Evaluation of diagnostic and therapeutic hysteroscopy outcomes at a tertiary hospital in Rwanda

BackgroundThe aim of the study is to analyse the overall satisfaction level of patients undergoing diagnostic and/or therapeutic hysteroscopy in an ambulatory setting and examine factors related to satisfaction.MethodsA retrospective descriptive study was conducted to analyse outpatient hysteroscopies performed between January 2020 and June 2022 at the University Hospital of Igualada. Patient demographic and clinical data as well as hysteroscopic features were collected. A telephonic questionnaire on patient satisfaction was conducted retrospectively.ResultsA total of 435 hysteroscopies were analysed. Hysteroscopy was successful in 95.6% of them with a clinical remission in 69.8% of patients. The mean pain score was 3.33 (Visual Analogue Scale). An average overall satisfaction score of 9 was obtained. Pain was the main reason in patients with low satisfaction ratings. A positive correlation was found between the patient satisfaction score and the level of information received before the procedure. An inverse relationship was detected between the patient satisfaction score and the pain experienced during the hysteroscopy.ConclusionsOutpatient diagnostic and/or therapeutic hysteroscopy is a technique accepted by the majority of patients and with a high level of satisfaction. Variables such as pain or the previous information received are important and directly related to the final satisfaction level of the procedure.

Background: Given the expansiveness of diagnostic and therapeutic hysteroscopy, promptly recognizing complications and intervening as necessary to prevent adverse outcomes and minimize legal risk is imperative. We aim to describe the litigious trends in hysteroscopic procedures across the United States; Methods: Publicly available lawsuits published on a well-known legal database, Westlaw, were reviewed. The search term "'hysteroscop!'" was used to filter cases for court opinions containing words with this prefix, including "hysteroscopy", "hysteroscopies", and "hysteroscopic." Adverse events, procedural outcomes, post-procedural surgery urgency, and resultant disabilities were extracted for themes; Results: The primary complication resulting in legal action was uterine perforation (52.9%), followed by claimed technical mistakes (23.5%) and damage to surrounding structures (11.8%). The most common outcome was the need for future corrective surgery (70.6%), and a number of cases resulted in permanent brain damage or death (23.6%). Of the patients that required subsequent corrective surgery (n = 12), 91.7% of them required emergent surgery. Patients sought damages most commonly from individual attending providers (41.2%), attending physician and practice groups/hospitals collectively (41.2%), and additional entities, including resident physicians in training and manufacturers. Awards ranged from $322,308 to $9,387,109; Conclusions: Medical malpractice litigation is challenging to patients and providers alike, often leading to financial, emotional, and professional burden. Our evaluation highlights the variability in adverse events from hysteroscopy which prompt litigation, financial burden of lawsuits, and legal risk of individual providers, in an attempt to improve safety of future procedures.

BackgroundHysteroscopy is considered the standard for evaluating the uterine cavity. Limited data exists regarding hysteroscopy in Ethiopia. Therefore, the objective of the study was to describe the diagnostic and operative hysteroscopic procedures at St. Paul’s Hospital.MethodologyA three-year retrospective descriptive study examined patients who underwent diagnostic and therapeutic hysteroscopy at the Center for Fertility and Reproductive Medicine, St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia, from June 2018 to June 2021. Descriptive statistics were employed to summarize the findings observed during the hysteroscopy procedures.ResultA total of 328 patient records underwent review and analysis in the study. The mean participant age was 31.9 years (31.9 ± 5.1 years), with about 81.4% being nulliparous. Primary infertility (48.5%) was the leading indication for hysteroscopic evaluation, followed by secondary amenorrhea (18%), secondary infertility (17.4%), and abnormal uterine bleeding (8.8%). Concerning hysteroscopic procedures, 6.1% of participants exhibited no uterine cavity abnormalities. Primary hysteroscopy findings comprised intracavitary adhesions (48.2%), endometrial polyps (18%), and submucosal myomas (9%). Adhesiolysis stood out as the foremost surgical procedure, conducted in 48.2% of patients, followed by polypectomy in 20.7%, and fibroid removal in 9%. The complication rate was 2.4%, exclusively during operative hysteroscopy, with uterine perforation observed in six patients.ConclusionOur hysteroscopic evaluation was predominantly requested for primary infertility cases, with secondary amenorrhea, secondary infertility, and abnormal uterine bleeding also being commonly encountered indications. Adhesiolysis was the leading intervention during hysteroscopy, while uterine perforation was the main complication. The hysteroscopy procedures exhibited a strong safety profile, with few complications noted. Future studies should address factors affecting outcomes in diagnostic and operative hysteroscopy, and common factors linked to intrauterine adhesions.

The leading place in the structure of gynecological diseases is occupied by intrauterine pathology, the "gold standard" of treatment of which is therapeutic hysteroscopy. Conducting hysteroscopy in outpatient conditions in the absence of anesthesia significantly reduces the workload of the inpatient unit, but requires high-quality training of specialists due to the labor intensity of the manipulation and the lack of opportunity to acquire skills intraoperatively. The use of biomodels for training allows specialists to master this technique in a short time.

Many women experience bleeding disorders that may have an anatomical or unexplained origin. Although hysterectomy is the most definitive and common treatment, it is highly invasive and resource-intensive. Less invasive therapies are therefore advised before hysterectomy for women with fibroids or bleeding disorders. This study has two aims related to treating bleeding disorders and uterine fibroids in the Netherlands: (1) to evaluate the regional variations in prevalence and surgical approaches; and (2) to assess the associations between regional rates of hysterectomies and less invasive surgical techniques to analyze whether hysterectomy can be replaced in routine practice. We completed a register-based study of claims data for bleeding disorders and fibroids in women between 2016 and 2020 using data from Statistics Netherlands for case-mix adjustment. Crude and case-mix adjusted regional hysterectomy rates were examined overall and by surgical approach. Coefficients of variation were used to measure regional variation and regression analyses were used to evaluate the association between hysterectomy and less invasive procedure rates across regions. Overall, 14 186 and 8821 hysterectomies were performed for bleeding disorders and fibroids, respectively. Laparoscopic approaches predominated (bleeding disorders 65%, fibroids 49%), followed by vaginal (bleeding disorders 24%, fibroids 5%) and abdominal (bleeding disorders 11%, fibroids 46%) approaches. Substantial regional differences were noted in both hysterectomy rates and the surgical approaches. For bleeding disorders, regional hysterectomy rates were positively associated with endometrial ablation rates (β = 0.11; P = 0.21) and therapeutic hysteroscopy rates (β = 0.14; P = 0.31). For fibroids, regional hysterectomy rates were positively associated with therapeutic hysteroscopy rates (β = 0.10; P = 0.34) and negatively associated with both embolization rates (β = -0.08; P = 0.08) and myomectomy rates (β = -0.03; P = 0.82). Regional variation exists in the rates of hysterectomy and minimally invasive techniques. The absence of a significant substitution effect provides no clear evidence that minimally invasive techniques have replaced hysterectomy in clinical practice. However, although the result was not significant, embolization could be an exception based on its stronger negative association.

This article examines the features of microbiocenosis of the vagina and endometrium in women with infertility and intrauterine pathology. Purpose - to study the peculiarities of the spectrum of microorganisms of the vagina and endometrium in women with infertility and intrauterine pathology in order to increase the effectiveness and prevention of complications of hysteroscopic interventions in such women. Materials and methods. An examination and dynamic observation of women was carried out for 6 months. The results of clinical-morphological, ultrasound, immunohistochemical and bacteriological monitoring are included. All patients underwent diagnostic and therapeutic hysteroscopy followed by bacteriological, morphological and immunohistochemical examination. Results. The study of quantitative indicators and species composition of the microbial flora of the uterine endothelium in women with infertility and intrauterine pathology showed a much wider spectrum of pathogenic and opportunistic microorganisms. Among the detected microorganisms are Esherichia coli (4%), Staphylococcus aureus (6%), Streptococcus B (2%), Lactobacillus spp. (2%). In a much larger number of women, pathogens of sexually transmitted infections were noted - Chlamydia trachomatis (12%), Mycoplasma hominis (14%), Ureaplasma urealyticum (10%). Obviously, one of the causes of the inflammatory process in the endometrium of the uterus is the imbalance of the microbiocenosis. Bacteriological research data showed a significant proportion of deviations in the vaginal biocenosis in the presence of intrauterine pathology, which is manifested by a significant decrease in the frequency of excretion of the main acid-forming lactobacilli compared to healthy patients. Thus, lactobacilli (21 strains) were detected in only 23 (46%) patients of the study group at a concentration of 6.2±1.1 lg CFU/ml, while in the control group - in 17 (85%) women at an average concentration of 6.8±1.2 lg CFU/ml. Conclusions. The obtained research results make it possible to determine the scientific position regarding the important role of an infectious factor in the development of intrauterine pathology, and the normalization of the microbiota of the genital tract is not only an important component of the treatment of hyperplastic processes, but also contributes to the prevention of possible relapses, the treatment of morphofunctional disorders in the endometrium of women with infertility. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the author.

Operative hysteroscopy versus ultrasound-guided electric vacuum aspiration for removal of retained products of conception: A prospective cohort study

Hyperplastic processes of the endometrium, in the structure of gynecological pathology, occupy from 15.0% to 50.0% in women of reproductive age, disrupting the reproductive function, manifested by infertility, miscarriage, long, irregular, painful menstruation, high frequency of chronic adnexitis (73.9 %), uterine leiomyomas (45.8%), genital endometriosis (17.7%), cervical erosion (26.0-34%). The development of the disease is associated both with inadequate treatment of the acute altering process and with the primary chronicity of inflammation with a violation of local mechanisms of anti-infective protection. We cannot ignore the important role of inflammatory diseases of the pelvic organs, which causes the increase in the fate of chronic endometritis to 70.0%, and the chronicity of the process, inadequate therapeutic options and resistance to medical measures cause a change in women's field, which, undoubtedly affects the implantation processes.
 The question of the role of an infectious factor in endometrial hyperplasia remains incompletely elucidated and understudied, which preserves the expediency of detailing the pathogenetic mechanisms of endometrial hyperplastic processes.
 The aim of the study: to evaluate the microbiocenosis of the vaginal mucosa in patients with hyperplastic processes of endometrium.
 Materials and methods. A comprehensive clinical and laboratory examination of 80 patients of reproductive age with endometrial hyperplastic processes was performed: 40 patients with endometrial hyperplasia without atypia (group 1), 40 patients with endometrial polyps (group 2). The control group consisted of 30 healthy women without gynecological pathology.
 All patients underwent diagnostic and therapeutic hysteroscopy followed by morphological and immunohistochemical examination. Bacterioscopic and investigation of biomaterial of the reproductive tract was carried out using the "Femoflor" test system in real time. The TORСH-group pathogens were verified by the DNA-PCR method.
 Research results. A significant proportion of menstrual cycle disorders (AUB - 55.0 %, algodismenorrhea - 41.3 %), generative function (infertility - 36.9 %, spontaneous abortions - 18.8 %, missed abortion- 8.8%) and also transferred inflammatory processes of the genitals (dysbiosis, PID, exo-endocervicitis - 75.0%).
 Based on the results of DNA-PCR data evaluation, the following were found: Chlamydia trachomatis — in 24 (30.0%) cases, Mycoplasma genitalium — in 21 (26.3%), Ureaplasma urealyticum — in 17 (21.3%), Candida albicans — in 18 (22.5%), in 37 (46.3%) cases – genital herpes (HSV) types 1 and 2, cytomegalovirus (CMV) and human papillomavirus type 16.18 (HPV) in 23 (28.8%) ), as well as viral (32.5%) and viral-bacterial associations (51.3%). According to the results of the evaluation of the microbiocenosis of the vagina in the examined women with impaired reproductive function against the background of endometrial hyperplasia and endometrial polyps, pronounced dysbiosis prevailed (47.5% and 62.5%, respectively).
 Conclusions. The obtained results confirm the scientific position regarding the important role of an infectious factor in the development of hyperplastic processes of endometrium, and the normalization of the microbiocenosis of the genital tract contributes to the effectiveness of treatment and the prevention of possible relapses.

Objectives:Conventionally, an assistant would be required to hold the ultrasound probe during therapeutic hysteroscopy. To manage without a skilled assistant, Lin developed a self-retaining hands-free probe method that can be used to hold an abdominal ultrasound probe. One can now perform ultrasound-guided hysteroscopic procedures single-handedly. The purpose of this study is to report the successful development of a method to keep an abdominal ultrasound probe self-retained without an assistant's help.Materials and Methods:A technique derived from improvisation with available equipment.Results:The hands-free ultrasound probe was used successfully in 2680 cases needing therapeutic hysteroscopy management for various endometrial pathologies. We only encountered one case of latex allergy, which serves as a reminder to ask about latex allergy before the procedure. Upon notification, the handle can be improvised to a latex-free solution. Compression indentation marks were of negligible concern as they resolved spontaneously within 1–2 h postsurgery. We have used this method successfully and to good effect, particularly in guiding us to avoid uterine perforations during dilation of the cervix as well as during the therapeutic hysteroscopy surgery itself. This device facilitates efficient and safe therapeutic hysteroscopic surgeries. In addition, this method encourages the reuse and recycling of plastic water bottles.Conclusion:The usage of Lin's self-retaining ultrasound probe method is practical, cheap, and not dependent on an assistant's participation during procedures.

Four year evaluation of therapeutic hysteroscopy under procedural sedation in an outpatient clinic

Office hysteroscopy before first in vitro fertilization. A randomized controlled trial

The study is devoted to the problem of surgical treatment, rehabilitation program and prevention of recurrences in intrauterine pathologies (polyposis and uterine adhesion) in women with reduced reproductive potential. The urgency of this problem is characterized by a high frequency of abnormal uterine bleeding, hypomenstrual syndrome and amenorrhea, infertility and miscarriage. Clinical data include the own experience of treatment and rehabilitation of 66 patients; women with intrauterine synechiae (32 people) were included in group 1; 34 patients with hyperplastic form of chronic endometritis and polyposis were included in group 2. The control group included 30 healthy patients without gynecological pathology and menstrual irregularities. All women underwent therapeutic hysteroscopy with adgeolysis and polypectomy. In the postoperative period, 24 patients of the main group received the proposed program to restore the endometrium and its implantation potential. The comparison group included 42 patients with general principles of postoperative management. The key points of the proposed program were: immunomodulatory therapy, hormone replacement therapy and the use of autoplasma. As a result of the study, a reduction in the recurrence of the adhesive process was proved, as well as a significantly higher number of cases of pregnancy. Thus, for the comprehensive treatment of intrauterine pathology in young women with reduced reproductive potential it is important not only to use minimally invasive office hysteroscopy, an active postoperative rehabilitation period is of great importance too.

Background and Objectives: The goal of this study was to evaluate the clinical sonographic evaluation of postmenopausal bleeding (PMB) followed by diagnostic and/or therapeutic hysteroscopy and guided biopsy in Jordanian hospitals. Materials and Methods: A retrospective multi-centric study was performed in hospitals in Al-Karak and Amman from 2014–2016. The study recruited 189 cases to evaluate the aetiology of postmenopausal bleeding. Atrophic endometrium was observed as a major cause of postmenopausal bleeding according to histopathology. The cases were also distributed according to parity in which nulliparous patients were observed. Results: Hysteroscopy was observed to be effective for the diagnosis of postmenopausal bleeding. Conclusion: There is a need to assess more approaches for the diagnosis of postmenopausal bleeding among women.

This is a prospective study conducted over a period of 2 years and 1 month (from September 2005 to October 2007). 60/117 (52.17%) patients who had laparoscopy for infertility at GMH had endometriosis. 60 patients operated for endometriosis at SHC and 40 patients managed at Anu Infertility Centre during the same period are also included in this study. All the 60 patients underwent operative laparoscopy for endometriosis. Adhesiolysis, electrocautery of surface endometriosis of the ovary, enucleation of endometriotic cyst, mobilization of ovary from uterus and pouch of Douglas and restoration of normal anatomy were carried out. Treatment interventions: Therapeutic hysteroscopy and laparoscopy, medical treatment by various ovulation induction protocols, monitoring by follicular sonography followed by pregnancy management were done in these women. Results: GMH—Seventeen 17 out of 18 coming for follow up conceived, 14 following ovulation induction and 3 after COH + IUI, by one year at GMH. SHC—14 out of 18 patients coming for follow up at the end of one year conceived, following ovulation induction 6, COH + IUI-3, IVF-3 and spontaneous 2. ANU—Out of 11 conceptions, COH + IUI resulted in 6, IVF in 4, spontaneous in 1—by one year. Pregnancy outcome: GMH: Ten delivered, Triplets in one, missed abortion two, emergency laparotomy in one. Pregnancy is continuing in 4. SHC: Eight patients delivered. Pregnancy is continuing in 4 patients. Ectopic-1, missed abortion-1. ANU: Five patients delivered. Pregnancy is continuing in 3 women, missed abortion-2, second trimester abruption-1. Discussion: The conception rate was 50% at the end of 6 months follow up <span s

Introduction. Abnormal uterine hemorrhages (AUH) are the most common symptom for presentation to gynecologist. Any uterine bleeding other than menstrual bleeding, which concerns the duration, frequency, quality or quantity of the bleeding is considered abnormal. Material and Methods. We realized a retrospective study based on medical records of the patients admitted for abnormal uterine hemorrhage at “Saint John” Emergency Clinical Hospital, “Bucur” Maternity between 2013 and 2016. From the patients with AUH, we focused on those who underwent hysteroscopies. Results. Our study included 146 patients. The age of patients varied from 22 to 71 years. Abnormal uterine bleeding was most prevalent among women of 40-50 years (20%), and the mean age was 42.65%. 82.88% from our patients had obstetrical history and only 17.12% didn’t give birth either as an option, or from primary or secondary infertility. 7.53% of the patients were hypertensive and 5.48% had endocrine pathology. All patients underwent diagnostic hysteroscopy and 4.79% patients therapeutic hysteroscopy. The therapeutic measures that were made are: hysteroscopic resection of the endometrium (47.3%), excision of polyps (36.99%), sinechiolysis (8.22%) and myomectomy (2.71%). The diagnoses were 46.48% endometrial polyp, 13.7% intramural leiomyoma, 13.7% IUD (intrauterine device) and 9.59% intrauterine synechiae, while 15.06% cumulated for uterine septum, endometrial hyperplasia, cervical polyp, foreign intrauterine bodies, secondary infertility, dysfunctional metrorrhagia. Conclusions. In patients with abnormal uterine hemorrhages, hysteroscopy provides the most accurate diagnosis and can reduce the burden of hysterectomy in many cases.

Manejo histeroscópico de los restos ovulares con energía mecánica

Since the introduction of smaller instruments, hysteroscopy is increasingly performed in an office-based setting. The aim of this cohort study was to compare operative hysteroscopy in an office-based setting with inpatient procedures to evaluate differences in procedure and analgesia-related parameters. All office-based hysteroscopic procedures during February 2014 to October 2015 were entered for analysis. Included were morcellation of fibroids, polyps and pregnancy remnants, synechiolysis, diagnostic hysteroscopy, and endometrial ablation. Comparative cases of patients undergoing hysteroscopic surgery in the operating room were searched during the years prior to initiation of the office-based setting (2012 and 2013). During the outpatient surgical procedures, patients were moderate to deeply sedated with propofol and alfentanyl. Two groups of 129 patients were analysed. Median operation time was significantly shorter in the office-based group (11 min [range 1-37]) compared to the operating room group (20 min [range 2-73], p &lt; 0.01). Median admission time was also shorter in the office-based group (135 min [range 60-150] versus 455 min [range 240-2865] (p &lt; 0.01)). The number of incomplete procedures was similar (3.9 % versus 2.3 %, p = 0.473). No significant difference in surgical or anaesthesiology complications was observed. Overall complication rate was 4.7 % in the office-based setting and 3.9 % in the operating room setting. Financial analysis showed that procedures in an office-based setting are at least half of the costs as compared to a clinical setting. Office-based hysteroscopic procedures under procedural sedation and analgesia demonstrate a low complication rate as well as shorter operation and admission time compared to outpatient procedures. Office-based hysteroscopic procedures showed lower healthcare costs.

A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting: preliminary results.

One Stop Outpatient Diagnostic and Therapeutic Hysteroscopy Examination in Patients with Intrauterine Cavitary Lesions