Balloon Catheter for Cervical Priming before Operative Hysteroscopy in Young Women: A Pilot Study.

Aim: To investigate regarding the safety and effectiveness of a balloon catheter (Aqueduct-100 device) to dilate the uterine cervix before operative hysteroscopies. Secondary objectives were to evaluate the duration of the dilatation procedure and to investigate on physicians' satisfaction with the device. Methods: Fifty women younger than 40 years, wishing pregnancies and diagnosed with apparently benign intrauterine lesions and/or uterine anomalies, were enrolled into this study and submitted to cervical priming with Aqueduct-100 device before operative hysteroscopy. Results: Initial cervical dilatation was ≤4 mm in all but one patient. Adequate (10 mm) cervical dilatation was achieved in only one patient, the remaining forty-nine needed additional cervical dilatation. All women, however, presented with a ≥6 mm cervical width after balloon catheter removal. The mean time to final cervical dilatation was 8.5 minutes. No perioperative complications occurred. Physicians reported, in the majority of cases, satisfaction for the dilatation achieved (66%), the ease of balloon catheter insertion/use (82%), and for the ease of additional dilatation (96%). Conclusions: Aqueduct-100 device before operative hysteroscopy is safe and useful to increase the baseline cervical width and facilitate additional dilatation, with good effects on physician satisfaction and acceptable dilatation times.

Hysteroscopic treatment of symptomatic cesarean-induced isthmocele: a prospective study.

An isthmocele, also known as a cesarean scar defect, is an emerging condition that typically affects women with a history of previous cesarean section, and its presence is a novel under-recognized cause of postmenstrual abnormal uterine bleeding and/or pelvic pain. The incidence of symptoms and their resolution after hysteroscopic surgery were evaluated prospectively in 120 consecutive isthmocele patients. Patients included only symptomatic premenopausal women. Transvaginal ultrasound and office hysteroscopy were used to diagnose isthmocele. Operative hysteroscopy was performed to correct the cesarean scar defect, and histologic findings were evaluated. Correction of an isthmocele via operative hysteroscopy was successful in all cases evaluated. Isthmoplasty resulted in the resolution of postmenstrual abnormal uterine bleeding and suprapubic pelvic pain in 80% of patients. In the remaining cases, 7% of patients had an improvement of symptoms, whereas 13% did not obtain any relief. Considering the recent diagnostic recognition of isthmoceles, we conclude that surgical treatment of this pathology by operative hysteroscopy may represent the best choice in symptomatic women because of its minimal invasiveness and beneficial therapeutic results.

A randomized controlled study comparing carbon dioxide versus normal saline as distension media in diagnostic office hysteroscopy: is the distension with carbon dioxide a problem?

OBJECTIVE: To compare two distension media, carbon dioxide (CO2) and saline, with regards to patient discomfort and the adequacy of the panoramic view in diagnostic hysteroscopy by the vaginoscopic approach. DESIGN: Randomized prospective study. SETTING: Tertiary referral centers for gynecologic care. PATIENT(S): 264 patients randomly allocated to two groups: CO2 (132 women) and normal saline (132 women). INTERVENTION(S): Office hysteroscopy performed with a forward-oblique 30° telescope (total diameter 5.1 mm) and CO2 as the distension medium or with a forward-oblique 30° telescope (final diameter 5.1mm) and saline solution as the distension medium. MAIN OUTCOME MEASURE(S): Global operative time, pain experienced by patients using a visual analogue scale (VAS), severity of the pain (VAS), incidence of collateral effects (shoulder-tip pain, nausea, or dizziness), degree of difficulty, and view (VAS). RESULT(S): Pelvic discomfort was comparable between groups, without statistically significant differences in intensity or degree of difficulty. However, the visual quality was statistically significantly higher when hysteroscopy was performed with CO2 as the distension medium. CONCLUSION(S): No relevant difference in pain or technical difficulty was found between the two distension media, but CO2 was associated with better quality visualization.