Local anaesthesia and cervical dilatation for outpatient diagnostic hysteroscopy

Hill, N. C. W.; Broadbent, J. A. Mark; Magos, Adam; Baumann, R; Lockwood, Gina

doi:10.3109/01443619209029916

Cited by 19 publications

(12 citation statements)

References 11 publications

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“…Over the last few years hysteroscopy has become a simple and accurate diagnostic method for assessment of intrauterine, endometrial and endocervical pathology. Recent advances in technology have enabled manufacturers of hysteroscopic equipment to significantly reduce the diameter of the instruments, allowing diagnostic hysteroscopy without anaesthesia to be a genuine outpatient ambulatory procedure 1 . This development is increasingly important for the perimenopausal and postmenopausal population who constitute a large portion of gynaecological referrals, with 70% of those referrals being related to abnormal uterine bleeding 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Recent advances in technology have enabled manufacturers of hysteroscopic equipment to signi®cantly reduce the diameter of the instruments, allowing diagnostic hysteroscopy without anaesthesia to be a genuine outpatient ambulatory procedure. 1 This development is increasingly important for the perimenopausal and postmenopausal population who constitute a large portion of gynaecological referrals, with 70% of those referrals being related to abnormal uterine bleeding. 2 Hormone replacement therapy (HRT) is commonly prescribed to relieve postmenopausal symptoms and vaginal bleeding is a common side-effect.…”

Section: Introductionmentioning

confidence: 99%

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The value of outpatient hysteroscopy in the management of postmenopausal bleeding: a review of 862 cases

et al. 2000

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Objective To evaluate the efficacy, reliability and acceptability of outpatient hysteroscopy in the investigation of postmenopausal bleeding in a major teaching hospital. Design A retrospective descriptive study of 862 women referred with postmenopausal bleeding for outpatient hysteroscopy. Methods Between 1994 and 1997, 862 women were referred to the Women's Endoscopy Unit at Nottingham City Hospital for postmenopausal bleeding. Of these women, 171 were receiving hormone replacement treatment. The endocervical canal and the endometrial cavity were assessed using either a 4‐mm rigid or a 3.5‐mm flexible hysteroscope according to the preference of the operator. All hysteroscopies were performed by consultants or experienced registrars. Pipelle endometrial biopsy was taken when indicated. Results The mean age of patients referred with postmenopausal bleeding was 58 years. Hysteroscopy was completed successfully in 97.2% of all patients. Cervical stenosis and pain were the main reasons for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in one‐third of all patients undergoing hysteroscopy. Intrauterine polyps were the commonest finding (13.9%) while submucous fibroids were detected in 10.7%. Endometrial biopsies were taken in 34.7%. Abnormal histological findings were reported in 28 cases, including eight instances of endometrial adenocarcinoma. After hysteroscopic assessment, 81% of patients were discharged while further surgical treatment was warranted in 14.6%. Conclusion Outpatient hysteroscopy is a reliable, safe and well‐tolerated diagnostic procedure for investigating endometrial and endocervical pathology in patients with postmenopausal bleeding. Whenever hysteroscopic findings appear suspicious an endometrial biopsy should be taken to exclude endometrial pathology.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The value of outpatient hysteroscopy in the management of postmenopausal bleeding: a review of 862 cases

et al. 2000

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“…Advances in technology have enabled manufacturers of hysteroscopic equipment to significantly reduce the diameter of the instruments, making diagnostic hysteroscopy without anaesthesia a genuine outpatient ambulatory procedure. 4 The efficacy and acceptability of a new method can be assessed by auditing large series. In this way factors that contribute to improved practice and better overall outcome may be identified.…”

Section: Introductionmentioning

confidence: 99%

“… 3 Panoramic hysteroscopy allows a complete visual inspection of the uterine cavity, the endometrium and the endocervical canal, and tissue biopsy allows histological confirmation of the diagnosis. Advances in technology have enabled manufacturers of hysteroscopic equipment to significantly reduce the diameter of the instruments, making diagnostic hysteroscopy without anaesthesia a genuine outpatient ambulatory procedure 4 …”

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confidence: 99%

A review of 2581 out‐patient diagnostic hysteroscopies in the management of abnormal uterine bleeding

1999

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Objective To evaluate the clinical efficacy, reliability and acceptability of out‐patient diagnostic hysteroscopy at a large teaching hospital. Setting The Women's Endoscopy Unit at Nottingham City Hospital, Nottingham, UK. Subjects Between 1994 and 1997, 2581 women were referred for menstrual problems and abnormal uterine bleeding. The endocervical canal and endometrial cavity were assessed using either a 4‐mm rigid or a 3.5‐mm flexible hysteroscope, according to the preference of the operator. All hysteroscopies were performed by consultants or experienced registrars. Endometrial biopsy was taken when indicated. Results The main indications for referral for diagnostic hysteroscopy included menorrhagia (37.5%), postmenopausal bleeding (33.4%), intermenstrual bleeding (26.7%) and metrorrhagia (8.8%). Less common indications included treatment with tamoxifen, review of previous endometrial pathology or abnormal glandular cells on cervical cytology, and investigation for infertility. The mean age of patients referred was 49.3 years. Hysteroscopy was completed successfully in 96.8% of all patients, with pain being the main reason for failure to complete the procedure. Local anaesthesia with paracervical infiltration was used in 34% of all patients. Submucous fibroids were the commonest cause of intrauterine pathology (11.4%) with the highest incidence found in women referred for menometrorrhagia (17.2%). Endometrial polyps were detected in 10.6% of all the patients. The endometrium was characterized by the hysteroscopist as atrophic, thickened, polypoid, haemorrhagic or malignant. Endometrial Pipelle biopsies were taken in 48.6% of all cases. Abnormal histological findings were reported in 61 cases including 11 instances of endometrial adenocarcinoma. The concordance rate between hysteroscopic and histological findings for all abnormalities was 63.9%. Further medical treatment was offered to 406 patients (16.3%), while 185 patients (17.3%) needed additional surgery as in‐patients. Conclusion Out‐patient hysteroscopy is a safe, acceptable and well‐tolerated procedure that provides useful information about the uterine cavity. Endometrial biopsy improves the diagnostic accuracy of hysteroscopy in detecting endometrial pathology.

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“…The use of anlgesics like mefenamic acid (9) and local anesthesia has been used for adequate performance of this procedure, intracervical instillation of anesthetics or paracervical block has been used (10), but the injection of anesthetics can be painful and cause bleeding (11,12). Lidocaine spray had been used and a reduction in the failure rate has been reported (13).…”

mentioning

confidence: 98%

Effectiveness of misoprostol for office hysteroscopy without anesthesia in infertile patients

Sordia-Hernández

Rosales-Tristan

Vazquez-Mendez

et al. 2011

Fertility and Sterility

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Local anaesthesia and cervical dilatation for outpatient diagnostic hysteroscopy

Cited by 19 publications

References 11 publications

The value of outpatient hysteroscopy in the management of postmenopausal bleeding: a review of 862 cases

The value of outpatient hysteroscopy in the management of postmenopausal bleeding: a review of 862 cases

A review of 2581 out‐patient diagnostic hysteroscopies in the management of abnormal uterine bleeding

Effectiveness of misoprostol for office hysteroscopy without anesthesia in infertile patients

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