Suprapubic pressure facilitates the procedure of office hysteroscopy: A randomized controlled trial

Abstract

Aim: To minimize the experienced pain during office hysteroscopy, a number of technical approaches and maneuvers are used. The aim of the study was to assess the effect of suprapubic pressure (SuPuP) applied during hysteroscopy. The impact of this maneuver on experienced pain (assessed by visual analog scale [VAS]) and duration of passage through the cervical canal was measured and compared to a reference group with no SuPuP. Methods: Hysteroscopy was performed in study subjects as part of their infertility work-up. Patients were randomized into two groups as part of a controlled trial. In group 1, SuPuP was applied while inserting the scope; in group 2, SuPuP was not applied. Pain experienced during the procedure was measured on a 0-10 VAS. Duration of passage through the cervical canal was measured by analyzing the video of the procedure. The effect of SuPuP was estimated by testing for between-groups differences in these outcomes. Results: The number of patients included the study was 60. Mean (SD) VAS score was 3.40 (1.276) in group 1 compared to 3.33 (0.802) in group 2 (P = 0.809). Mean (SD) time of passage through the cervical canal in group 1 was 30.5 (18.37) seconds compared to 43.0 (24.51) seconds in group 2 (P = 0.029). Conclusion: Applying suprapubic pressure could facilitate the procedure by significantly shortening the duration of the passage through the cervical canal, but significantly not reduces the pain experienced during hysteroscopy. Further studies are to be undertaken to investigate the advantages of suprapubic pressure during office hysteroscopy.

Warm saline effectiveness for pain relief in office hysteroscopy: A systematic review and meta‐analysis of randomized controlled trials

“…1 The procedure requires the administration of miniaturized endoscopic equipment for adequate visualization and examination of the uterine cavity without the need for operating room and regional or general anesthesia. 2 Normal saline is commonly suggested as a distention medium in the procedure as it is associated with improvement in image clarity and reduction in episodes of vasovagal attacks compared to carbon dioxide. 3 Distension of the uterine myometrial wall by saline usually leads to contractile activity making patients report colicky pain of moderate to severe intensity.…”

“…Office hysteroscopy is the gold technique for the diagnosis and treatment of intrauterine pathologies related to infertility and abnormal uterine bleeding 1 . The procedure requires the administration of miniaturized endoscopic equipment for adequate visualization and examination of the uterine cavity without the need for operating room and regional or general anesthesia 2 . Normal saline is commonly suggested as a distention medium in the procedure as it is associated with improvement in image clarity and reduction in episodes of vasovagal attacks compared to carbon dioxide 3 …”

Letter to ‘Suprapubic pressure facilitates the procedure of office hysteroscopy: A randomized controlled trial’: Technical considerations

“…Dear Editor, We have read the article published by Török et al 1 with great interest. The authors suggest a gentle maneuver applied through the abdominal wall and toward the anterior uterus (i.e.…”