Hysteroscopic Management of Intrauterine Pathologies: A Case Series of 296 Patients

Abstract

Aim:To discuss the incidence of various hysteroscopic findings in patients of infertility, abnormal uterine bleeding (AUB), and postmenopausal bleeding and to compare the prevalence of various uterine pathologies in patients of primary and secondary infertility. Materials and methods:This is a retrospective observational study, which evaluated 296 patients who underwent diagnostic hysteroscopy for evaluation of primary or secondary infertility, AUB, and postmenopausal bleeding over a period of 18 months in a Gynae-endoscopy Unit. Detailed hysteroscopic evaluation of the endocervical canal and uterine cavity in all recruited cases was done by the same surgeon and the data were collected by reviewing the case records.Results: Among the 296 cases analyzed, 157 cases were of primary infertility, 81 cases were of secondary infertility, 45 cases were of AUB, and 13 cases presented with postmenopausal bleeding. Among the primary infertility patients, 58.6% had abnormal findings on hysteroscopy, while among the secondary infertility patients, hysteroscopy revealed abnormalities in as high as 72.5% cases. In the present study, uterine synechiae was the most common abnormality detected among the infertile patients. Endometrial polyps were the most common pathology detected among patients with AUB and postmenopausal bleeding. Conclusion:Hysteroscopy is a minimally invasive and highly safe technique to directly visualize the endocervical canal, uterine cavity, and tubal ostia. It has an added advantage of treating the pathology in the same sitting, thus improving the clinical outcomes. Based on our findings, we conclude that uterine pathologies are a major contributor in causing infertility and menstrual irregularities, which are missed on blind modalities like hysterosalpingography and dilatation and curettage.Clinical significance: This article stresses on the use of hysteroscopy as a primary diagnostic modality in evaluating patients of infertility, AUB, and postmenopausal bleeding in order to increase the detection rates of uterine pathologies.