Polish Society of Gynecologists and Obstetricians Guidelines for the application of hysteroscopy in gynecology
Mariusz ZimmerMichał PomorskiPaweł KamińskiJacek DoniecHubert HurasPiotr SieroszewskiJerzy SikoraRafał StojkoArtur LudwinMichał RadwanTomasz Fuchs
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This guideline presents current management recommendations which may be modified and altered in justifiable cases, after careful analysis of a given clinical case, which in the future might constitute grounds for modification and updating. OBJECTIVESThe objective of this guideline is to present up-to-date knowledge about the application of hysteroscopy in gynecology, based on the experience of the authors and reliable sources from the literature.To investigate the diagnostic value of combined hysteroscopy with ultrasonography.477 patients were diagnosed by hysteroscopy, ultrasonography, or hysteroscopy combined with ultrasound. The results of the 3 groups were compared with the findings after operations.This study indicated to diagnose intrauterine lesions, intramural diseases or pelvic disorders, hysteroscopy with ultrasonography was significantly better than either methods alone. The accuracy rate, false positive rate as well as false negative rate were 98.32%, 1.26% and 0.04% respectively.Hysteroscopy is used for diagnosis and treatment of intrauterine lesions, and ultrasonography is difficult to show actual location of lesions within uterine cavity. The present study has shown that hysteroscopy combined with ultrasound could increase the effectiveness and accuracy of uterine diseases' diagnosis.
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【Objective】 To study the diagnostic value hysteroscopy on abnormal uterine bleeding(AUB).【Methods】 150 patients with AUB under hysteroscopy.We adopted diagnostic dilatation and urettage or biopcy.Take pathologic results as the definite diagnoses.【Results】 The coincidence rate of hysteroscopy and pathology was 92.0%,and the rate through transvaginal B-ultrasonograpy was 50.7%,There was significant difference between them(u=10.87,P0.01) 【Colusion】 Hysteroscopy is more precise and direct.Hysteroscopy combination pathology is the safe and effective procedure in diagnosing abnormal uterine bleeding.
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To determine whether diagnostic hysteroscopy posed any risk of causing the formation of intrauterine adhesions 108 women were studied. Diagnostic hysteroscopy was performed; following tubal surgery, a second-look hysteroscopy was undertaken. Adhesion were noted in 1 of 100 of those patients in whom no prior adhesions had been noted.
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The aim of this review is to define clinical guidelines for the management of menopausal women with abnormal uterine bleeding. Hysteroscopy has proved to be the most accurate and reliable method for the diagnosis of intrauterine diseases. Many authors have recently proposed the use of hysteroscopy as a first line procedure in the approach to menopausal women. With continuing improvement in technology, and development of modern narrow-diameter hysteroscopes, light sources and distension-medium insufflators, hysteroscopy can now be performed as an outpatient procedure. Because of its higher diagnostic accuracy, hysteroscopy is replacing dilatation and curettage for the investigation of abnormal uterine bleeding. Diagnostic dilatation and curettage should be done with hysteroscopy to obtain visual image of the endometrial cavity and to exclude focal disease. Hysteroscopy thus turns a ,"blind" procedure into one allowing directed curettage, helps prevent missing unsuspected polypes and ensures that the most visibly abnormal areas are sampled.
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Office diagnostic hysteroscopy allows physicians to directly view the endometrial cavity, tubal ostia, and endocervical canal without taking the patient to the operating room (OR). We sought to determine whether office hysteroscopy performed to evaluate abnormal uterine bleeding decreases the need for hysteroscopy performed in the OR and the associated financial and risk implications.One hundred thirty patients who underwent office diagnostic hysteroscopy between January 2009 and March 2012 at 2 outpatient clinics in an academic university setting were identified. Records were reviewed from paper charts and electronic medical records. Hospital charts for patients who required hysteroscopy in the OR were reviewed as well. Charge estimates were obtained from our billing department. These results were analyzed for review of the data.Seventy-five of the 130 women who underwent diagnostic office hysteroscopy for abnormal bleeding did not need to undergo hysteroscopy in the OR. This represents estimated savings of $1498 per patient (95% confidence interval, $1051-$1923) in procedure charges. Among the 55 women who underwent OR hysteroscopy, there was 71% agreement between findings on hysteroscopy in the office and in the OR.Office hysteroscopy is a useful diagnostic tool that can help decrease the rate of diagnostic hysteroscopy in the OR under anesthesia when used in a select patient population.
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