Hysteroscopic Polyp Resection Research Articles

Dilapan-S versus Phloroglucinol for Cervical Dilatation in Operative Hysteroscopy and Polyp Resection: A Prospective Cohort Study

Background: To compare the effects of Dilapan-S versus phloroglucinol on cervical dilation in hysteroscopic polyp resection. Methods: This prospective, observational study enrolled non-menopausal patients with endometrial polyps who underwent operative hysteroscopy for transcervical polyp resection between October 2021 and October 2022. The patients were given Dilapan-S or phloroglucinol for cervical dilation. The primary outcome was cervical dilation time; secondary outcomes included cervical softening and adverse events. Non-inferiority was prespecified with a margin of 6 seconds. Results: Among 105 included patients, 55 were given phloroglucinol and 50 Dilapan-S. There were no significant differences in age, body mass index (BMI), history of vaginal delivery, hysteroscopic electrotomy, and cervical conization between the two groups (all p > 0.05). The cervical dilation time in the Dilapan-S group was shorter than in the phloroglucinol group (41.74 ± 8.68 s vs. 62.04 ± 9.55 s, non-inferiority p < 0.001). Also, more patients achieved highly effective cervical softening in the Dilapan-S group compared to the phloroglucinol group (44/50 vs. 1/55, p < 0.001). There were 4 cases of diarrhea (p = 0.103), 12 cases of vaginal bleeding (p < 0.001), and 4 cases of abdominal pain in the Dilapan-S group (p = 0.103), and none in the phloroglucinol group. There were also 5 cases of intraoperative water leakage in the phloroglucinol group and 8 cases in the Dilapan-S group (p = 0.283). Conclusions: Dilapan-S is found to be equally effective for cervical dilation as phloroglucinol; however, it is associated with a higher incidence of diarrhea, vaginal bleeding, and abdominal pain complications.

Does hysteroscopic resection of polyps require cycle cancellation in women undergoing controlled ovarian hyperstimulation in the ICSI cycle?

Objective:Endometrial polyps are one of the most extensive pathologies in the uterus and can be detected incidentally during assisted reproductive therapy in asymptomatic women.Materials and Methods:In patients planned for in vitro fertilization or intracytoplasmic sperm injection (ICSI) treatment, embryo freezing, or cycle cancelation options are mandatory in many clinics when detected at the beginning of the cycle. In our study, in ICSI treatment, patients with a single endometrial polyp smaller than 1.5 cm, who underwent hysteroscopic polyp resection at the beginning of the cycle and underwent fresh embryo transfer without canceling the treatment (n=31), and patients with the same characteristics of endometrial polyp who underwent hysteroscopic polyp resection before the cycle (n=34) are compared within the pregnancy, abortion and live birth rates.Results:As a result, no statistical difference was found between the two groups’ pregnancy, abortion, and live birth rates.Conclusion:Hysteroscopic resection of polyps during ovarian stimulation in ICSI treatment does not affect pregnancy and live birth rates and may eliminate the necessity of freezing.

Atypical endometrial polyps and the incidence of endometrial cancer: a retrospective cohort study.

The aim of this study was to evaluate the incidence of endometrial carcinoma, proven after hysterectomy, in patients diagnosed with atypical endometrial hyperplasia confined to a polyp. A secondary aim was to establish factors associated with (pre-)malignant alterations in a polyp. A retrospective cohort study. Maastricht University Medical Centre (MUMC+) and Máxima Medical Centre in Eindhoven/Veldhoven (Máxima MC). Women who underwent a hysteroscopic polyp resection between 2008 and 2016. Patient characteristics and histopathology results of the polyp and, in the case of a hysterectomy, uterus were collected from patients' charts. A total of 1445 complete hysteroscopic polyp resections were included. Of those, 1390 polyps showed benign histopathology results, 39 polyps contained atypical hyperplasia and 16 polyps contained endometrial carcinoma. A hysterectomy was performed in 35 women who were diagnosed with atypical hyperplasia confined to a polyp after hysteroscopic polyp resection. Histopathological assessment showed no additional (pre-)malignant changes of the endometrium in 12 women (30.8%), atypical hyperplasia in 11 women (28.2%) and endometrial carcinoma in 12 women (30.8%). None of the prognostic factors under consideration were significantly associated with (pre-)malignant changes in a polyp. The incidence of endometrial carcinoma in the surrounding endometrium after complete resection of a polyp with atypical hyperplasia is 30.8% in this study. This supports the current advice to perform a hysterectomy and bilateral salpingo-oophorectomy. No prognostic factor for (pre-)malignant changes in a polyp was established. The incidence of endometrial carcinoma after complete resection of a polyp with atypical hyperplasia is high.

Hysteroscopic Resection of Endometrial Polyps and Assisted Reproductive Technology Pregnancy Outcomes Compared with No Treatment: A Systematic Review

Endometrial polyps are frequently encountered in the uterine cavity of infertile women. There is much debate regarding the treatment of endometrial polyps in patients who are undergoing assisted reproductive technology (ART). A systematic review was performed by searching PubMed, Embase, and the Cochrane Library for retrospective or prospective studies that compared the effect of hysteroscopic resection of polyps with no treatment on pregnancy outcomes of patients who underwent ART. The primary outcomes were clinical pregnancy, live birth, miscarriage, and implantation rates after ART. Eight studies with a total of 2267 patients were included. The results showed that hysteroscopic resection of endometrial polyps (mean size <2 cm) was associated with an increased rate of clinical pregnancy in patients who underwent intrauterine insemination. No clear benefit was observed for clinical pregnancy, live birth, miscarriage, or implantation rates in patients who underwent in vitro fertilization/intracytoplasmic sperm injection cycles. In conclusion, the effect of hysteroscopic polypectomy on pregnancy outcomes of patients who have undergone ART remains unclear. More prospective, randomized controlled trials are warranted to determine appropriate treatment.

Risk of malignancy on suspicion of polyps in menopausal women

Improved performances in gynaecological ultrasonography have enabled an increasing number of often asymptomatic endometrial polyps to be detected. Most of these polyps are removed surgically, as a precautionary measure, so as not to miss a case of endometrial cancer. Nonetheless, this management strategy is based solely on the sonographer’s judgement and a number of these operations, which are probably of no benefit, could be avoided. In order to do so, risk factors for malignancy need to be identified. ObjectiveEstimate the prevalence of lesions in menopausal patients with a pre-operative diagnosis of endometrial polyp. Establish risk factors for malignancy. Study designThis is a single-centre retrospective study. Enrolment criteria were menopausal patients aged over 45 who had undergone hysteroscopic resection of a polyp. Pre-op diagnosis was made either by ultrasonography or diagnostic hysteroscopy. Malignant lesions included cancers and atypical hyperplasia. Benign lesions consisted of simple polyps, non-atypical simple hyperplasia and non-atypical complex hyperplasia. Risk factors studied were existing abnormal uterine bleeding, endometrial thickness, personal or first-degree family history of gynaecological cancer (breast, cervix, endometrium, ovary) and age on diagnosis. Results631 patients were enrolled of whom 30 presented a malignant disorder (4.75%); 579 patients (91.76%) presented a simple polyp, 11 a non-atypical simple hyperplasia (1.74%) and 11 a non-atypical complex hyperplasia (1.74%).On univariate analysis age alone proved to be statistically significant (OR 1.05; 95%CI=[1.02–1.09] p<0.01), with a threshold of 59 years of age on the ROC curve. On multivariate analysis, factors predictive of a malignant lesion were age (OR=1.06; 95%CI [1.02–1.10]), existence of AUB (OR=2.4; 95% CI [1.07–5.42]) and family history (OR=2.88; 95%CI [1.08–7.67]). Neither the univariate nor multivariate model was able to demonstrate a statistically significant relationship with respect to endometrial thickness.The risk of malignancy was 12.3% in patients aged over 59 presenting AUB. For all other subgroups, the risk varied between 2.31 and 3.78%. ConclusionThe risk of a malignant lesion appears to be high (12%) in menopausal patients aged over 59 presenting an endometrial polyp detected when there is pre-existing AUB. In this situation, hysteroscopic resection of endometrial polyps should therefore be routinely proposed.For other patients, the risk of a malignant lesion is low but not insignificant, standing at about 3%. Each patient record should therefore be discussed on an individual case basis, taking into consideration the patient’s pre-existing conditions, after providing clear and appropriate information.

Acceptability of Endometrial Polyp Resection under Local Anaesthesia

<strong><em>Introduction</em></strong>: New evidence is emerging to suggest that outpatient endometrial polyp removal under hysteroscopic guidance by morcellation with local anaesthesia is non-inferior to in patient polypectomy under general anaesthesia. However, evidence on its acceptability warrants further evaluation. <strong><em>Objective: </em></strong>To assess the patient’s acceptability of endometrial polyp resection under local anesthesia in an outpatient setting. <strong><em>Methodology </em></strong>: A prospective cohort study was carried out for three months on all patients who underwent this procedure under local anaesthesia in a secondary care unit in the United Kingdom. Intra-operative and post-operative acceptability was assessed by a standard questionnaire filled immediately after the procedure and before discharge on the first post-operative day. <strong><em>Results </em></strong>: Fifty patients underwent this procedure. The mean age was 56.48(range36-83). Complete resection of the polyps was achieved in 94% of the patients, while 6% had partial resection without total failure. Average, intra operative, immediate post operative and day 1 post operative pain scores were 2.38, 1.44 and 1.38 respectively and were in the mild category of the Discrete Quantitative Pain Verbal Rating Scale. Seventy eight percent of the patients were totally satisfied with the procedure while 14% and 8% were generally and fairly satisfied. None expressed that the procedure was unacceptable. Ninety four percent opted to recommend the procedure to a friend while 96% of patients expressed their willingness to undergo the procedure under local anesthesia, if they were to have another resection of the polyp. <strong><em>Conclusion</em></strong>: Outpatient hysteroscopic polyp resection by morcellation under local anesthesia is well tolerated and accepted by patients in an outpatient setting.

Reproductive outcomes following hysteroscopic resection of endometrial polyps of different location, number and size in patients with infertility

We aimed to assess the pregnancy rates after hysteroscopic polypectomy in infertility patients with endometrial polyps and to compare pregnancy rates among subgroups with polyps of different location, size and number. All patients who underwent hysteroscopic evaluation which revealed endometrial polyps were included. Patients with any intrauterine pathology other than polyp and those undergoing frozen embryo transfer (ET) cycles were excluded. Patients were evaluated according to polyp location, size and number. Rates of β-hCG positivity and clinical pregnancy were compared. Clinical pregnancy rates after polypectomy was 41.7% for multiple polyps, 30.8% for isthmus zone polyps, 28.6% for anterior wall polyps, 27.3% for cornual zone, 22.2% for posterior uterine wall polyps and 11.8% for fundal polyps (p = 0.532). There appears no difference regarding reproductive outcomes after hysteroscopic resection of polyps situated in different intrauterine locations. Similarly, chance of conceiving seems not to change after hysteroscopic treatment of polyps of different size and number.

Appropriate interval between endometrial polyp resection and the proceeding IVF start

Endometrial polyp is the commenest pathology among the structural uterine abnormalities. In this study we compared the IVF outcomes of patients who underwent hysteroscopic endometrial polyp excision with respect to the time interval between the polyp resection and the subsequent IVF cycle. A total of 60 patients were divided into two groups according to the time interval between the hysteroscopic polyp resection and the start of the following IVF cycle. Of these, 29 patients had the IVF procedures <6 months after the polyp resection, whereas in 31 patients comprising the comparison group, IVF interventions were done ≥ 6 months after the resection. The IVF outcomes were compared. Differences in the mean number of retrieved oocytes, metaphase II (MII) oocytes and transferred embryos, ratios of MII oocytes, and G1, G2 and G3 embryo rates were insignificant between the groups (p > 0.05). The fertilization, implantation, and clinical pregnancy rates were also similar between the groups (p > 0.05). IVF outcomes seem to be unrelated to the time interval between the hysteroscopic polyp resection and the initiation of the IVF; the success rates may not be superior if the treatment is started in the first few months postoperatively.

The effects of the number, location, dimension and histopathological diagnosis of endometrial polyps on laboratory and clinical findings

The aim of this study was to evaluate the effects of the number, location, dimension and histopathological diagnosis of endometrial polyps on laboratory and clinical findings. Seventy three women with endometrial polyps who underwent hysteroscopic polyp resection at Gynecology Clinic of Bakirkoy Dr. Sadi Konuk Education and Research Hospital were evaluated retrospectively from January 2008 to July 2009. Sociodemographic characteristics, symptomatology and menopausal status of the patients were documented. Polypectomy was performed by bipolar resectoscope in all cases under general anesthesia in operating room. Hemoglobin levels were measured just before and after 3 months later operation. The number, location, dimension, histopathological diagnosis of endometrial polyps and clinical symptoms were recorded. The histopathological diagnosis were benign endometrial polyp in 70 (%95,8) cases, complex endometrial hyperplasia with atypia in two cases (%2,73) and endometrial carcinoma in one case (%1,36). Ninety percent of the patients in the menopausal group and %84,9 of the patient in the reproductive age group were symptomatic. In addition, %88,6 of polyp in the reproductive-age and %85 of polyp in the menopausal group were single. The polyp number, dimension and location were not statistically correlated with symptomatology (P=0,346, P=0,350 and P=0,742, respectively) and histopathological diagnosis (P=0,825, P=0,751 and P=0,099, respectively). Polyp location, number and dimension do not correlate with histopathological diagnosis and symtomatology. The hemoglobin levels were significantly lower in cases with symptoms.

Management of endometrial polyps diagnosed before or during ICSI cycles

This retrospective study aimed to shed light on the management options of endometrial polyps diagnosed before or during intracytoplasmic sperm injection (ICSI) treatment. The study included all fresh ICSI cycles performed in the Anatolia IVF Center between July 2005 and January 2009. Group 1 consisted of 47 patients who were diagnosed with an endometrial polyp before their ICSI cycle. All patients diagnosed with an endometrial polyp by transvaginal ultrasonography before the ICSI cycle underwent hysteroscopic polyp resection. Group 1 was compared with 47 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 2). Group 3 included 128 patients diagnosed with an endometrial polyp during stimulation in their ICSI cycles. Group 3 was compared with 128 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 4). Patients diagnosed with an endometrial polyp before ICSI cycles were similar to their controls with regard to clinical pregnancy (29.8% versus 38.3%) and live-birth (25.5% versus 31.9%) rates per transfer, as were patients diagnosed with an endometrial polyp during ovarian stimulation (clinical pregnancy rates 45.3% versus 46.9%; live-birth rates 40.6% versus 39.8%). In conclusion, further studies are required to identify the most appropriate management of endometrial polyps. In our retrospective study, we aimed to shed light on management options of endometrial polyps diagnosed before or during intracytoplasmic sperm injection (ICSI) treatment. This study included all fresh ICSI cycles performed at the Anatolia IVF Center between July 2005 and January 2009. Group 1 consisted of 47 patients who were diagnosed with an endometrial polyp before their ICSI cycle. All patients diagnosed with an endometrial polyp by transvaginal ultrasonography before the ICSI cycle underwent hysteroscopic polyp resection. Group 1 was compared was compared to 47 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 2). Group 3 included 128 patients diagnosed with an endometrial polyp during stimulation in their ICSI cycles. Group 3 was compared to 128 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 4). Patients diagnosed with an endometrial polyp before ICSI cycles were similar to their controls with regard to pregnancy rates and outcomes. Patients diagnosed with an endometrial polyp during ovarian stimulation were similar to their controls with regard to pregnancy rates and outcomes. In conclusion, endometrial polyps <1.5 cm occurring during ovarian stimulation do not require any intervention. Resection of an endometrial polyp <1.5 cm detected before an ICSI cycle is not required and might be even harmful.

Prevalence, 1-Year Regression Rate, and Clinical Significance of Asymptomatic Endometrial Polyps: Cross-sectional Study

Study Ojective To estimate the prevalence, 1-year regression rate, and clinical significance of endometrial polyps in women aged 45 to 50 years. Design Cross-sectional study (Canadian Task Force II-2). Setting University teaching hospital. Patients Two hundred fifty-seven of 1000 randomly selected women aged 45 to 50 years. Interventions Transvaginal ultrasonography and saline infusion sonography were performed in all study participants and were repeated in women with endometrial polyps after 12 months. Polyps present at follow-up were removed by hysteroscopic polyp resection. Measurements and Main Results Endometrial polyps were diagnosed in 31 women (12.1%). At 1 year, the polyp regression rate was 27%. Myomas occurred more often in women with endometrial polyps, and women with polyps experienced significantly heavier periodic bleeding compared with women without polyps. Conclusion Our study findings suggest that endometrial polyps are common in women aged 45 to 50 years and that women with such polyps experience heavier periodic bleeding. Although some polyps seem to regress spontaneously during 1-year follow-up, most seem to persist.

Hysteroscopic Resection of Polyps Exclusively in Cervical Block – Is it Feasible?

Hysteroscopic Resection of Polyps Exclusively in Cervical Block – Is it Feasible?

Outcomes of endometrial-polyp treatment with hysteroscopy in operating room

To assess the results of using a resectoscope in the hysteroscopic resection of endometrial polyps that were previously diagnosed by office hysteroscopy and to demonstrate the necessity of extraction for histological study. A prospective long-term follow-up study (level of evidence II-2). University Hospital. 303 women presenting a hysteroscopic image of an endometrial polyp. Interventions: Office hysteroscopy, hysteroscopic resection of polyps by means of a resectoscope and an anatomopathological study of the polyps. Statistical analysis was performed. 303 diagnosed endometrial polyp formations were resected by means of hysteroscopy during surgery. In all cases, biopsies of the uterine cavity or of the polyp were negative. Resection of the polyps with hysteroscopy in the operating room using a resectoscope proved to be a safe technique. The anatomopathological study of the polyps showed hyperplasia with atypias in 10 cases (3.3%) and endometrial cancer in 9 women (3.0%). Our study data suggest that endometrial polyps should be resected because they may harbor malignant or premalignant lesions. Hysteroscopic surgery is recommended for its simplicity and scant complications.

OC116: Transvaginal ultrasound‐guided polypectomy versus hysteroscopic polyp resection: a randomised controlled trial

OC116: Transvaginal ultrasound‐guided polypectomy versus hysteroscopic polyp resection: a randomised controlled trial

Endometrial polyps smaller than 1.5 cm do not affect ICSI outcome

This study aimed to determine whether the presence of endometrial polyps discovered during ovarian stimulation affects the outcomes of intracytoplasmic sperm injection (ICSI) cycles. This retrospective descriptive study was conducted in a private assisted reproductive technology unit. Medical records of ICSI cycles performed between January 2003 and December 2004 were reviewed. Patients were divided into three groups: patients with endometrial polyps discovered during ovarian stimulation (group 1, n = 15), patients who underwent hysteroscopic polyp resection prior to their ICSI cycle (group 2, n = 40) and patients without polyps (group 3, n = 956). Main outcome measures were clinical pregnancy rates and implantation rates. Age of the patients, age of the husbands, body mass index, total amount of gonadotrophins used, length of stimulation, peak oestradiol concentrations, peak endometrial thickness and number of embryos replaced were not significantly different between the groups, nor were the pregnancy and implantation rates. Only one patient (12.5%) from the first group experienced miscarriage within 12 weeks of pregnancy. In conclusion, endometrial polyps discovered during ovarian stimulation do not negatively affect pregnancy and implantation outcomes in ICSI cycles.