Hysteroscopy – indications, course, complications. Diagnostic and operational hysteroscopy

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Diagnostic hysteroscopy is nothing more than uterine endoscopy. It is a gynecological examination that allows to assess the condition of the inside of the uterine cavity. The doctor usually refers to this examination when he has doubts as to the accuracy of the diagnosis. Diagnostic hysteroscopy of the uterus allows for an accurate assessment of the organ. Find out what exactly this examination is about and what is an operative hysteroscopy!

Hysteroscopy – treatment history

Prior to the advent of the hysteroscope, the standard blind dilatation and curettage (D&C) procedure was used together with hysterosalpingography (HSG) to evaluate the uterus. It was not until the German doctor Philipp Bozzini, in 1805, looked into the urethra of a living patient for the first time, and that was the beginning of endoscopy, which has now evolved into modern endoscopic surgery. The credit for the first successful hysteroscopy goes to Pantaleoni, who in 1869 assessed the condition of a 60-year-old woman and detected polypoid growth in the uterus using hysteroscopy. It was he who performed a hysteroscopic examination using a cystoscope with an internal light system and lenses.

Over time, hysteroscopy procedures evolved, and subsequent doctors, such as Von Midulicz, Radecka and Freund, used saline. Thereafter, a fluid called dextran 70 was started to be used as an expansion medium as it was found to be superior to other expansion agents due to its property of being highly viscous and not miscible with blood.

Different specialists used different dilating agents to improve visibility and ensure safety, especially during surgical procedures. The credit for using 1,5% glycine instead of dextran in operative endoscopy goes to none other than Jaques Hamou, a French surgeon. An ideal dilator that is completely physiological and will not cause fluid overload or electrolyte disturbances has not yet been found.

See also: What does an enlarged uterus mean?

Hysteroscopy – what is it?

Hysteroscopy is nothing more than an endoscopy of the uterus (the name is derived from the Greek language in which hysteria denotes the uterus, and a scope – viewing, therefore it can be said that hysteroscopy is loosely translated as “viewing the uterus”), that is, an examination with a high level of safety. The chance of any complications is small, and in the case of removing the lesions appearing in the uterus, it does not result in a long and burdensome convalescence.

All this means that hysteroscopy is often used both in the process of recognizing problems in female reproductive organs and in their therapy. Therefore, there are two types of hysteroscopy: diagnostic and operational.

Diagnostic hysteroscopy – indications

An indication for diagnostic hysteroscopy may be abnormal bleeding of unknown cause. Hysteroscopy is also performed in women who have problems getting pregnant. The doctor will also refer you for this examination if he suspects that there are defects in the structure of the uterus.

Diagnostic hysteroscopy – research

Before executing diagnostic hysteroscopy the doctor orders tests. You will need a Pap smear and blood group test. In addition, we should perform a morphology, sodium, potassium and glucose levels. The latter tests allow the administration of anesthesia.

Also read: Diagnosis of infertility in women – what tests should be performed?

Diagnostic hysteroscopy – course

How is diagnostic hysteroscopy performed? Before the test, you should refrain from urinating for a minimum of 1,5-2 hours. The examination is performed on an ordinary gynecological chair. The doctor gives anesthesia and then disinfects the vaginal opening.

The examination is performed using a hysteroscope. It has two parts – a handle and a sleeve. There are knobs on the handle. They are used to regulate the supply of light and carbon dioxide. The hysteroscope is connected to the monitor. Thanks to this, the doctor is able to look at each fragment very carefully. The sleeve allows the insertion of tools. This makes it possible to download test pieces.

If the test goes without any problems or complications and you feel fine, you can go home. However, rest is important. You should avoid carrying heavy objects for a while. Failure to follow the rules can lead to vaginal bleeding.

Diagnostic hysteroscopy – safety

It is said that hysteroscopy is completely safe. Properly performed, it does not cause any complications. Sometimes the examination is painless for the patient and anesthesia is administered for the psychological comfort.

Diagnostic hysteroscopy – length of the procedure

Hysteroscopy is a short examination. It only takes about 10 minutes. They can be performed at the National Health Fund, as well as privately. The decision to perform the examination should always be made by the doctor.

Diagnostic hysteroscopy – contraindications

It should be known that diagnostic hysteroscopy cannot be performed during pregnancy. In addition, the test cannot be performed when we are dealing with the onset of menstrual bleeding. Another, but very important, contraindication to the assessment of the inside of the uterus is the ongoing inflammation.

Operative hysteroscopy – indications

Surgical hysteroscopy is performed immediately after diagnostic hysteroscopy. It involves the insertion of a micro-tool through the hysteroscope’s sleeve, which the doctor uses to carry out surgical procedures.

If the diagnostic hysteroscopy provides the doctor with information about the presence of pathology in the reproductive organ, it is usually necessary to perform an operative hysteroscopy. This method is minimally invasive and allows for precise removal of lesions located in the uterus. Thanks to it, we can get rid of adhesions, polyps and fibroids. In addition, the hysteroscopy procedure allows for the correction of congenital uterine defects, such as removal of the uterine septum, as well as the collection of specimens from the mucosa for histopathological examination.

Operative hysteroscopy – preparation

Before performing an operative hysteroscopy, hormone treatment is used in most cases. Its purpose is to reduce the thickness of the uterine walls. You will need to do a vaginal cleanliness test. Sometimes, after its implementation, the doctor orders the use of vaginal globules for several days to clean the vagina.

Surgical hysteroscopy – the course of the procedure

This hysteroscopy is performed at the beginning of the cycle, as soon as the bleeding has stopped. You must not drink, eat or take any medications for about 6 hours before the procedure. Surgical hysteroscopy is always performed under general anesthesia. The hysteroscope used to remove the lesions has a slightly larger diameter than the one used during diagnostics. Usually, the patient can leave the hospital a few hours after the surgery. However, if there are any complications or irregularities, the time may be extended up to 24 hours.

Operative hysteroscopy – complications

After an operative hysteroscopy, complications are possible, but similar to any medical procedurepossible complications cannot be completely excluded. Bleeding is the most common. One of the more serious complications is uterine rupture or bladder perforation. Sometimes such a condition requires opening the abdominal wall to reduce the damage as quickly as possible and limit its unpleasant consequences. In addition, infections may occur, for example, related to bacteria transferred into the uterus directly from the vagina.

Considering general anesthesia, complications in the anesthetic area may arise. In most cases, however, it is sufficient to use the laparoscopic method.

However, operative hysteroscopy is not a method which causes complications frequently. This is why you should not be afraid of the test or the operating method. If there are indications, they should be done as soon as possible. Early detection of changes allows for their more efficient removal. Thanks to this, they will not have time to develop or turn into malignant changes. If you notice any disturbing symptoms after the procedure, please consult your doctor.

Surgical hysteroscopy – contraindications

Contraindications for performing the surgical hysteroscopy include: profuse uterine bleeding, recent or existing inflammation of the genital organs, pregnancy, complications of hysteroscopy, cervical cancer, damage to the uterine wall; infection, pulmonary embolism (rarely, with CO2 gas).

Hysteroscopy – intercourse after hysteroscopy

In the case of hysteroscopy, as in any medical procedure, the time after the procedure is important, which should be spent on convalescence. The length of this period depends on the type of hysteroscopy performed, as well as the reason why it was carried out. In the case of diagnostic hysteroscopy, patients are usually recommended not to have sexual intercourse within one day after its performance, and until possible bleeding ceases.

In most cases, this bleeding will last for up to 7 days after the procedure and resembles spotting. During this time, remember to maintain proper personal hygiene.

Hysteroscopy – bleeding after hysteroscopy

If bleeding occurs, do not take it lightly and carefully observe your body, paying attention to the extent of the bleeding. Observations should also concern other possible effects after the surgery. In such cases, you should rest and take care of personal hygiene.

Occasionally, genital spotting may occur after sexual intercourse has begun, even after waiting for a period of time. However, it should be added that this is not a cause for concern, because we are dealing with the so-called contact bleeding, which is associated with irritation around the mouth of the cervix. However, if the bleeding becomes intense and lasts a long time, you should see your doctor immediately.

Hysteroscopy – becoming pregnant after surgery

In the case of intercourse, these are allowed as early as 3-4 weeks after the surgery, and therefore, there is no reason to try to get pregnant after this time. Interestingly just Surgical hysteroscopy is considered a method of infertility treatment, because the presence of polyps or adhesions may make it difficult to become pregnant or report it. All this makes this type of diagnosis and treatment recommended to people who have problems with conception or maintenance of pregnancy.

Read more about it: Hysteroscopy in the diagnosis of female infertility – indications, course, complications [EXPLAINED]

Hysteroscopy — hysteroscope

The hysteroscope is a tool used in both types of hysteroscopy. In the case of diagnostic hysteroscopy, the device has a smaller diameter, which is associated with much lower discomfort experienced by the woman during the examination. Therefore, for operative hysteroscopy, general anesthesia is necessary when introducing a hysteroscope. As for the appearance of this device, it consists of a long, flexible tube, which is equipped with a digital camera and a lamp.

Thanks to the speculum, the hysteroscope is inserted inside the uterus, and the image transmitted from there is visible on the monitor screen. As a result, the doctor can precisely assess the patient’s condition, and in the event of any lesions, observe their location and size. It is also worth adding that in the case of a surgical procedure, surgical instruments are introduced into the uterus through the hysteroscope, which makes it possible to perform an operation with a low level of invasiveness.

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