0000000000041547
AUTHOR
Attilio Di Spiezio Sardo
Is Hysteroscopy Better than Ultrasonography for Uterine Cavity Evaluation? An Evidence-Based and Patient-Oriented Approach
Evaluation of the uterine cavity is an important part of the gynecological check, especially in symptomatic women and, over the last few decades, a number of technical and technological advancements has allowed a superb investigation of this organ. Traditionally, transvaginal ultrasound (TVUS) has been the first-line diagnostic tool for evaluating uterine diseases, also considering that gynecologists are familiar with the technique since it is included in the basic training in obstetrics and gynecology. Nevertheless, to date “office hysteroscopy” received growing attention since the development of smaller-diameter hysteroscopes which has made it possible to easily perform the hysteroscopy …
Hysteroscopic Isthmoplasty: Step-by-Step Technique
Study Objective To demonstrate our technique for surgical hysteroscopy performed with a standard-size resectoscope or miniresectoscope in 3 cases of isthmocele. Design Step-by-step demonstration of the technique using slides, pictures, and video (educative video) (Canadian Task Force classification III). Setting Isthmocele is a characteristic semidiverticular anomaly of the anterior isthmic wall of the uterus, located at the site of a previous cesarean delivery scar. The etiopathogenesis of isthmocele remains poorly understood, although several hypotheses have been proposed. Factors that may possibly play a role in niche development include a very low incision through cervical tissue, inade…
Feasibility and Acceptability of Office-Based Polypectomy With a 16F Mini-Resectoscope: A Multicenter Clinical Study
Abstract Study Objective To investigate the feasibility and acceptability of office hysteroscopic polypectomy using a novel continuous-flow operative 16F mini-resectoscope. Design Multicenter prospective case series (Canadian Task Force classification III). Setting “SS Antonio e Biagio” Hospital, Alessandria, and University “Federico II” of Naples. Patients One hundred eighty-two patients with endometrial polyps. Interventions Hysteroscopic polypectomy performed with 16F mini-resectoscope in an office setting, without analgesia and/or anesthesia. Measurements and Main Results Polypectomy was successfully performed in 175 patients in a single surgical step (96.15%), with only 1 patient (.54%…
Vaginohysteroscopy for the diagnosis and treatment of vaginal lesions.
Abstract Background The vaginoscopic approach for hysteroscopy allows detailed endoscopic evaluation of the vaginal walls, fornices, and exocervix. Objectives To review the feasibility and efficacy of vaginohysteroscopy in the diagnosis and treatment of vaginal lesions. Search strategy A systematic review was performed of PubMed/Medline, Embase, Google Scholar, and the Cochrane Database to identify papers published in English. The search terms were “hysteroscopy,” “vaginoscopy,” “vagino-hysteroscopy,” and “vaginal lesion.” The last review was performed on January 31, 2015. Selection criteria Studies in which the diagnosis and treatment of vaginal lesions used the vaginoscopic approach and h…
Chronic Endometritis
Chronic endometritis is a persistent inflammation of the inner lining of the uterine cavity. Several studies have demonstrated that it is a condition frequently associated with repeated unexplained implantation failure at in vitro fertilization, recurrent miscarriage, as well as poor obstetric outcomes such as preterm labor. The aim of this paper is to provide information about diagnosis and treatment of this condition to improve reproductive outcome. In fact, significantly higher rate of successful pregnancies was achieved in those patients in whom antibiotic treatment was able to normalize both hysteroscopic and histologic endometrial pattern compared with women who were not treated or wi…
Tips and tricks in office hysteroscopy
Abstract Office hysteroscopy is a minimally invasive procedure that has been shown to be highly accurate in diagnosing abnormalities of the endometrial cavity and the endocervical canal. It allows the direct visualizing of uterine pathology without the need for general anesthesia and the use of an operating room, generating cost savings and greater compliance among patients. The advent of small-diameter hysteroscopes, the use of saline solution as a distension media, as well as the vaginoscopic technique have widely contributed to the diffusion of this technique worldwide, and currently it can be considered the gold standard for the examination of the uterine cavity. The improved technology…
Hysteroscopy and treatment of uterine polyps.
This article summarizes and analyzes the salient topics on the diagnosis and management of endometrial polyps, focusing on the role of the hysteroscopy. Noninvasive investigations such as transvaginal ultrasonography, with or without the use of three-dimensional ultrasonography (3D US) and contrast techniques, remain the mainstay of first-line investigation. Hysteroscopic resection represents the gold standard minimally invasive treatment for endometrial polyps. It is the most effective management and allows histologic assessment, whereas blind biopsy or curettage have low diagnostic accuracy and should not be performed.
Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.
Abstract Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pre…
The Role of Hysteroscopy in the Diagnosis and Treatment of Adenomyosis
Uterine adenomyosis is a common gynecologic disorder in women of reproductive age, characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Dysmenorrhea, abnormal uterine bleeding, chronic pelvic pain, and deep dyspareunia are common symptoms of this pathological condition. However, adenomyosis is often an incidental finding in specimens obtained from hysterectomy or uterine biopsies. The recent evolution of diagnostic imaging techniques, such as transvaginal sonography, hysterosalpingography, and magnetic resonance imaging, has contributed to improving accuracy in the identification of this pathology. Hysteroscopy offers the advantage of direct visualiz…
Follow-Up and Relook Hysteroscopy
Intra-uterine adhesions (IUAs) after initial treatment in patients with Asherman’s Syndrome are one of the main challenging issues in the gynecological practice, since its incidence has been increasing over the last few decades, with a reported recurrence rate up to 30%. Asherman syndrome is characterized by variable scarring inside the uterine cavity that can lead to partial or complete dysfunction of the endometrium with impairment of fertility and menstrual pattern (amenorrhea and hypomenorrhea).
Childhood cancer survival in Europe 1999-2007: results of EUROCARE-5-a population-based study.
To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field. Survival and cure rates for childhood cancers in Europe have greatly improved over the past 40 years and are mostly good, although not in all European countries. The EUROCARE-5 survival study estimates survival of children diagnosed with cancer between 2000 and 2007, assesses whether survival differences among European countries have changed, and investigates changes from 1999 to 2007. We analysed survival data for 157,499 children (age 0-14 years) diagnosed between Jan 1, 1978 and Dec 31, 2007. They came from 74 population-based cancer registries in 29 countries. We calculated …
Endometrial biopsy: Indications, techniques and recommendations. An evidence-based guideline for clinical practice
This practice guideline provides updated evidence for the gynecologist who performs endometrial biopsy (EB) in gynecologic clinical practice. An international committee of gynecology experts developed the recommendations according to AGREE Reporting Guideline. An adequate tissue sampling is mandatory when performing an EB. Blind methods should not be first choice in patients with suspected endometrial malignancy. Hysteroscopy is the targeted-biopsy method with highest diagnostic accuracy and cost-effectiveness. Blind suction techniques are not reliable for the diagnosis of endometrial polyps. In low resources settings, and in absence of the capacity to perform office hysteroscopy, blind tec…
Office hysteroscopic treatment of a vanishing external uterine orifice in a postmenopausal woman with an obstetrical history of 44 abortions
Abstract Cervical stenosis, defined as cervical scarring of variable degree, represents a significant anatomical impediment to hysteroscopic procedures. Acquired cervical stenoses are more common than congenital forms and they are mainly associated with aging, estrogen–progesteron drugs, cervical trauma or carcinoma. The overcoming of cervical stenosis at office hysteroscopy is challenging and it often fails requiring the scheduling of the patient for an in-patient treatment under general anesthesia. We report the office hysteroscopy treatment of a vanishing external uterine orifice in a postmenopausal woman with an ultrasonographic report of a heterogeneous and thick endometrium suggestive…
Prevention of intrauterine post-surgical adhesions in hysteroscopy. A systematic review
Abstract Objective The purpose of the present review is to provide a survey of the various measures of preventing adhesions used in hysteroscopic surgery. Study Design A systematic computerized literature search was conducted to provide a survey of the various measures used in hysteroscopic surgery to prevent adhesions. Finally, 29 studies were included in the analysis, showing a wide variety of methods and agents advocated in international literature. They are explained in various sections, based on the IUA prevention approach adopted (surgical technique, early second-look hysteroscopy, barrier method, pharmacological therapy). Results The results of our review show that (i) use of surgica…
Role of Ovarian Suspension in Preventing Postsurgical Ovarian Adhesions in Patients with Stage III-IV Pelvic Endometriosis: A Systematic Review.
Endometriosis is a benign complex gynecological condition with high morbidity that affects women of reproductive age. Pelvic adhesion formation represents a serious clinical challenge in the management of patients with endometriosis. Several interventions have been proposed over the last few years aiming to reduce post-operative ovarian adhesions formation. The aim of this study is to summarize the evidence of the efficacy of ovarian suspension in the prevention of post-operative ovarian adhesions formation in women undergoing laparoscopic surgery for stage III-IV endometriosis. The research was conducted using electronic databases. A review of the abstracts of all references retrieved from…