“See and treat hysteroscopy” in the management of endometrial polyp

Abstract

Aims: The development and refinement of instruments and equipment led to the progressive use of “see and treat hysteroscopy” (HY), as a reliable alternative to the operative hysteroscopy (OHy) in the treatment of endometrial target lesions. We carried out a prospective study with the aim of evaluate the effectiveness and feasibility of HY for the treatment of endometrial polyps (EPs) in women complaining for abnormal uterine bleeding (AUB). Methods: All the patients (pt) admitted to our Institution were submitted to HY, if a suspicion of EP at the ultrasound assessment was reported in women complaining for AUB. Variables related to the surgical procedure and the patients’ compliance were registered. The pain was measured with NRS scale and defined as the pain felt during and up to 3 h after the procedure (perioperative pain). Results: Overall 219 pts were enrolled. 93.2% of EPs was radically removed by HY without any major surgical complications (bleeding or uterine perforation). The mean duration of HY was 15 min. 13.3% of the pts had to be submitted to more than one procedure because of EPs dimensions (23.28 mm ± 15.7 DS versus 13.6 mm ± 8.8 DS, p = 0.0001) or numbers (1.59 ± 1.0 DS versus 1.22 ± 0.4 DS; p = 0.003). OHy was performed in the 6.8% of the pts initially submitted to HY; major reasons were patient's choice (6/15 pt, that is 2.7% of overall population) or intraoperative vasovagal reaction (4/15 pt, that is 1.8% of overall population). No differences were reported between HY and OHy in EPs mean diameter (14.9 mm ± DS 10.6 vs. 18 mm ± DS 9.6, p 0.5) or numbers (1.25 ± DS 0.6 vs. 1.07 ± 0.3, p 0.6). Perioperative pain resulted as feeble or mild pain according to NRS pain score in 61.2% of the patients; overall mean NRS was 5.5 ± DS 2. Women with a previous vaginal delivery (32.5% versus 16.7% of nulliparae, p 0.01) or taking progestins as a concomitant therapy (77.8% versus 38.7% without therapy, p 0.01) judged more commonly as feeble the perioperative pain. Conclusions: Immediate HY is a fast, effective and feasible outpatient surgical procedure in the treatment of EPs, regardless their numbers or dimensions. The diffusion of HY could reduce patient's hospital admission and OHy's indications, without reducing the quality of treatment and histological specimen. Immediate HY could speed up the diagnostic management of EPs in women with AUB. Progestins therapy may improve intraoperative pain, because of their uterine cervical muscle relaxant and anti-inflammatory properties.