investigation of abnormal uterine bleeding; 2. Hysteroscopy will detect some fibroids and polyps missed by a combination of transvaginal ultrasound and Pipelle endometrial sampling; 3. The quality of histological samples obtained by outpatient Pipelle were comparable to those obtained by formal inpatient curettage; and 4. Outpatient procedures were well tolerated, with good patient acceptability. CONCLUSION: Transvaginal sonography and endometrial biopsy can safely be used as the initial investigations in the management of abnormal uterine bleeding. Hysteroscopy can be used as a second line investigation. Outpatient hysteroscopy with local anaesthesia is well tolerated although general anesthesia may occasionally be necessary.

Adult↗
PubMed2000

Does hysteroscopy facilitate tumor cell dissemination? Incidence of peritoneal cytology from patients with early stage endometrial carcinoma following dilatation and curettage (D & C) versus hysteroscopy and D & C.

BACKGROUND: In several case reports, distension and irrigation of the uterine cavity during fluid hysteroscopy was suspected to cause tumor cell dissemination into the abdominal cavity in patients with endometrial carcinoma. It was the aim of this study to compare the incidence of positive peritoneal cytology in patients who underwent dilatation and curettage (D & C) with or without previous hysteroscopy. METHODS: The authors conducted a multicentric, retrospective cohort analysis. One hundred thirteen consecutive patients with endometrial carcinoma treated between 1996 and 1997 were included. Endometrial carcinoma had to be limited to the inner half or less than the inner half of the myometrium (pathologic Stage IA,B). Positive peritoneal cytology was obtained during staging laparotomy. Patients underwent D & C either with or without prior diagnostic fluid hysteroscopy. No selection or randomization was applied to the two groups. Positive peritoneal cytology, defined as malignant or suspicious, was considered the primary statistical endpoint. RESULTS: Peritoneal cytology was suspicious or positive in 10 of 113 patients (9%). The presence of suspicious or positive peritoneal cytology was associated with a history of hysteroscopy (P = 0.04) but not with myometrial invasion (P = 0.57), histologic subtype (P = 1.00) or grade (r = 0.16, P = 0.10), or the time between D & C and staging laparotomy (r = 0.04, P = 0.66). CONCLUSIONS: Based on the limited extent of endometrial carcinoma in the current analysis, our data strongly suggest dissemination of endometrial carcinoma cells after fluid hysteroscopy. Determining whether a positive peritoneal cytology affects the prognoses of patients without further evidence of extrauterine disease will require longer follow-up.

Adult↗
PubMed1982

Comparison of fluid hysteroscopy and CO2 hysteroscopy.

A total of 247 women were subjected to liquid and CO2-hysteroscopy used as adjuncts in the screening of bleeding abnormalities in reproductive and post-menopausal groups. A point system of scoring proved quite useful. Using CO2-hysteroscopy the percentage of the detected malignancies corresponded to the percentages obtained by curettage in the age group of these patients. In liquid hysteroscopy, a group already suspicious for malignancy yielded a higher percentage of malignancies detected than normally expected. In post-menopausal women 41.7% of the cases examined wer malignant. The nine point scoring system used in liquid hysteroscopy correlated well with the histological findings. Both hysteroscopic techniques have their application and both are complementary, since they can be used for different indications in the visualization of the uterine cavity.

Carbon Dioxide↗
PubMed1995

[Is co-administration of ethanol to the distension medium in surgical hysteroscopy a screening method to prevent fluid overload? A prospective randomized comparative study of ablative versus non-ablative hysteroscopy and various ethanol concentrations].

OBJECTIVE: Is it possible to diagnose early a beginning fluid absorption during operative hysteroscopy by adding ethanol to the distension medium? METHODS: A prospectively randomised comparative study of ablative versus non-ablative operative hysteroscopy with differing ethanol concentration was performed. Purisole (a mannitol/sorbitol solution) was used as distension medium. RESULTS: The results of the study show that at those hysteroscopical procedures at which the endometrium is not or only minimally injured (e.g. syneciolysis, hysteroscopic proximal tubal catheterisation) an intraoperative screening is not necessary due to the low absorbing amounts. At the hysteroscopical procedures as the resection of myoma, endometriumablation and septumresection, however, an addition of ethanol of 2% to the distension medium has proved to be useful, because with this method absorbing amounts from 400 mls can be established by positive values of breath alcohol. As the result of a further absorption of fluid, but delayed in time compared to the first positive value of breath alcohol, there is an increase of the central venous pressure and a hyponatraemia. CONCLUSION: The intraoperative ethanol-monitoring is a non-invasive procedure which can be performed at ablative-operative hysteroscopies and has no negative influence on the course of the intervention and the general condition of the patients.

Adult↗
PubMed1992

Anaesthetic implications of 32% Dextran-70 (Hyskon) during hysteroscopy: hysteroscopy syndrome.

This review describes the properties and side effects of Hyskon and the implications for the patient and anaesthetist during hysteroscopy. The amount of Hyskon absorbed is dependent on the injection pressure, the extent of tissue trauma, the seal of the hysteroscope around the cervix, and the duration of infusion. The mechanism of pulmonary oedema after absorbtion of Hyskon is fluid overload, and not injury to pulmonary capillary endothelium. The haematological effects are primarily due to haemodilution. However, case reports suggest that Dextran 70 may cause a syndrome resembling disseminated intravascular coagulation. The allergic response to Hyskon consists of both an anaphylactic and an anaphylactoid component. It is recommended that hysteroscopy with Hyskon be limited to 45 min, and that all possible measures be taken to minimize tissue trauma and bleeding. The volume of Hyskon should be limited to less than 500 ml, since pulmonary oedema and coagulopathy have been described with even lesser amounts. The cumulative volume of Hyskon should be monitored frequently and the patient should be closely monitored for signs of impending pulmonary oedema.

Anesthesia, Local↗
PubMed1996

[Addition of ethanol to the distension medium in surgical hysteroscopy as screening to prevent "fluid overload". A prospective randomized comparative study of ablative versus non-ablative surgical hysteroscopy and different ethanol concentration].

For answering the question at which hysteroscopical procedures an intraoperative screening method is necessary to avoid a fluid overload and whether a beginning fluid absorption can be diagnosed early by adding ethanol to the distension medium, a prospectively randomised comparative study of ablative versus non-ablative operative hysteroscopy with differing ethanol concentrations was performed (n = 120). Purisole (a mannit/sorbit solution) was used a distension medium. The measuring parameters (breath alcohol, amount of absorbed fluid, haematocrit and haemoglobin values, central venous pressure, heart frequency) were intraoperatively determined at 5-minute intervals. The results of the study show that with those hysteroscopical procedures during which the endometrium is not or only minimally injured (e.g. syneciolysis, hysteroscopic proximal tubal catheterisation). Intraoperative screening is not necessary due to the low absorbing amounts. With hysteroscopical procedures such as resection of myoma, endometrium ablation and septum resection, however, an addition of ethanol of 2% to the distension medium has proved useful, because with this method absorption amounts of 400 ml and more can be detected by positive values of breath alcohol. As the result of a further absorption of fluid, delayed in time compared to the first positive value of breath alcohol, there is an increase in central venous pressure and hyponatraemia. Intraoperative ethanol monitoring is a non-invasive procedure which can be performed during ablative-operative hysteroscopies and has no negative influence on the course of the intervention and the general condition of the patients.

Adult↗
PubMed2003

Diagnostic hysteroscopy: a valuable diagnostic tool in the diagnosis of structural intra-cavital pathology and endometrial hyperplasia or carcinoma?. Six years of experience with non-clinical diagnostic hysteroscopy.

OBJECTIVE: 1045 diagnostic hysteroscopic procedures performed throughout six consecutive years were evaluated, focussing on its value in diagnosing endometrial hyperplasia and carcinoma. DESIGN: Retrospective study performed in the gynaecological endoscopy clinic of a training hospital. Subjects were 1045 pre- and post-menopausal patients. RESULTS: A normal cavity was found in 54.2%. Most common abnormal findings were fibroids (21.0%) and endometrial polyps (14.4%). Hysteroscopically diagnosed hyperplasia of the endometrium was confirmed histologically in only less than half the cases. Endometrial carcinoma was suspected on hysteroscopic view in two cases of a total of seven proven cases. In three cases initially an endometrial polyp and in two cases a fibroid was diagnosed. Once the diagnosis was missed even after biopsy taking. CONCLUSIONS: Diagnostic hysteroscopy is a valuable diagnostic tool in diagnosing structural intra-cavital pathology, very suitable for the outpatient clinic. The value in diagnosing hyperplasia or endometrial carcinoma is limited and even after guided biopsy a malignancy cannot be ruled out.

Biopsy↗
PubMed1992

[Evaluating the possibility of performing diagnostic and operative hysteroscopy depending on the type of hysteroscopy and agent used for filling the uterine cavity].

The aim of the paper is to present own experiences concerning diagnostic and operative hysteroscopy performed with 4 types of hysteroscopes. Flexible hysteroscope HYP 1T, rigid hysteroscope 5 mm in diameter with single flow, operative hysteroscope 8 mm in diameter with constant flow, hysteroresectoscope 9 mm in diameter with constant flow produced by Olympus; for filling the uterine cavity CO2 0.2% NaCl, 5% glucose, Purisol, Hyskon were implemented. In even case the degree of hardship of the procedure, traumatism for the patient, degree of operated-on patient's safety during the procedure, possibility of applied in the presence of bleeding, price of instrument and agents applied for filling the uterine cavity were estimated. It has been found out that the use of rigid hysteroscope 5 mm in diameter and operative hysteroscope 8 mm in diameter with constant flow and utilization of CO2 as well as Purisol and Hyskon solutions provide possibility of extensive diagnosis and therapy.

Female↗
PubMed1994

[Hysteroscopy syndrome. Absorption of irrigation fluid in surgical hysteroscopy].

The availability of adequate endoscopic instruments has led to an increased interest in hysteroscopic surgical procedures. An electrolyte-free irrigation fluid is essential for the distention of the uterine cavity, with acceptable uterine distention occurring at 80-150 mmHg. The HSK syndrome, the intravascular absorption of a hypotonic irrigation fluid with subsequent hypotonic hyperhydration with hyponatremia, has to be considered as a risk during hysteroscopic procedures. Analogous to the TUR syndrome, intravasation occurs through the vascular spaces opened during large ablative surgical procedures resulting in the absorption of the fluid used for irrigation. Occasionally, a tear in the lower uterine segment from dilation or perforation of the uterus may expose large vascular channels. Outflow through the tubes is not a significant factor. Continuous CVP measurement allows the detection of intravascular absorption of the irrigation fluid and may be included in the routine monitoring for these procedures. The duration of the hysteroscopic procedure should be limited to 60 min. Addition of ethanol to the irrigating fluid may be suitable for early detection of fluid absorption. However, commercial solutions are not yet available.

Absorption↗