Clinical Diagnosis of Endometrial Polyps Using Multioperator Algorithm Combined with Hysteroscopy

Exploring the effects of uterine imaging and hysteroscopy of endometrial polyps, this article has chosen the treatment effect of 50 cases of intrauterine polyps to observe hysteroscopy. The results showed that the diagnosis and sensitivity, specificity, positive, negative, and consistency were passed through various diagnostic methods ( P < 0.05 ). The diagnostic sensitivity of antidiagnosis combination and series combination was 90.0%, 64.0%, 96.0%, 92.0%, 80.0%, 80.0%, 88.0%, and 92.0%, parallel diagnosis with high sensitivity, significantly higher than simple diagnosis ( P < 0.05 ). Therefore, in the clinical treatment of endometrial polyps, hysteroscopic surgery is a safe and effective treatment, which can remove endometrial quality, improve the clinical symptoms of patients, and reduce the interference and postoperative recovery process of surgical trauma.

Acute Severe Hyponatremia following Hysteroscopic Procedure in a Young Patient: A Case Report and Review of the Literature

Background. Hysteroscopic surgery is a minimally invasive procedure used to diagnose and treat intrauterine pathologies. It requires distension of the uterine cavity for the adequate visualization of the operative field. Glycine (1.5%) is one of the most commonly used solutions because it is nonconductive and also has good optical properties. However, acute hyponatremia is a critical complication that can develop after the absorption of a sufficient amount of the irrigation medium. Case Presentation. We report a case of a 43-year-old female patient who developed acute symptomatic hyponatremia (104 mEq/L) and pulmonary edema secondary to hysteroscopic resection of leiomyoma and hastily approached with rapid sodium correction measures. Conclusion. Multiple strategies can be taken to reduce the risk of fluid absorption and subsequent hyponatremia. Moreover, attention should be paid to the treatment approach for patients with acute hyponatremia following hysteroscopic procedures; rapid correction of acute hyponatremia for such patients might be safe, although there is no consensus in the literature, and further trials are needed.

Comparing levonorgestrel intrauterine system versus hysteroscopic resection in patients with postmenstrual spotting related to a niche in the caesarean scar (MIHYS NICHE trial): protocol of a randomised controlled trial

IntroductionRecently, the rate of caesarean sections (CS) worldwide has risen and CS-associated complications such as niche have increased substantially. Until now, evidence-based clinical guidelines for the treatment of niche-related symptoms remain absent. In patients with postmenstrual spotting, it has not been studied if the effect of levonorgestrel 52 mg intrauterine system (LNG-IUS 52 mg) is superior to that of hysteroscopy. This study will answer the question of whether LNG-IUS 52 mg is more effective in improving postmenstrual spotting than hysteroscopic niche resection in women with niche-related spotting at 6 months after randomisation.Methods and analysisThis is a randomised controlled trial. A total of 208 women with postmenstrual spotting related to niche in the caesarean uterine scar of at least 2 mm and residual myometrium of at least 2.2 mm evaluated by MRI will be included. Women desiring to conceive within 1 year, with contraindications for LNG-IUS 52 mg or hysteroscopic surgery will be excluded. After informed consent is obtained, eligible women will be randomly allocated to LNG-IUS 52 mg or hysteroscopic niche resection at 1:1. The primary outcome is the efficacy in reducing postmenstrual spotting at 6 months after randomisation. The secondary outcomes include menstrual pattern, total days of blood loss per month, rate of amenorrhoea, side effects and complications.We will use a Visual Analogue Scale for chronic pelvic pain, urological symptoms and women’s satisfaction (five-point Likert scale).Ethics and disseminationThe study was approved by the local medical ethics committee and by the Institutional Review Board of the International Peace Maternity and Child Health Hospital, Shanghai, China (No. GKLW 2019-08). Participants will sign a written informed consent before participation. The results of this study will be submitted to a peer-reviewed journal for publication.Trial registration numberChiCTR1900025677.

Intrauterine Adhesions Combined with Robert's Uterus : A Case Report and Literature Review

Background: Robert's uterus, a rare congenital abnormality of Mullerian duct development, has oblique septum and non-communicating asymmetric hemi-cavity. Key clinical characterization of the congenital disorder is presence of hematometra and severe dysmenorrhea, some patients experience acute abdominal pain in association with menstruation. Due to the difficulty of preoperative diagnosis and high rate of misdiagnosis, Preoperative assessment matters the choice of emergency surgery and avoid a second surgery. No systematic literature review in detail has been reported previously.Case presentation: We reported a rare case of Robert’s uterus with severe abdominal pain during menstruation, in which the patient initially underwent emergency laparoscopic right ovarian cystectomy, right salpingectomy, and pelvic adhesiolysis on suspicion of ovarian teratoma torsion. However, dysmenorrhea still existed or even aggravated after the operation, hysteroscopic surgery was performed three month later, which revealed two asymmetric uterine cavities, hematometra was located in the right-side blind cavity, and thus diagnosed as Robert’s uterus and severe uterine adhesion, which, to our knowledge, has not been reported previously. Hysteroscopic incision of the septum and intrauterine adhesion were performed. Subsequently, Two-year follow-up showed no obvious dysmenorrhea recurrence. Conclusion: Robert's uterus is uncommon but can mimic other common and acute abdominal disease. Advance imaging technologies, such as three-dimensional ultrasound and magnetic resonance imaging combined with hysteroscopy and laparoscopy are less invasive for diagnosis and treatment of Robert’s uterus. Septal resection is main surgical procedure, combining laparoscopy and hysteroscopy is conducive and less invasive treatment.

Comparative evaluation of the bispectral index (BIS) and BISpro during propofol anaesthesia

Objective To compare the accuracy, correlation and agreement between the bispectral index (BIS) and BISpro during propofol anaesthesia. Methods The BIS, BISpro, heart rate, target-concentration of propofol and Observer’s Assessment of Alertness and Sedation (OAA/S) score were recorded every 30 s in female patients scheduled for hysteroscopic surgery. Propofol anaesthesia was induced by an initial target-controlled concentration (1.0 μg/ml) followed by a stepwise increase (0.5 μg/ml) until the patient was unresponsive. Spearman’s correlation coefficient and prediction probability were calculated for the association between sedation levels and the above parameters. The ability of investigated parameters to distinguish between OAA/S scores was analysed. Bland–Altman analysis was used to compare the agreement between BIS and BISpro. The BIS and BISpro cut-off values for lost response were also determined. Results Out of 30 patients in total, a high correlation was found between BIS and BISpro, and both correlated well with OAA/S score. Only BIS was able to distinguish all investigated OAA/S states accurately, but the ability to predict OAA/S score 5 to loss of response was comparable between BIS and BISpro. The calculated cut-off values were 68 for BIS and 70 for BISpro. Conclusion BISpro and BIS are reliable monitors of general anaesthesia during sedation. Trial registration number: Chinese Clinical Trial Registry (URL: www.chictr.org.cn ): ChiCTR1900024037 (retrospectively registered).

Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion

Purpose To determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency. Methods In a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation. Results Laparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift. Conclusion When CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency.

Reproductive Performance Following Hysteroscopic Surgery for Uterine Septum: Results from a Single Surgeon Data

Uterine septum can negatively affect reproductive outcomes in women. Based on evidence from retrospective observational studies, hysteroscopic incision has been considered a solution to improve reproductive performance, however there has been recent controversy on the need for surgery for uterine septum. High quality evidence from prospective studies is still lacking, and until it is available, experts are encouraged to publish their data. We are therefore presenting our data that involves analysis of the patient characteristics, surgical approach and long-term reproductive outcomes of women who received treatment for uterine septum under the care of a single surgeon. This includes all women (99) who underwent hysteroscopic surgery for uterine septum between January 2001 and December 2019. Of those 99 women treated for intrauterine septum who were trying to conceive, 91.4% (64/70) achieved pregnancy, 78.6% (55/70) had live births and 8.6% (6/70) had miscarriages. No statistically significant difference was found in the live birth rates when data was analyzed in subgroups based on age, reason for referral/aetiology and severity of pathology. Our study results support the view that surgical treatment of uterine septa is beneficial in improving reproductive outcomes.