Saline infusion sonography vs. flexible office hysteroscopy, comparing patient satisfaction and pain perception

Abstract

OBJECTIVE: Abnormal uterine bleeding is a common complaint presenting to gynecology clinics. Work-up of this is varied given the multiple diagnostic tools that can be utilized. Studies have demonstrated that saline infusion sonography (SIS) and office hysteroscopy have similar diagnostic ability. Few studies have examined which procedure is better tolerated. The purpose of this study is to determine if there is a difference in pain perception and satisfaction in patients undergoing SIS compared to flexible office hysteroscopy (fOHS). DESIGN: Prospective, randomized, cross-over study. MATERIALS AND METHODS: Women who were scheduled to have fOHS from 6/2006-4/2008 were eligible. Following enrollment, participants were randomized to either having the fOHS first or the SIS. A fifteen minute washout period was allowed prior to the subsequent procedure. After each procedure, participants completed a questionnaire regarding their experience. Pain and tolerance were analyzed with a Visual Analogue Scale (VAS). RESULTS: 42 women enrolled. Average age was 40.5 years. No significant difference was noted in demographics between the two groups.76% Caucasian, 79% parous, and 12% menopausal. Average time taken for fOHS was 255 seconds vs. 296 seconds for SIS. There was no significant difference between identification of pathology between with the two imaging modalities. Overall pain and tolerance scores were significantly lower for fOHS than SIS. When performing the sub-analysis, pain and tolerance scores for subjects undergoing fOHS first were lower than those undergoing it secondarily. SIS scores did not differ between the two groups. No participants were unsatisfied with fOHS whereas 9 were unsatisfied with SIS. If requiring this type of procedure again, 78% of women preferred to have the fOHS. Six women preferred the SIS, all of whom were in the group that had the SIS first. Comfort during the procedure was most important for 74%. Time for the procedure was least important for 43%.Table 1VAS of Pain and Tolerance During and After the ProceduresfOHS (cm)SIS (cm)p valuePain during1.723.74<0.05Tolerance during1.293.04<0.05Pain after1.122.31<0.05Overall tolerance0.782.8<0.05 Open table in a new tab CONCLUSIONS: Consistent with the reported literature, there was no significant difference in diagnosis of pathology for SIS and fOHS in this study. fOHS is the preferred procedure with respect to patient tolerance, pain levels, and satisfaction.