Diagnostic hysteroscopy in the third millennium. Indications and role

Background. The present paper analyses a recent personal series of 284 diagnostic hysteroscopies carried out between May 1999 and December 2001 at the Operating Unit of the University Gynaecology and Obstetrics Departmentof the Hospital of Avezzano. Emphasis is laid on the description of the indications underlying the investigation and on the hysteroscopic and histological findings in the cases examined. Methods. The sample was also subdivided into two groups depending on the fertility or postmenopausal status of the patients. In the sample of 284,89 (31.3%) patients were subjected to local anaesthesia with paracervical block, while the remaining 195 (68.7%) did not receive any form of anaestetic. The hysteroscopies were generally carried out in day surgery, using the commonest and most tried and tested hysteroscopic optic systems and carbon dioxide as a means for distending the uterine cavity. None of the hysteroscopies gave rise to important complications. Results. In both the group of patients in fertile age and in the group of post-menopause patients, the main indication for hysteroscopy was anomalous uterine bleeding (AUB) for which a total of 159/284 hysteroscopies (56%) were carried out, of which 68 (42.8%) in patients in fertile age and 91 (57.2%) in post-menopause patients. In the group of post-menopause patients hysteroscopy was carried out for this indication in 73.4% of cases (91/124) while in fertile age it was performed in 42.5% of cases (68/160). Conclusions. Underlying AUB in the post-menopause patient endometrial hypo-atrophy was evidenced in 59 of 91 patients examined (64.9%), while in fertile age most of the 68 cases of AUB proved to be of dysfunctional nature: hystological examination showed a proliferative endometrium in 29 cases, secretory in 7 and hyperplastic in 12 cases (11 cases of simple endometrial hyperplasia with atypia and 1 of complex hyperplasia with atypia). Finally, hysteroscopy made it possible to diagnose 6 cases of endometrial adenocarcinoma (6.6% of patients with AUB in post-menopause).