Burak SEZGİN, Ercan SARUHAN, Eren AKBABA, Melike NUR AKIN

Five years outcomes of hysteroscopy experience in a tertiary center

Objective: We aimed to document our hysteroscopy (HS) experience for a period of 5 years in an academic hospital. Material and Methods: Data from patients who underwent HS for any indication were retrospectively analyzed. The clinical and histopathological outcomes of patients with diagnostic or operative HS were documented. Results: The mean age of 202 patients included in the study was 42.83±9.58 years, their mean gravidy was 2.67±1.29, and their mean parity was 2.04±0.95. One hundred and sixty-two (80.2%) of the patients were at premenopausal period and 40 (19.8%) of them were at postmenopausal period. The most common comorbidities detected in patients were hypertension (9.4%), diabetes mellitus (4.5%), thyroid disease (4%), and breast cancer (3.5%), respectively. The mean pre-operative endometrial thickness was 12.80±6.10 mm. One hundred and thirty-five patients underwent saline infusion sonohysterography (SIS) procedure before HS, and a mass like lesion in the uterine cavity was detected in 97.8% of them. The average largest diameter of these intracavitary masses detected was 13.72±6.21 mm. Seven (3.5%) of all patients needed HS again. The most common indications for HS were menometrorrhagia (54.5%), polymenorrhea (14.4%), postmenopausal bleeding (10.9%), and infertility (9.4%). As a complication, uterine perforation was detected in 1 (0.5%) of cases and excessive bleeding in 2 (1%) of them. The most common localization of the masses in the uterine cavity was fundus (43.4%). As a result of histopathological examination, endometrial polyps were reported in 59 cases (70.3%) and myoma uteri in 21 (9.4%) cases. Conclusion: The most common reason for HS in our clinic was endometrial polyp. The most common symptom and surgical intervention were determined as menometrorrhagia and resection of polyp, respectively. In the detection of intracavitary lesions, the use of SIS before HS was a common procedure. Our complication rate was found to be low in line with the literature.

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1. Bonnamy L, Marret H, Perrotin F, Body G, Berger C, Lansac J. Sonohysterography: A prospective survey of results and complications in 81 patients. Eur J Obstet Gynecol Reprod Biol 2002;102(1):42–7.
2. Van Dongen H, De Kroon CD, Jacobi CE, Trimbos JB, Jansen FW. Diagnostic hysteroscopy in abnormal uterine bleeding: A systematic review and meta-analysis. BJOG An Int J Obstet Gynaecol 2007;114(6):664–75.
3. Bettocchi S, Nappi L, Ceci O, Selvaggi L. Office hysteroscopy. Obstet Gynecol Clin North Am 2004;31(3):641–54.
4. Pantaleoni DC. On endoscopic examination of the cavity of the womb. Med Press Circ 1869;8:26–7.
5. Vraneš HS, Djaković I, Kraljević Z, Radoš SN, Leniček T, Kuna K. Clinical value of transvaginal ultrasonography in comparison to hysteroscopy with histopathologic examination in diagnosing endometrial abnormalities. Acta Clin Croat 2019;58(2):249–54.
6. Bingol B, Gunenc Z, Gedikbasi A, Guner H, Tasdemir S, Tiras B. Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy. J Obstet Gynaecol 2011;31(1):54–8.
7. Serden SP. Diagnostic hysteroscopy to evaluate the cause of abnormal uterine bleeding. Obstet Gynecol Clin North Am 2000;27(2):277–86.
8. La Sala GB, Blasi I, Gallinelli A, Debbi C, Lopopolo G, Vinci V, et al. Diagnostic accuracy of sonohysterography and transvaginal sonography as compared with hysteroscopy and endometrial biopsy: A prospective study. Minerva Ginecol 2011;63(5):421-7.
9. El-Mazny A, Abou-Salem N, El-Sherbiny W, Saber W. Outpatient hysteroscopy: A routine investigation before assisted reproductive techniques? Fertil Steril 2011;95(1):272–6.
10. Zolghadri J, Momtahan M, Aminian K, Ghaffarpasand F, Tavana Z. The value of hysteroscopy in diagnosis of chronic endometritis in patients with unexplained recurrent spontaneous abortion. Eur J Obstet Gynecol Reprod Biol 2011;155(2):217–20.
11. Dendrinos S, Grigoriou O, Sakkas EG, Makrakis E, Creatsas G. Hysteroscopy in the evaluation of habitual abortions. Eur J Contracept Reprod Health Care 2008;13(2):198–200.
12. Koskas M, Mergui JL, Yazbeck C, Uzan S, Nizard J. Office hysteroscopy for ınfertility: A series of 557 consecutive cases. Obstet Gynecol Int 2010;2010:168096.
13. Lasmar RB, Barrozo PR, Parente RC, Lasmar BP, da Rosa DB, Penna IA, et al. Hysteroscopic evaluation in patients with infertility. Rev Bras Ginecol Obstet 2010;32(8):393–7.
14. Bartkowiak R, Kamiński P, Wielgoś M, Marianowski L. Accuracy of transvaginal sonography, sonohysterography and hysteroscopy in diagnosis of intrauterine pathology. Ginekol Pol 2003;74(3):203–9.
15. Nessar A, Nazik H, Murat HA. Salin infüzyon sonografisi ile ön tanı konulan hastaların histeroskopik tanılarının karşılaştırılması. Zeynep Kamil Tıp Bül 2014;45(1):1.
16. Cooper JM, Brady RM. Intraoperative and early postoperative complications of operative hysteroscopy. Obstet Gynecol Clin North Am 2000;27(2):347–66.
17. Istre O. Managing bleeding, fluid absorption and uterine perforation at hysteroscopy. Best Pract Res Clin Obstet Gynaecol 2009;23(5):619–29.
18. Yücel B, Demirel E, Kelekci S, Shawki O. Hysteroscopic evaluation of tubal peristaltic dysfunction in unexplained infertility. J Obstet Gynaecol 2018;38(4):511–5.
19. Promberger R, Simek IM, Nouri K, Obermaier K, Kurz C, Ott J. Accuracy of tubal patency assessment in diagnostic hysteroscopy compared with laparoscopy in ınfertile women: A retrospective cohort study. J Minim Invasive Gynecol 2018;25(5):794–9.
20. Gkrozou F, Koliopoulos G, Vrekoussis T, Valasoulis G, Lavasidis L, Navrozoglou I, et al. A systematic review and meta-analysis of randomized studies comparing misoprostol versus placebo for cervical ripening prior to hysteroscopy. Eur J Obstet Gynecol Reprod Biol 2011;158(1):17–23.
21. Selk A, Kroft J. Misoprostol in operative hysteroscopy: A systematic review and meta-analysis. Obstet Gynecol 2011;118(4):941–9.