Page 31 - World Journal of Laparoscopic Surgery

WJOLS

Role of Hysteroscopy in Gynecological Conditions
Group IV (suspected leiomyoma uteri) in 3 (37.5%) out of diSCuSSion
8 patients leiomyoma was diagnosed, however in rest of Fritz Nagele et al evaluated the feasibility and accepta-
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the patients no myoma was revealed on hysteroscopy. bility of outpatient diagnostic hysteroscopy and found
In group V (lost IUCD with irregular bleeding) in that most common indication for hysteroscopy was
3 patients (60%) out of 5 cases hysteroscopy revealed Cut abnormal uterine bleeding (87%). Ariel Reviel et al found
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in the uterine cavity. In one patient arms of copper T were hysteroscopy revealed more information than curettage
embedded into the myometrium (Fig. 2). In all these 3 cases in cases of abnormal uterine bleeding.
copper T was removed vaginally. In the 2 cases where IUD garuti g et al found that hysteroscopy showed
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was not present in the cavity, IUD was seen to be lying in sensitivity and specificity of 94.2 and 88.8% respectively
the abdominal cavity. In one patient IUD was removed in predicting normal or abnormal histopathology of
laproscopically and in other patient by minilaparotomy endometrium. Arslan S et al reported hysteroscopy has a
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as the IUD was found to be perforating the myometrium positive predictive value of 71.4% and negative predictive
into the bladder. Rest of the 2 patients had expelled the value of 95.4% in diagnosing hyperplasia.
IUCD per vaginally unnoticed. In group VI (secondary In the present study on 69 patients significant findings
amenorrhea) 3 (60%) out of 5 had abnormal hysteroscopic were detected in 74% patients. Among 69 patients, there
findings. All these 3 patients had atrophic endometrium. were 28 patients (40.5%) with dysfunctional uterine
In the present study on 69 patients, the procedure bleeding. Dysfunctional uterine bleeding was the
failed on first attempt in 4 patients (7.25%). In 3 of these commonest indication for hysteroscopy in the present
cases there was cervical stenosis and in 1 patient visua- study. Lasmar RB et al studied 4044 patients with
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lization of the uterine cavity was not very clear due to abnormal uterine bleeding.
uterine bleeding provoked by the passage of the instru- Dysfunctional uterine bleeding has been the commonest
ment. In all 4 cases, procedure was successful on 2nd indication for hysteroscopy because it is difficult to
attempt, however one patient required general anesthesia. make the correct diagnosis by pelvic examination. In the
present study, 85.7% significant findings were observed
in DUB group and in 14.29% no pathology was seen.
Normal uterine cavity and cervical canal were found in
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814 (20.1%) patients in Lasmar RB et al study.
In our series the commonest cause of bleeding has
been hyperplastic endometrium found in 28.50% cases,
the endometrial polyp seen in 18% and proliferative endo-
metrium was observed in 28.9% of patients. Endocervical
polyp, submucous myoma and atrophic endometrium
were the cause of bleeding in 3.6% patients. Lasmar RB
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et al in their large study on 4044 patients with abnormal
uterine bleeding found endometrial polyp as the most
frequent hysteroscopic finding, accounting for 1,374
(33.9%) cases. Endometrial hyperplasia was diagnosed
Fig. 1: Submucous myoma in 613 (15.1%) patients only.
In the present study, 15 patients were included in the
group of infertility. Uterine and tubal pathology taken
together were responsible for infertility in 80% patients.
The uterine pathology was observed in 13.4% and ostial
pathology in 66.6% in the present study. Tubercular
endometritis was diagnosed in 6.7% cases which were
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proved on histopathological examination. Alwani et al
have also reported tubercular endometritis in 9.09% of
his infertility patients in India.
In the present study, submucous leiomyoma uterus were
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detected in 6.7% infertility patients, Valle RF (1980) observed
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myoma in 7.7% and Roll and Hilgrath in 10% of cases. The
results of the above authors are quite near to our study.
In the present study, tubal ostia were found to be
Fig. 2: Arms of IUD embedded into the myometrium blocked in 66.6% of cases. In 10 patients tubal blockage
World Journal of Laparoscopic Surgery, September-December 2014;7(3):129-132 131