Diagnostic Office Hysteroscopy Research Articles

Correlation between hysteroscopic features and specific microbial species in women with chronic endometritis

Objective and rationaleChronic endometritis (CE) has recently been associated with unexplained infertility and recurrent miscarriages. The current gold standard for CE detection is histopathological examination. However, office hysteroscopy and endometrial cultures are also significant, due to the possible link between CE and various microorganisms. Bacterial colonization of the endometrium has been associated with reduced success rates of in vitro fertilisation embryo transfer. Few studies have tried to correlate CE hysteroscopy findings with pathogenic microorganisms. This prospective cohort study sought to establish whether hysteroscopic diagnostic lesions correlate with specific microbial species. MethodsThe study encompassed women undergoing diagnostic tests for a range of subfertility health issues. 189 women completed the standard office diagnostic hysteroscopy (DH). 181 had also endometrial samples taken for microbial culture investigation. Correlation analysis (χ2 and Fisher's exact test) between hysteroscopic findings suggestive of CE and endometrial cultures was carried out. Logistic regression models were also fitted to measure whether a positive endometrial culture could affect CE conditions. ResultsA significant association of E. coli was observed between the hysteroscopically characterized CE + group with focal hyperplasia, when compared to the non–CE group. Logistic regression analysis revealed that women positive for E. coli were 4.423 times more likely to have focal endometrial hyperplasia. No other significant correlations were identified between DH and positive endometrial cultures. ConclusionsThe presence of E. coli in the endometrium was significantly correlated with focal hyperplasia findings from hysteroscopy, emphasizing the importance of microbial cultures in the diagnosis and targeted treatment of CE in women with subfertility.

Hysteroscopic morcellation vs. curettage for removal of retained products of conception: a multicenter randomized controlled trial

To study the comparison between hysteroscopic morcellation (HM) of retained products of conception (RPOC) with ultrasound (US)-guided electric vacuum aspiration in terms of intrauterine adhesion (IUA) formation, efficacy, and complications. A randomized controlled, nonblinded trial. Three teaching hospitals and one university hospital from April 2015 to June 2022. A total of 133 women with RPOC on US, ranging from 1-4 cm, were randomized to receive either HM or electric vacuum aspiration. Hysteroscopic morcellation was performed with the TruClear System (Medtronic, Minneapolis, MN, USA). Electric vacuum aspiration was performed using an 8- or 10-mm flexible plastic Karman cannula under US guidance. Women allocated to vacuum aspiration underwent the procedure as soon as possible. In the HM group, an office diagnostic hysteroscopy was planned a minimum of 6 weeks after the end of pregnancy, followed by retained product of conception removal at least 8 weeks after the end of the pregnancy. Postoperatively, an office second-look hysteroscopy was scheduled to assess the primary outcome of IUAs. Postoperative IUAs were seen in 14.3% (9/63) of patients in the HM group and 20.6% (13/64) of patients in the vacuum aspiration group (-6% [-19.1% to 7.1%]). Significantly more RPOC were removed completely by HM compared with vacuum aspiration (95.2% vs. 82.5% (-14% [-24.9% to -3.1%]), and additional operative hysteroscopy was less frequently necessary in the HM group (12.5%) compared with the vacuum aspiration group (31.3%) (-20.1% [-34.3% to -6%]). The median operating time was shorter for vacuum aspiration compared with HM (5.80 minutes vs. 7.15 minutes). No differences were observed between HM and vacuum aspiration for the occurrence of intraoperative or postoperative complications (5.5% vs. 5.0% and 2.7% vs. 1.3%, respectively). In our randomized controlled trial, no significant differences were found in the occurrence of IUAs and complications. However, the RPOC were more often completely removed by HM than vacuum aspiration, and the HM group required fewer additional hysteroscopic treatments. NTR4923 (https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923). Date of registration: November 23, 2014, date of initial participant enrollment: January 1, 2015.

Efficacy of Oral Nifedipine, Naproxen, or Placebo for Pain Relief During Diagnostic Hysteroscopy in an Office Setting: A Randomized Pilot Study

To compare nifedipine, naproxen, or placebo for pain relief during diagnostic hysteroscopy. Double-blind, randomized controlled pilot study. University hospital. Women scheduled for office diagnostic hysteroscopy (n=60). Women received nifedipine (2 tablets of 10 mg), naproxen (2 tablets of 250 mg), or placebo (2 tablets of 500 mg lactose) 30 to 60 minutes prior to hysteroscopy. Sixty patients were enrolled in the study (21 in the nifedipine group, 19 in the naproxen group, and 20 in the placebo group). The median pain scores during hysteroscope insertion, measured on a Visual Analog Scale (VAS), were 1 (interquartile range (IQR) 0-0), 2 (0-4) and 1 (0-1) in the nifedipine, naproxen and placebo group, respectively (P,14). The median VAS scores during hysteroscopy were 5 (IQR 2-7), 5 (4-8) and 5 (3-7) in the nifedipine, naproxen and placebo group, respectively (P,73). The median VAS scores immediately after hysteroscopy were 2 (IQR 0-4), 3 (0-6) and 3 (1-5) in the nifedipine, naproxen and placebo group, respectively (P,40). The median VAS scores 30 minutes after hysteroscopy were 1 (IQR 0-2), 1 (0-1) and 1 (0-2) in the nifedipine, naproxen and placebo group, respectively (P,63). Hysteroscope insertion failed in 1 case (naproxen group) because of cervica`l stenosis (P,32). Flushes, fatigue and vertigo, 30 minutes after the procedure, were significantly more prevalent in the nifedipine group compared to the naproxen (p < .001, p,03, p,03, respectively) and the placebo group (p < .001, p,01, p,01, respectively). Palpitations occurred only in the nifedipine group (p < .001). The day after the procedure, the headache was most prevalent in the nifedipine group compared to the naproxen group (p,001) and the placebo group (p,001). In our pilot study, pain relief and success rates for office diagnostic hysteroscopy were not significantly different between nifedipine, naproxen, and placebo. Nifedipine was associated with more, albeit tolerable, side-effects.

Prevalence of hysteroscopic alterations in patients with recurrent pregnancy loss

ObjectiveTo determine the prevalence of uterine malformations and endometrial disorders diagnosed through office hysteroscopy in women with recurrent pregnancy loss (RPL). MethodsRetrospective analysis of medical records of 114 patients referred to a tertiary academic hospital in Belo Horizonte, Brazil, between January 2014 and August 2022, due to a history of two or more miscarriages (RPL group) and 1144 women preparing for in vitro fertilization due to couple infertility (control group). All the participants underwent a diagnostic office hysteroscopy in the proliferative phase of the menstrual cycle. The prevalence of hysteroscopic alterations was compared between the RPL and control groups and between women with two versus three or more miscarriages, using the chi-square test. ResultsIn comparison with the control group, the RPL group had a higher prevalence of uterine malformations (15.8% vs. 4.6%, p<0.001), endometrial adhesions (12.3% vs. 3.3%, p<0.001) and endometritis (10.5% vs. 3.7%), and a lower prevalence of endometrial polyps (6.1% vs. 14.9%, p=0.01). Congenital malformations were present in 18/114 patients (15.9%), of which 11 cases (9.7%) were a septate/bicornuate uterus. There was no difference between the prevalence of hysteroscopic alterations in patients with two versus three or more miscarriages (35.3% versus 42.8%, χ2=0.395, p=0.529). ConclusionThe frequency of uterine malformations and endometrial disorders can be high in patients with RPL, including those with only two previous miscarriages. This finding supports the investigation of uterine disorders in women with a history of RPL.

Vaginal Isonicotinic Acid Hydrazide Prior to Diagnostic Office Hysteroscopy in Primarily Infertile Patients: A Randomized Double-Blinded Clinical Trial

Objective: The aim of this research was to learn if 900 mg of vaginal isonicotinic acid hydrazide (INH) reduced pain and improved insertion ease during diagnostic outpatient hysteroscopy (DOH) in nulliparous infertile patients, when administered 12 hours before DOH. Materials and Methods: A double-blinded, randomized, controlled study was carried out at a university teaching hospital. Primary infertile women (150) were allocated randomly to receive 900 mg of INH vaginally or a placebo 12 hours before DOH for infertility assessment. Patients were requested to assess the intensity of their pain on a visual analogue scale ranging from 1 to 10 during the DOH, which was the study's primary objective. Secondary outcomes were the time it took to insert the hysteroscope via the external cervical os and to view the uterus, patient satisfaction, postprocedural analgesic needs, and the ease with which DOH was performed. Results: Both groups shared baseline features. The INH group had a reduced mean pain score during DOH (3.9 ± 0.8 versus 5.8 ± 0.8; p < 0.001). DOH was easier in the INH group; ease of insertion score in the INH group was lower than in the placebo group (5.3 ± 0.1 versus 7.3 ± 1.1; p < 0.001). The INH group had greater satisfaction (7.6 ± 1.3 versus 5.1 ± 0.9; p < 0.001) and needed less analgesia (p = 0.02) than the placebo group. Both groups had comparable adverse effects. Conclusions: In nulliparous infertile women, 900 mg of vaginal INH 12 hours before DOH reduces perceived pain more effectively than a placebo, facilitating easier hysteroscope insertion and improving patient satisfaction. (J GYNECOL SURG 39:43)

Effect of misoprostol on cervical transition pain in office hysteroscopy: Results of a tertiary center

Objective: Office hysteroscopy is a method that has become increasingly popular because of its low complication rate, rapid recovery, and cost-effectiveness. Pain is the biggest obstacle to the successful completion of office hysteroscopy procedures. Thus, the present study aimed to investigate the efficacy of misoprostol in providing cervical ripening, and thus reducing pain during the cervical transition of hysteroscopy.&#x0D; Methods: This research was conducted as an observational case-control study. Seventy-nine patients who underwent office hysteroscopy were included. Twenty-nine patients were administered 200 μg of vaginal misoprostol 4 h before office hysteroscopy, whereas the control group consisting of 50 patients was not provided with premedication for cervical dilatation. Patients were asked to rate their pain between 0 and 10 using the visual analog scale (VAS) 30 min after the procedure.&#x0D; Results: VAS pain scores after diagnostic office hysteroscopy (3.61 ± 0.61) and operative office hysteroscopy (4.45 ± 0.82) were significantly lower in the misoprostol group than in the control group patients. None of the patients experienced serious side effects caused by misoprostol and requested to end the procedure.&#x0D; Conclusion: A significant reduction in the VAS pain score was detected in patients who were administered 200 μg of vaginal misoprostol 4 h before office hysteroscopy. Misoprostol facilitated transition by providing cervical maturation and reduced the risk of pain-related unsuccessful hysteroscopy.

Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini-hysteroscope?

To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini-hysteroscope. A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS <4) and moderate or severe pain (VAS ≥ 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined. Moderate pain (4 ≤ VAS < 7) was observed in 38% of patients (n= 117) and 14 patients (5%) experienced severe pain (VAS ≥ 7). In multivariate analysis, nulliparity (p= 0.01; OR, 4.6; 95% CI, 1.7-13.2), postmenopausal state (p= 0.02; OR, 2.2; 95% CI, 1.2-4.3), excessive flexion of the cervix and retroverted uterus (p<0.001; OR, 4.1; 95% CI, 2.0-8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy. In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy.

Prevalence of Endometrial Polyp by Office Hysteroscopy at a Tertiary Care Centre in Western Maharashtra: A Prospective Cohort Study

Introduction: Endometrial polyps occur in different reproductive age groups and make it a distinct pathological entity with diverse clinical manifestations. Aim: To determine the prevalence of endometrial polyp detected by office hysteroscopy, among different cohorts of patients attending the Gynaecology outpatient department at a tertiary care centre in western Maharashtra, India. Materials and Methods: A prospective cohort study was conducted in women who underwent office hysteroscopy, in view of infertility and Abnormal Uterine Bleeding (AUB) at a tertiary care centre in western Maharashtra, India from November 2020 to October 2021. The study included a total of 227 patients which were divided into four cohorts of women namely, infertility patients (aged 25-35 years) (N=115), AUB patients (aged 40- 44 years) (N=29), AUB patients (aged 45-50 years) (N=49) and in postmenopausal women (aged more than 51 years) (N=34). Results were expressed in terms of frequency and percentages. Results: Endometrial polyp was detected among 45 patients (19.82%) out of a total 227 patients who underwent office hysteroscopy. The prevalence rate was 16 (13.9) among women with infertility, 5 (17.2) among 40-44 years old women with AUB, 15 (30.6) among 45-50 years old women with AUB and 9 (26.5) among postmenopausal women. Conclusion: Endometrial polyp has a significant prevalence in patients with infertility as well as in patients with AUB. It can be easily detected by diagnostic office hysteroscopy, which should be included in the work-up of such patients.

Hysteroscopic evaluation of uterine cavity in women with unexplained infertility

Objective: To detect missed uterine abnormalities on primary work up in unexplained infertile women. Study design: An observational study was performed in the outpatient infertility clinic of Beni-Suef University Hospitals. It included 100 women with unexplained infertility. Diagnostic office hysteroscopy was done for all participants. Women were grouped according to the infertility type and compared as regards uterine abnormalities detected. Results: Uterine abnormalities were detected by hysteroscopy in 29% of women. No significant difference was found regarding the hysteroscopic findings between primary and secondary infertility groups. However, uterine polyp cases were detected more in women with primary infertility (55.5% /18). A significant difference in intrauterine adhesions between both groups being detected only in secondary infertility group (p value =0.006). Conclusion: Outpatient preliminary and routine diagnostic office hysteroscopy may be a beneficial part of a primary and secondary infertility workup.

A Pilot Study of Guided Conservative Hysteroscopic Evacuation of Early Miscarriage

<h3>Study Objective</h3> To evaluate initial feasibility and experience with guided hysteroscopic morcellation of uterine evacuation of early miscarriage. <h3>Design</h3> Prospective pilot study in a tertiary University hospital in Israel from May to October 2020. <h3>Setting</h3> Procedures were done under general anesthesia in the operating room. <h3>Patients or Participants</h3> Ten women with confirmed early miscarriage at gestational age of under 10 weeks from the last menstrual period. <h3>Interventions</h3> Hysteroscopic TRUCLEAR® tissue removal system was used for evacuation of early miscarriage. Procedures were done under ultrasound guidance. The procedures were recorded. (video). Data including the length of the procedure, visibility, complete evacuation, bleeding, complications, and follow-up ultrasound were documented. Patient consent to present and publish has been obtained. <h3>Measurements and Main Results</h3> Complete evacuation was recorded inall cases. No adverse events were recorded in any of the ten procedures. Mean time of the procedure was 24 minutes. In four cases (40%) an additional suction curettage was performed after the hysteroscopic procedure due to obscured visibility or abnormal ultrasound scan at the end of the procedure. However, RPOC were found in only one case (10%) in the suction specimen. Normal uterine cavity without evidence of retained products of conception (RPOC) was documented in follow-up evaluation by ultrasound in all cases, four patients underwent a diagnostic office hysteroscopy that demonstrated a normal cavity without evidence of adhesions. <h3>Conclusion</h3> Under vision Hysteroscopic morcellation seems to be a safe and feasible technique for management early miscarriage. This method may have a potential as an innovative treatment of miscarriage in selected cases. Further studies are needed to refine the indications and the surgical technique.

P–750 Clinical efficacy of virtual reality for acute pain and anxiety management during outpatient hysteroscopy and endometrial biopsy in subfertile patients

Abstract Study question Does the use of virtual reality (VR) headsets in diagnostic office hysteroscopy (HSC) with endometrial biopsy (EB) reduce anxiety and pain scores in the patient? Summary answer Virtual reality during office HSC do not seem to improve relaxation, anxiety, or pain scores. Physicians have a good perception of patients’ pain. What is known already Women undergoing outpatient HSC experience high levels of preoperative anxiety, which increase pain and discomfort during the procedure. The experience of pain is a complex phenomenon, which simultaneously occurs on cognitive, emotional, and behavioural levels, and is influenced by many factors. A Cochrane review failed to show a significant difference between different types of pain relief (analgesics, local anaesthetic and verbal support techniques …). VR is a multisensory immersion providing an interactive high level distraction, occupying a large portion of humans’ finite attentional resources (vision and audio), and leaving less cognitive capacity available to process pain. Study design, size, duration The sample size for this prospective randomized controlled trial was calculated at 196 patients (98 per group), considering a power of at least 80% to detect superiority of adding a VR headset versus standard care, standard deviation (SD = 2.0), using a two-sided, t-test, at significance level alpha of 0.05. The preliminary results after 1 month include a sample of 48 patients: 25 in the VR group and 23 controls. Participants/materials, setting, methods All 48 patients suffer subfertility and underwent HSC with EB at our tertiary-care fertility center. We used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Before and immediately after the exam, both patients and surgeons fill out a questionnaire using the 10.0cm visual analog scale (VAS). Main results and the role of chance The mean duration of HSC was 3min43sec in the VR group, (range 2–6min), compared to 4min50 in the control group (range 1–12minutes), which was not significantly different (p = 0.09). Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after HSC and one week later. According to VAS, stress levels did not differ significantly (p &amp;gt; 0.05) between the VR group and the control group, or within time: 5.08 to 5.36 to 3.08 vs 4.48 to 4.83 to 2.48 before, during and after HSC respectively. Fear levels prior to HSC at 4.28 for VR patients and 3.52 for controls did not increase significantly during HSC in both groups: 4.44 vs 4.17. During HSC, pain levels increased from 1.40 to 4.720 in the VR group vs 0.65 to 4.109 (NS) in the controls, to decrease again afterwards to 2.60 vs 2.17 (NS) respectively. Physicians rated the average pain levels of VR patients as 3.32 compared to 3.0 for controls, which was significantly correlated to patients’ perception (p &amp;lt; 0,005). Patients gave a positive rating to the VR experience (satisfaction score 7.17). Limitations, reasons for caution These are preliminary results, evaluating only a fourth of the required sample. A population selection bias could exist, as recruited patients were willing to accept VR. The very short induction period of 2 minutes could influence the effect of (immersiveness into) VR. Wider implications of the findings: Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Introducing VR might increase patient tolerance for longer or more painful procedures. Offering a range of options will increase the spectrum of successful procedures in the outpatient setting and improve patient experience. Trial registration number B.U.N. 1432020000050

P–317 Uterine cavity in patients with repeated implantation failure (RIF) and before the first IVFprogram

Abstract Study question What is the frequency of uterine pathology and histological analysis of chronic endometritis in the RIF group and in patients before the first IVF program? Summary answer We report a lower incidence of chronic endometritis in the group of patients just preparing for the first IVF program and higher effectiveness What is known already Chronic endometritis (CE) is one of the reasons for implantation failures in IVF cycles. The presence of chronic inflammation in the endometrium changes its susceptibility, resulting in failed implantations and loss of pregnancy. CE diagnostics is rather complicated. Visual examination during hysteroscopy allows one to suspect CE in 20–70%, routine histology - in 10–20%. The new gold standard is immunohistochemistry (IHC). Study design, size, duration A continuous study of 2003 hysteroscopies was carried out, conducted in 1944 patients from May 2018 to January 2020. All patients were divided into 2 groups: 1 - 650 patients preparing for IVF for the first time; 2 - 1294 with repeated implantation failures. Participants/materials, setting, methods All included patients had diagnostic office hysteroscopy (OH) with biopsy and IHC CD 138, CD 20, and CD 8. We compared the frequency of CE detection by visual examination during hysteroscopy, routine histology and IHC of the two groups, as well as the effectiveness of 1 course of antibiotic therapy with CE. Main results and the role of chance In group 1 of women preparing for IVF for the first time, during visual examination by hysteroscopy, CE was detected in 17% (110/650), in group 2 RIF - in 27% (349/1294), p &amp;lt; 0.001. Routine histology also more often detected CE in the RIF group, 42% (543/1294) compared with group 1 - 23% (149/650), p &amp;lt; 0.001. IHC markers of CE were detected in 81.8% (1058/1294) of samples from RIP group than in group 1 - 71.4% (464/650), p &amp;lt; 0.001. At the same time, IHC mild CE was more common in group 1 in 320/650 (49.2%), p &amp;lt; 0.001. In the second group, mild, moderate and severe CE occurred with the same frequency (33.2%, 36.5%, 30.3%, respectively). The frequency of CE detection by IHC in the groups after 1 course of antibiotic therapy with fluoroquinolones was 31.2% (145/464) and 43.2% (457/1058), respectively, p &amp;lt; 0.001. The pregnancy rate (PR) also differed and was the lowest in the RIF group: in group 1 after treatment with CE PR = 42.7% (198/464), in group 2 after treatment with CE PR = 27.2% (288 / 1058), p &amp;lt; 0.05. Limitations, reasons for caution The limitations are related to study design. More research is also needed. Wider implications of the findings: The question of overdiagnosis of CE using IHC remains open. Therefore, well-designed prospective studies or RCTs should be conducted to clarify possible correlations between ChE and poor reproductive outcomes and the effectiveness of endometrial interventions and treatments. Trial registration number not avaliable

P-750 Clinical efficacy of virtual reality for acute pain and anxiety management during outpatient hysteroscopy and endometrial biopsy in subfertile patients

Abstract Study question Does the use of virtual reality (VR) headsets in diagnostic office hysteroscopy (HSC) with endometrial biopsy (EB) reduce anxiety and pain scores in the patient? Summary answer Virtual reality during office HSC do not seem to improve relaxation, anxiety, or pain scores. Physicians have a good perception of patients’ pain. What is known already Women undergoing outpatient HSC experience high levels of preoperative anxiety, which increase pain and discomfort during the procedure. The experience of pain is a complex phenomenon, which simultaneously occurs on cognitive, emotional, and behavioural levels, and is influenced by many factors. A Cochrane review failed to show a significant difference between different types of pain relief (analgesics, local anaesthetic and verbal support techniques …). VR is a multisensory immersion providing an interactive high level distraction, occupying a large portion of humans’ finite attentional resources (vision and audio), and leaving less cognitive capacity available to process pain. Study design, size, duration The sample size for this prospective randomized controlled trial was calculated at 196 patients (98 per group), considering a power of at least 80% to detect superiority of adding a VR headset versus standard care, standard deviation (SD = 2.0), using a two-sided, t-test, at significance level alpha of 0.05. The preliminary results after 1 month include a sample of 48 patients 25 in the VR group and 23 controls. Participants/materials, setting, methods All 48 patients suffer subfertility and underwent HSC with EB at our tertiary-care fertility center. We used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Before and immediately after the exam, both patients and surgeons fill out a questionnaire using the 10.0cm visual analog scale (VAS). Main results and the role of chance The mean duration of HSC was 3min43sec in the VR group, (range 2-6min), compared to 4min50 in the control group (range 1-12minutes), which was not significantly different (p = 0.09). Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after HSC and one week later. According to VAS, stress levels did not differ significantly (p &amp;gt; 0.05) between the VR group and the control group, or within time 5.08 to 5.36 to 3.08 vs 4.48 to 4.83 to 2.48 before, during and after HSC respectively. Fear levels prior to HSC at 4.28 for VR patients and 3.52 for controls did not increase significantly during HSC in both groups: 4.44 vs 4.17. During HSC, pain levels increased from 1.40 to 4.720 in the VR group vs 0.65 to 4.109 (NS) in the controls, to decrease again afterwards to 2.60 vs 2.17 (NS) respectively. Physicians rated the average pain levels of VR patients as 3.32 compared to 3.0 for controls, which was significantly correlated to patients’ perception (p &amp;lt; 0,005). Patients gave a positive rating to the VR experience (satisfaction score 7.17). Limitations, reasons for caution These are preliminary results, evaluating only a fourth of the required sample. A population selection bias could exist, as recruited patients were willing to accept VR. The very short induction period of 2 minutes could influence the effect of (immersiveness into) VR. Wider implications of the findings Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Introducing VR might increase patient tolerance for longer or more painful procedures. Offering a range of options will increase the spectrum of successful procedures in the outpatient setting and improve patient experience. Trial registration number B.U.N. 1432020000050

Determining the Optimal Time Interval between Vaginal Dinoprostone Administration and Diagnostic Office Hysteroscopy in Nulliparous Women: A Randomized, Double-blind Trial

To determine the optimal timing of vaginal dinoprostone administration before office hysteroscopy (OH) in nulliparous women. Randomized, double-blind trial. Tertiary referral hospital. A total of 180 nulliparous women undergoing diagnostic OH. We randomly allocated the women to long-interval or short-interval dinoprostone groups: three mg dinoprostone was administered vaginally 12 hours before OH in the long-interval group and 3 hours before OH in the short-interval group. The primary outcome was pain during OH measured using a 100-mm visual analog scale (0=no pain; 100=worst pain imaginable). The secondary outcomes were ease of hysteroscope passage, patient satisfaction score, and drug-related adverse effects. The patients in the long-interval dinoprostone group had lower pain scores during OH (p <.001). Contrarily, pain scores 30 minutes after the procedure were similar in both groups (p=.1). The patient satisfaction score was higher and clinicians found hysteroscope passage through the cervical canal easier and quicker in the long-interval dinoprostone group than in the short-interval group (p <.001, p=.003, and p <.001, respectively). Side effects were comparable in both study groups. Vaginal dinoprostone administered 12 hours before OH was more effective than that administered 3 hours before OH in reducing pain during OH in nulliparous women, with easier hysteroscope insertion, shorter procedure duration, and higher patient satisfaction score.

Warm distension fluid reduces pain severity in office hysteroscopy: a randomized controlled trial.

BACKGROUND: Abnormal uterine bleeding (AUB) affects approximately 14% to 25% of women of reproductive age. The most common use of office hysteroscopy is to evaluate pathologies related to AUB and reproductive health, but office hysteroscopy can also be used for the diagnosis and treatment of other intrauterine pathologies.OBJECTIVE: Investigate the effects of the temperature of the distension fluid on pain severity in patients undergoing diagnostic office hysteroscopy due to AUB.DESIGN: Randomized controlled clinical trial.SETTING: Tertiary care center in Turkey.PATIENTS AND METHODS: One hundred perimenopausal patients with AUB were randomly allocated according to the temperature of the distension fluid used in office hysteroscopy (37°C or 25°C). Pain intensity was assessed using a visual analog scale (VAS). Six VAS measurements were compared over the course of the hysteroscopy: pre-treatment (VAS-1), at vaginal entry (VAS-2), at the cervical ostium transition (VAS-3), while in the cavity (VAS-4), at the end of the procedure (VAS-5), and 30 minutes after the end of the procedure (VAS-6).MAIN OUTCOME MEASURE: VASSAMPLE SIZE: Fifty in each group enrolled, one drop out.RESULTS: The VAS-3, VAS-4, and VAS-5 scores were significantly lower for patients in the warm fluid group than in the room temperature group (P<.05), whereas the VAS-1, VAS-2, and VAS-6 scores were similar in both groups.CONCLUSION: The application of warm distension fluid in office hysteroscopy reduces pain severity compared with the application of an unheated fluid.LIMITATIONS: The main limitations of the study were that a subgroup analysis could not be performed due to an insufficient number of cases, and we were unable to evaluate vasovagal symptoms.CONFLICT OF INTEREST: None.

Role of Diagnostic Office Hysteroscopy in Abnormal Uterine Bleeding and its Histopathological Correlation in Child Bearing Period

Strange uterine draining characterized as a seeping from uterine form which is irregular in volume, routineness or potentially timing that has been available for most of the most recent a half year. Assessment of the patients was by history taking, general and nearby assessment, research facility examinations, transvaginal ultrasonography, hysteroscopy and dilatation and curettage with biobsy. To evaluate the Role of Office Hysteroscopy in finding of Abnormal Uterine Bleeding and its Histopathological Correlation in Child Bearing Period. This examination was imminent observational investigation carried on 100 ladies of conceptive age bunch from 18-40 years took care of Benha college emergency clinics between November 2018 to November 2020 to assess the symptomatic and restorative function of office hysteroscopy in anomalous uterine draining and its histopathological connection in ladies inside kid bearing period. Office hysteroscopy had affectability of 88%, explicitness of 84,2%, positive prescient estimation of 96%, negative prescient estimation of 61.5% and demonstrative precision of 87% for diagnosing the intrauterine reason for unusual uterine dying. Office hysteroscopy is a straightforward, essential and generally safe outpatient strategy which permits a satisfactory investigation of the uterine cavity under visual control.

Addition of Lidocaine to the Distension Medium in Hysteroscopy Decreases Pain during the Procedure–A Randomized Double-blind, Placebo-controlled Trial

To evaluate the effect of adding a local anesthetic to the distension medium in office diagnostic hysteroscopy using the vaginoscopic approach on pain during the procedure. Secondary aims included documenting side effects, patient satisfaction, and the time needed to complete the procedure. Randomized double-blind placebo-controlled study. University-affiliated hospital; office hysteroscopy clinic. Total of 100 patients who underwent office hysteroscopies divided in half with 50 in the intervention group and 50 in the control group. Ten mL of lidocaine 2% added to 1000 mL of saline solution that was used as the distension medium for hysteroscopy in the study group vs 1000 mL of saline alone in the control group. A significant difference was found in the increment of pain as measured by visual analog scale after the hysteroscopy between the 2 groups. Patients receiving lidocaine had an average rise of 1.9 in the visual analog scale score after the procedure compared with 2.9 in the control group (p = .033). There was also a nonsignificant trend for shorter duration of hysteroscopy in the intervention group compared with the control group (180.1 vs 222.1 seconds, p = .08). Patients' satisfaction was high in both groups (98% for the study group and 92% for the control group). Success rates were also similar between the 2 groups at approximately 95%. No side effects were recorded in either group. The addition of local anesthetic to the distension medium in office hysteroscopy produces significant reduction in pain during the procedure without adding time to the procedure and without side effects.

Diagnostic office hysteroscopy with the Storz TrophyScope® versus Cooper surgical Endosee®.

Office hysteroscopy (OH) is becoming increasingly popular. Our objective was to determine the use patterns, reported pain scores, and success rates of OH with the 2.9 mm Storz TrophyScope® and handheld portable Cooper surgical Endosee® device in a clinic without previous office hysteroscopy experience. A prospective cohort study of a hysteroscopy quality improvement database was conducted in a tertiary care center gynecology clinic. Patients undergoing OH with either the Storz TrophyScope® or Cooper Surgical Endosee® device were included. Of the 171 office hysteroscopies, 77 utilized the TrophyScope®, with 8 (10%) being inadequate, while 94 utilized Endosee®, with 13 (14%) being inadequate (P=0.50). Of the 13 inadequate Endosee® hysteroscopies, 4 (31%) were due to visualization, 4 (31%) to patient intolerance, 3 (23%) to cervical stenosis, and 2 (15%) to a combination of these factors. Of the 8 inadequate TrophyScope® hysteroscopies, 7 (87%) were due to patient intolerance and 1 (13%) to cervical stenosis. Of the 150 adequate office procedures performed, 52 cases underwent subsequent procedures in the operating room (OR). Of these, 26 (84%) of 31 Endosee® cases and 18 (86%) of 21 TrophyScope® cases were in agreement with OR procedure findings. A subgroup analysis comparing mean pain levels did not significantly differ between the two hysteroscopes. There was no difference in accuracy with OR pathologic diagnoses, adequacy of procedure, and reported pain scores when comparing the TrophyScope® and Endosee® in this prospective cohort. Larger studies are needed to confirm the sensitivity, and specificity for these newer, disposable office hysteroscopic devices.

Pain management during diagnostic office hysteroscopy in postmenopausal women: a randomized study

Objective: This study aimed to compare efficacy and safety of lidocaine versus tramadol versus placebo in reducing the pain of diagnostic outpatient hysteroscopy (OH) in postmenopausal women.Materials and methods: This randomized double-blinded study included 156 menopausal women who received intrauterine lidocaine infusion or oral tramadol (50 mg) or placebo before diagnostic OH (52 women/group). Primary outcome was pain severity during the procedure using a 10-cm visual analog scale. Secondary outcomes were pain scores 10 and 30 min post procedure, satisfaction level, and ease of cervical entry.Results: Lidocaine had lower pain scores compared to placebo during and 10 min after the procedure (p < 0.001). Tramadol had lower pain scores than placebo during the procedure (p = 0.04), 10 min after the procedure (p = 0.03), and 30 min after the procedure (p = 0.04). Both lidocaine and tramadol resulted in an easier procedure than placebo (p < 0.001 and p = 0.04, respectively). Lidocaine had an easier cervical entry compared to tramadol (p = 0.004). Satisfaction scores in the lidocaine and tramadol groups were significantly higher than in the placebo group (p < 0.001).Conclusions: Lidocaine and tramadol were effective in reducing postmenopausal women-reported pain during and after diagnostic OH. However, lidocaine was better than tramadol in facilitating hysteroscope passage through the cervical canal and the reduction in pain levels with lidocaine was clinically relevant.Trial registration number: NCT03701984

1438 Experience with the Storz Trophyscope® Versus Cooper Surgical Endosee® for Office Diagnostic Hysteroscopy

Study Objective Determine use patterns and success rates for office diagnostic hysteroscopy with the 2.9 mm Storz TROPHYSCOPE® and handheld portable Cooper Surgical Endosee device in a clinic setting. Design Prospective cohort study of a hysteroscopy quality improvement database. Setting Gynecology clinic in a tertiary care center. Patients or Participants Patients undergoing office hysteroscopy with either the Storz Trophyscope or Cooper Surgical Endosee device. Interventions Diagnostic office hysteroscopy. Measurements and Main Results Of the 172 office hysteroscopies, 78 utilized the Trophyscope, with 8 (10%) being inadequate, while 94 utilized Endosee, with 13 (14%) being inadequate (p=.64). Of the 13 inadequate Endosee hysteroscopies, 3 (23%) were due to visualization, 5 (39%) due to patient intolerance, 3 (23%) due to cervical stenosis, and 2 (15%) due to both patient intolerance and stenosis. Of the 8 inadequate Trophyscope hysteroscopies, 7 (87%) were due to patient intolerance and 1 (13%) to cervical stenosis (p=0.14). Of the 151 adequate office procedures performed, 52 cases underwent subsequent procedures in the operating room (OR) with hysteroscopy or hysterectomy (Table 1). Of these, 27 (84%) of 32 Endosee cases and 15 (75%) of 20 Trophyscope cases were in agreement with findings from the OR procedure (p=0.48). Conclusion There is no difference in adequate visualization or pathologic diagnoses with the Endosee and TrophyScope devices in this prospective cohort. Larger, adequately powered studies are needed to confirm the sensitivity and specificity for these newer, disposable office hysteroscopic devices. Determine use patterns and success rates for office diagnostic hysteroscopy with the 2.9 mm Storz TROPHYSCOPE® and handheld portable Cooper Surgical Endosee device in a clinic setting. Prospective cohort study of a hysteroscopy quality improvement database. Gynecology clinic in a tertiary care center. Patients undergoing office hysteroscopy with either the Storz Trophyscope or Cooper Surgical Endosee device. Diagnostic office hysteroscopy. Of the 172 office hysteroscopies, 78 utilized the Trophyscope, with 8 (10%) being inadequate, while 94 utilized Endosee, with 13 (14%) being inadequate (p=.64). Of the 13 inadequate Endosee hysteroscopies, 3 (23%) were due to visualization, 5 (39%) due to patient intolerance, 3 (23%) due to cervical stenosis, and 2 (15%) due to both patient intolerance and stenosis. Of the 8 inadequate Trophyscope hysteroscopies, 7 (87%) were due to patient intolerance and 1 (13%) to cervical stenosis (p=0.14). Of the 151 adequate office procedures performed, 52 cases underwent subsequent procedures in the operating room (OR) with hysteroscopy or hysterectomy (Table 1). Of these, 27 (84%) of 32 Endosee cases and 15 (75%) of 20 Trophyscope cases were in agreement with findings from the OR procedure (p=0.48). There is no difference in adequate visualization or pathologic diagnoses with the Endosee and TrophyScope devices in this prospective cohort. Larger, adequately powered studies are needed to confirm the sensitivity and specificity for these newer, disposable office hysteroscopic devices.