Optimum uterine filling pressure for outpatient diagnostic hysteroscopy: a double-blind, randomized controlled trial.

This study designed a double-blind, randomized controlled trial to assess whether adequate visibility can be achieved with lower uterine filling pressures using normal saline for diagnostic outpatient hysteroscopy and whether patient discomfort can be reduced. A total of 234 patients were randomized to 40 mmHg (77 patients), 70 mmHg (78 patients) or 100 mmHg (79 patients) of uterine filling pressures. The primary outcome measure was the proportion of procedures where adequate visibility was achieved during diagnostic outpatient hysteroscopy. The secondary outcome was the level of pain experienced by the patient as assessed using a visual analogue scale. There was adequate visibility in 87.0% of cases in 40 mmHg group, 94.9% in 70 mmHg group and 97.5% in 100 mmHg group. Visibility was lower with 40 mmHg compared with 70 and 100 mmHg (P < 0.05). The mean pain score in each group was not significantly different. In conclusion, this study showed that there was a higher trend towards inadequate visibility with lower filling pressures. Pressures of 70 and 100 mmHg may be equivalent to each other but not to a pressure level of 40 mmHg. Pain scores do not differ significantly with the pressure options used.

See-and-treat outpatient hysteroscopy: an analysis of 1109 examinations.

The aim of this study was to assess the feasibility of diagnostic and therapeutic outpatient hysteroscopy. Data were collected prospectively from 1109 consecutive hysteroscopy examinations. The main outcome measure was success and failure of diagnostic and therapeutic outpatient hysteroscopy examination. The mean age (sd) was 47.7 (11.8) years and 53.3% and 39.5% of subjects were post-menopausal and nulliparous, respectively. The most common indications for referral were post-menopausal bleeding (39.8%), menorrhagia (25.7%) and irregular periods (14.5%). Hysteroscopy examination was successfully completed in 96.2% (1067/1109) of the subjects. Success was negatively influenced by age and menopausal status but not parity, although the differences between the age groups and pre- versus post-menopausal groups were minimal. The most common abnormalities were intrauterine polyps (425/1109, 38.3%) and submucous fibroids (142/1109, 12.8%). Of these two groups, respectively, 285/425 (67.1%) and 23/142 (16.2%) subjects had complete polyp and fibroid resection in the outpatient setting and 116/425 (27.3%) and 63/142 (44.4%) underwent polyp and fibroid resection under general anaesthesia. In conclusion, diagnostic and therapeutic hysteroscopy is feasible and highly successful in an outpatient setting. The majority of subjects with endometrial polyps and intrauterine adhesions are amenable to a see-and-treat approach.