How do Dutch gynecologists currently remove benign endometrial polyps. What changes have occurred in polypectomy practices since 2003. Why is hysteroscopic polypectomy becoming more prevalent. How does the setting and anesthesia for polyp removal vary among hospitals.

Overview of Endometrial Polyps and Their Removal

Endometrial polyps are benign growths in the uterine lining that are frequently associated with abnormal uterine bleeding. While they have a low potential for malignancy, factors like advanced age and postmenopausal bleeding can increase cancer risk. Most gynecologists opt to remove endometrial polyps in patients experiencing abnormal bleeding symptoms, with the goal of improving symptoms and patient satisfaction.

Traditionally, dilation and curettage (D&C) was used to remove polyps. However, research has shown D&C often fails to detect or completely remove polyps. Hysteroscopic removal has now become the preferred method for many gynecologists.

Current Polypectomy Practices Among Dutch Gynecologists

A 2009 survey of Dutch gynecologists provides insight into current practices for endometrial polyp removal:

• 78% of responding gynecologists remove endometrial polyps themselves
• 74% perform removals in an inpatient setting
• 54% use general or regional anesthesia
• 91% remove polyps under direct hysteroscopic vision

These results indicate hysteroscopic polypectomy has become the dominant technique, aligning with best practices for more accurate and complete polyp removal.

Comparing Polypectomy Practices: 2003 vs. 2009

Analyzing the 2009 survey results against a similar 2003 survey reveals several key trends in Dutch gynecological practice:

• Increase in local/no anesthesia use: 46% in 2009 vs. 22% in 2003
• Growth in direct hysteroscopic vision: 91% in 2009 vs. 64% in 2003
• Rise in 5 Fr electrosurgical instrument use: 44% in 2009 vs. 19% in 2003

These shifts indicate a move towards less invasive, outpatient-friendly procedures for endometrial polyp removal.

Differences in Polypectomy Settings: Teaching vs. Non-Teaching Hospitals

The survey revealed interesting variations in practice between different hospital types:

• 43% of gynecologists in teaching hospitals perform polypectomies in outpatient settings
• Only 19% of gynecologists in non-teaching hospitals use outpatient settings

This significant difference (p < 0.001) suggests teaching hospitals may be earlier adopters of minimally invasive techniques and outpatient procedures.

The Rise of Hysteroscopic Polypectomy in the Netherlands

Hysteroscopic polypectomy has become the most frequently performed hysteroscopic procedure in the Netherlands. This trend is driven by several factors:

1. Improved visualization: Direct hysteroscopic vision allows for more accurate polyp identification and removal
2. Higher success rates: Hysteroscopy is more effective at completely removing polyps compared to D&C
3. Minimally invasive: The procedure can often be performed on an outpatient basis with minimal anesthesia
4. Technological advancements: Smaller diameter hysteroscopes and improved instruments have made the procedure more accessible

Anesthesia Trends in Endometrial Polyp Removal

The shift towards local or no anesthesia for polypectomy procedures represents a significant change in practice. This trend offers several benefits:

• Reduced risks associated with general anesthesia
• Faster recovery times for patients
• Lower costs for both patients and healthcare systems
• Increased accessibility of the procedure in outpatient settings

However, the choice of anesthesia must always be tailored to the individual patient’s needs, polyp characteristics, and procedural complexity.

The Role of 5 Fr Electrosurgical Instruments in Modern Polypectomy

The increased use of 5 Fr electrosurgical instruments for polyp removal reflects technological advancements in the field. These instruments offer several advantages:

• Precise cutting and coagulation capabilities
• Smaller diameter, allowing for less cervical dilation
• Improved maneuverability within the uterine cavity
• Potential for reduced procedure time and patient discomfort

The adoption of these instruments has likely contributed to the overall shift towards outpatient hysteroscopic polypectomy.

Implications for Patient Care and Healthcare Systems

The evolving practices in endometrial polyp removal have significant implications:

• Improved patient experience: Less invasive procedures with faster recovery times
• Potential cost savings: Shift from inpatient to outpatient procedures
• Increased accessibility: More patients can undergo polyp removal without general anesthesia
• Enhanced training opportunities: More procedures performed in teaching hospital outpatient settings

These changes align with broader trends in gynecology and medicine towards minimally invasive, patient-centered care.

Challenges and Future Directions in Endometrial Polyp Management

Despite the progress in polypectomy techniques, several challenges and areas for future research remain:

1. Optimal patient selection: Determining which patients are best suited for outpatient vs. inpatient procedures
2. Long-term outcomes: Assessing the impact of different removal techniques on symptom resolution and polyp recurrence
3. Standardization of care: Developing evidence-based guidelines for polyp management across different healthcare settings
4. Technology integration: Evaluating the role of newer technologies like morcellators in polyp removal
5. Training and education: Ensuring gynecologists are proficient in the latest hysteroscopic techniques

Addressing these challenges will be crucial for continuing to improve endometrial polyp management.

The Importance of Individualized Care

While trends show a clear shift towards outpatient hysteroscopic polypectomy, it’s essential to remember that treatment should be tailored to each patient’s unique circumstances. Factors to consider include:

• Polyp size and location
• Patient’s medical history and comorbidities
• Presence of abnormal uterine bleeding
• Risk factors for malignancy
• Patient preferences and anxiety levels

Gynecologists must weigh these factors when deciding on the most appropriate setting, anesthesia, and technique for polyp removal.

The Economic Impact of Changing Polypectomy Practices

The shift towards outpatient hysteroscopic polypectomy has potential economic implications for healthcare systems:

• Reduced hospital stays: Fewer inpatient procedures mean lower costs for facilities and insurers
• Increased throughput: Outpatient procedures allow for more efficient use of resources and shorter wait times
• Equipment investments: Hospitals may need to invest in hysteroscopic equipment and training
• Reimbursement changes: Insurance and healthcare systems may need to adjust payment models to reflect the shift in care settings

Further economic analyses are needed to fully understand the cost-effectiveness of these changing practices.

Patient Education and Informed Consent

As polypectomy practices evolve, patient education becomes increasingly important. Gynecologists should discuss:

• The reasons for polyp removal
• Available procedure options and their pros/cons
• What to expect during and after the procedure
• Potential risks and complications
• Follow-up care and the possibility of polyp recurrence

Providing clear, comprehensive information helps patients make informed decisions about their care and can improve overall satisfaction with the treatment process.

Integrating Polypectomy into Comprehensive Gynecological Care

Endometrial polyp removal should be viewed as part of a broader approach to gynecological health. This integrated care model includes:

• Thorough initial evaluations to determine the cause of abnormal uterine bleeding
• Appropriate use of imaging studies like transvaginal ultrasound and sonohysterography
• Consideration of hormonal treatments in conjunction with or as an alternative to polypectomy
• Long-term follow-up to monitor for symptom recurrence or polyp regrowth
• Addressing other aspects of reproductive and menopausal health

By taking a comprehensive approach, gynecologists can provide more effective, patient-centered care that goes beyond simply removing polyps.

The Role of Minimally Invasive Gynecology Specialists

As hysteroscopic techniques become more advanced, there is a growing role for minimally invasive gynecology specialists. These experts can:

• Handle more complex cases that may not be suitable for general gynecologists
• Serve as resources for training and mentoring other physicians
• Drive innovation in techniques and technologies
• Participate in research to further advance the field

The development of this subspecialty may further accelerate the trend towards minimally invasive polypectomy procedures.

Global Perspectives on Endometrial Polyp Management

While this survey focused on Dutch practices, it’s important to consider global variations in polyp management:

• Resource availability: Access to hysteroscopic equipment varies widely between countries and regions
• Training differences: Some areas may have limited exposure to advanced hysteroscopic techniques
• Cultural factors: Patient preferences and healthcare norms can influence treatment approaches
• Healthcare system structures: Insurance coverage and healthcare delivery models impact procedure choices

Understanding these global differences can help inform best practices and identify areas for international collaboration and knowledge sharing.

The Future of Polyp Diagnosis and Treatment

Looking ahead, several emerging technologies and approaches may further transform endometrial polyp management:

• Artificial intelligence for improved polyp detection and characterization
• Office-based “see-and-treat” hysteroscopy systems
• Novel energy sources for more efficient polyp removal
• Molecular markers to better assess malignancy risk
• Targeted drug therapies to shrink or prevent polyps

Continued research and innovation in these areas will likely lead to even more effective, patient-friendly approaches to endometrial polyp management in the coming years.

Current practice in the removal of benign endometrial polyps: a Dutch survey

Gynecol Surg. 2012; 9(2): 163–168.

,¹,^1,2,³,² and ²

Lotte J. E. W. van Dijk

¹Department of Obstetrics & Gynecology, TweeSteden Hospital, Tilburg, The Netherlands

Maria C. Breijer

¹Department of Obstetrics & Gynecology, TweeSteden Hospital, Tilburg, The Netherlands

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

Sebastiaan Veersema

³Department of Obstetrics & Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands

Ben W. J. Mol

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

Anne Timmermans

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

¹Department of Obstetrics & Gynecology, TweeSteden Hospital, Tilburg, The Netherlands

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

³Department of Obstetrics & Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands

Corresponding author.

Received 2011 Aug 15; Accepted 2011 Oct 1.

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

This article has been cited by other articles in PMC.

Abstract

The purpose of this study is to evaluate the current practice of Dutch gynecologists in the removal of benign endometrial polyps and compare these results with the results of a previous study from 2003. In 2009 Dutch gynecologists were surveyed by a mailed questionnaire about polypectomy. Gynecologists answered questions about their individual performance of polypectomy: setting, form of anesthesia, method, and instrument use. The results were compared with the results from the previous survey. The response rate was 70% (585 of 837 gynecologists). Among the respondents, 455 (78%) stated to remove endometrial polyps themselves. Polyps were mostly removed in an inpatient setting (337; 74%) under general or regional anesthesia (247; 54%) and under direct hysteroscopic vision (411; 91%). Gynecologists working in a teaching hospital removed polyps more often in an outpatient setting compared with gynecologists working in a nonteaching hospital [118 (43%) vs. 35 (19%) p < 0.001]. These results are in accordance with the results from 2003. Compared to 2003 there was an increase in the number of gynecologists performing polypectomies with local or no anesthesia [211 (46%) vs. 98 (22%), p < 0.001]. An increase was also noted in the number of gynecologists using direct hysteroscopic vision [411 (91%) vs. 290 (64%), p < 0.001] and 5 Fr electrosurgical instruments [181 (44%) vs. 56 (19%), p < 0.001]. Compared to the situation in 2003, there is an increase in removal under direct hysteroscopic vision, with 5 Fr electrosurgical instruments, using local or no anesthesia. This implies there is progress in outpatient hysteroscopic polypectomy in the Netherlands.

Keywords: Polypectomy, Hysteroscopy, Inpatient, Outpatient

Background

Benign endometrial polyps are frequently associated with abnormal uterine bleeding [1–4]. Endometrial polyps have a low potential for (pre)malignancy. However age and postmenopausal bleeding are factors which are associated with malignancy [3, 5–7]. Most gynecologists (up to 93%) will remove endometrial polyps in patients with abnormal uterine bleeding symptoms [8]. Although case series, cohort studies, and retrospective studies on this subject exist, few studies address this question prospectively in a comparative cohort study or a randomized controlled trial [9, 10]. Removing endometrial polyps is thought to improve symptoms of abnormal uterine bleeding and increase satisfaction rate in women with endometrial polyps [11, 12]. The evidence that justifies the removal of endometrial polyps however is limited.

Traditionally, endometrial polyps were removed by dilatation and curettage (D&C). However, in approximately 57% of the D&C procedures endometrial polyps are not detected and D&C fails to extract endometrial polyps in 60–87% of the cases [13, 14]. Former surveys have demonstrated that D&C for polyp removal has not been completely abandoned: 2% of gynecologists in the UK removed polyps with D&C and 56% removed polyps with D&C following hysteroscopy [8]. In 2003, in the Netherlands, 4% of the gynecologists removed polyps with D&C and 27% used D&C following hysteroscopic localization. The preferred method of Dutch gynecologists is hysteroscopic removal (69%) [15]. Moreover, hysteroscopic polypectomy is the most performed hysteroscopic procedure in the Netherlands [16].

Large prospective cohort studies and randomized controlled trials have demonstrated that outpatient hysteroscopy and polypectomy are feasible, safe, and effective with high patient satisfaction rates [17–23]. Compared to the inpatient setting, patients treated in the outpatient setting recover faster, leading to a decrease in time away from home and work [24]. Nevertheless, our previous study revealed that in 2003, outpatient hysteroscopic polypectomy in the Netherlands was not practiced on a large scale (29% of gynecologists). However, we saw that outpatient hysteroscopic polyp removal was more often practiced in teaching hospitals compared with nonteaching hospitals. We therefore hypothesized that there might be a tendency towards outpatient hysteroscopic polypectomy. To evaluate this hypothesis, we conducted the current survey.

Materials and methods

All practicing gynecologists, holding membership of the Dutch association of obstetrics and gynecology (NVOG), in 2009 were identified from the national database. Gynecologists in training were not included. All gynecologists were approached by mail and received a questionnaire with a cover letter and prepaid return envelope. Different criteria were met to achieve the best response rate: the questionnaire was brief, fitting on one page; was explicit; and had a structured format consisting of three items subdivided in closed questions. To assure a higher response rate, a reminder was sent to the nonresponders after 8 weeks and a second reminder was sent by mail and email after another 12 weeks.

The questionnaire concerned questions about the medical practice of gynecologists, when a benign polyp was suspected following ultrasound or endometrial biopsy. Recipients were asked in what type of hospital they were working: a teaching hospital, with a residency program for gynecology, or a nonteaching hospital. Subsequently, gynecologists were asked to report whether they performed endometrial polypectomy themselves. Only those who did were then requested to report about setting (inpatient, day care, outpatient), form of anesthesia (general, regional, local or none), method of polyp removal (D&C, D&C after hysteroscopic localization or under direct hysteroscopic visualization), and type of hysteroscopic instrument used (5 Fr mechanical instruments, 5 Fr electrosurgical instruments, resectoscope, or morcellator).

Respondents were asked to report whether they performed the different modalities as a standard method, incidentally or never at all. The options that were chosen as a standard were used for further analysis. It was possible to leave questions unanswered or give multiple answers to one question (e.g., general and regional anesthesia as a standard method).

An inpatient setting was considered an operating theater with an anesthesiologist present for general or regional anesthesia and at least one night stay in the hospital. A day care setting was considered an operating theater with an anesthesiologist present, but discharge from the hospital the same day. A “walk-in-walk-out” procedure, without the presence of an anesthesiologist and without hospital admission, was considered an outpatient setting. Since the inpatient setting and day care setting both require hospital admission and use of an operating theater, they were analyzed together as one category. The same was applied to the form of anesthesia: general and regional anesthesia both require an anesthesiologist and were analyzed as one category. Local anesthesia is administered by a gynecologist and was therefore analyzed together with no anesthesia as one category. These categories enabled comparison of the current results with the results from 2003.

Statistical analysis

All data were processed anonymously. The information was collected, and descriptive statistical analyses were performed with SPSS for Windows® Release 15.0 Standard Version (Chicago, IL, USA). Answers given by gynecologists working in teaching hospitals were compared to answers given by gynecologists working in nonteaching hospitals. The data from this study were also compared to the data from our survey conducted in 2003 [15]. The chi-square test was used to compare proportions. Differences between groups were considered statistically significant at p < 0.05. All p values were two sided.

Findings

In 2009 a total of 837 gynecologists were registered in the Netherlands. After the first mailing, 409 questionnaires were returned. Another 87 gynecologists responded after the first reminder. A second reminder was sent, with a response of 89. In total a number of 585 (70%) gynecologists participated. Not all respondents answered all items of the questionnaire. Therefore subcalculations with different denominators were made.

Current practice

Of the 585 participating gynecologists, 455 (78%) performed polypectomy for endometrial polyps themselves. Table  shows the current practice of removing endometrial polyps. An inpatient or day care setting was used routinely by 337 (74%) gynecologists, with general or regional anesthesia by 247 (54%) gynecologists. Removal under direct hysteroscopic vision was the most used method of polypectomy, used by 411 (91%) respondents. Removal under direct hysteroscopic visualization was practiced routinely with 5 Fr mechanical instruments, 5 Fr electrosurgical instruments, or resectoscope by 166 (40%), 181 (44%), and 174 (42%) respondents, respectively.

Table 1

Current practice in 2009 concerning removal of endometrial polyps

	Total	Teaching (n = 275)	Nonteaching (n = 180)	p value
Setting
-Inpatient/day care	337 (74)	193 (70)	144 (80)	0. 019
-Outpatient	153 (34)	118 (43)	35 (19)	<0.001
Anesthesia
-General/regional	247 (54)	133 (48)	114 (63)	0.002
-Local/no	211 (46)	152 (55)	59 (33)	<0.001
Method
-D&C	6 (1)	2 (1)	4 (2)	ns
-D&C after hysteroscopy	37 (8)	15 (6)	22 (12)	0. 010
-Direct hysteroscopic vision	411 (91)	257 (94)	154 (86)	0.005
Hysteroscopic vision	n = 411	n = 257	n = 154
Instrument
-5 Fr mechanical	166 (40)	102 (40)	64 (42)	ns
-5 Fr electrosurgical	181 (44)	122 (47)	59 (38)	ns
-Resectoscope	174 (42)	106 (41)	68 (44)	ns
-Morcellator	12 (3)	10 (4)	2 (1)	ns

Outpatient polypectomy was carried out by 153 (34%) of the respondents, and 211 (46%) used local or no anesthesia. Separating this last group, it shows that 76 gynecologists (17%) used local anesthesia vs. 145 (32%) no anesthesia (p < 0.001). Table  shows the method of polyp removal vs. form of anesthesia. In case of D&C after hysteroscopic localization, more gynecologists used general or regional anesthesia than local or no anesthesia (13% vs. 1%, p < 0.001).

Table 2

Method of polyp removal versus form of anesthesia

	General/regional anesthesia	Local/no anesthesia	p value
D&C	3 (1)	1 (1)	ns
D&C following hysteroscopy	32 (13)	3 (1)	<0. 001
Under direct hysteroscopic vision	214 (86)	206 (98)	ns
Total	249	210

Teaching vs. nonteaching hospitals

In teaching hospitals, gynecologists removed polyps significantly more in an outpatient setting compared with gynecologists in nonteaching hospitals (43% vs. 19%, p < 0.001; Table ). Local or no anesthesia was more often used in teaching hospitals compared with nonteaching hospitals (55% vs. 33%, p < 0.001). Direct hysteroscopic vision was the most common method of polypectomy in both types of hospitals.

Comparison with practice in 2003

In 2003 and in 2009, an equal number of gynecologists (455) reported to remove endometrial polyps themselves. These results turned out this way by chance. In both years the majority of Dutch gynecologists performed polypectomy in an inpatient setting under general or regional anesthesia (Table ). Though, significantly less general or regional anesthesia (54% vs. 72%, p < 0.001) and more local or no anesthesia (46% vs. 22%, p < 0.001) is used in 2009 compared with 2003. This applies both for teaching and nonteaching hospitals (numbers not shown separately). In 2009, 145 gynecologists (32%) used no anesthesia vs. 21 (5%) in 2003 (p < 0.001). A shift towards the removal under direct hysteroscopic vision is seen in 2009 compared with 2003 (91% vs. 64%, p < 0.001), with a decrease in use of D&C (9% vs. 29%, p < 0.001). The 5 Fr electrosurgical instruments are more frequently used in 2009 compared with 2003 (44% vs. 19%, p < 0.001).

Table 3

Comparison numbers of 2009 with 2003

	Total 2009, n = 455	Total 2003, n = 455	p value
Setting
-Inpatient/day care	337 (74)	321 (71)	ns
-Outpatient	153 (34)	129 (28)	ns
Anesthesia
-General/regional	247 (54)	326 (72)	<0. 001
-Local/no	211 (46)	98 (22)	<0.001
Method
-D&C	6 (1)	17 (4)	0.03
-D&C after hysteroscopy	37 (8)	115 (25)	<0.001
-Direct hysteroscopic vision	411 (91)	290 (64)	<0.001
Hysteroscopic vision	2009, n = 411	2003, n = 290
Instrument
-5 Fr mechanical	166 (40)	197 (68)	<0. 001
-5 Fr electrosurgical	181 (44)	56 (19)	<0.001
-Resectoscope	174 (42)	159 (55)	0.001
-Morcellator	12 (3)	na	na

Discussion

Our survey shows that the majority of gynecologists in the Netherlands remove endometrial polyps in an inpatient setting, under direct hysteroscopic vision. More gynecologists in teaching hospitals perform polypectomy in an outpatient setting compared with nonteaching hospitals. Comparing current practice to the situation in 2003, we found an increase in hysteroscopic polyp removal with a decrease in D&C removal. Furthermore, we noted a decrease in the use of general or regional anesthesia and an increase in the number of gynecologists performing hysteroscopy with local or no anesthesia; no difference in the use of outpatient setting was noted. We also found an increase in the number of gynecologists using 5 French electrosurgical instruments.

There are two limitations that need to be addressed regarding the present study. First, our response rate is marginal. Our results should however be considered valid as a response rate of 70% is a level where the impact of nonresponse bias is negligible [25]. Moreover, the questionnaires were concise and met different criteria to achieve the best response rate. We met these criteria by using a short one-page questionnaire with return envelopes and reminders [26, 27].

The second limitation concerns the fact that we only considered the number of gynecologists removing polyps, and we did not display the number of polypectomies they performed. This could mean that few gynecologists perform polypectomies in an outpatient setting, but the major part of the number of polypectomies in the Netherlands (by a minor group of gynecologists) is performed outpatient. To get an impression of the number of uterine polypectomies per year, we sent all departments of gynecology in the Netherlands a letter and asked for the annual report of their department. However, the annual reports of the various hospitals differed in layout and classification. Some hospitals classified their therapeutic hysteroscopies in subcategories like hysteroscopic polypectomy, while others grouped them under the same denominator, without separation in numbers of polypectomies. We could therefore not include this information in our current survey.

In 2003 we hypothesized a tendency towards outpatient hysteroscopic removal of polyps for the future. Although we could not show such an increase directly in the number of gynecologists performing outpatient hysteroscopic polypectomy, our results imply that there is a tendency towards outpatient hysteroscopic polypectomy. We found an increase in the number of gynecologists performing polypectomy under direct hysteroscopic vision with local or no anesthesia and a decrease in D&C after hysteroscopy and the use of general or regional anesthesia. Considering the fact that an increase in local and no anesthesia was observed, it can only be concluded that more gynecologists are performing hysteroscopy as a “walk-in-walk-out” office procedure.

Hysteroscopic polypectomy seems to be integrated in the daily practice of most hospitals in the Netherlands [16]. Possible explanations for the shift towards outpatient hysteroscopic polypectomy can be mentioned on a speculative basis. First, the Dutch obstetrics and gynecology residency curriculum requires hysteroscopic polypectomy for graduation. The curriculum includes a basic surgical skill course with additionally the possibility to attend advanced courses and congresses on hysteroscopy. Each year many residents and gynecologists participate in these courses, which enhance the implementation of basic minimally invasive surgery skills training into the residency curriculum [28, 29]. Second, in 2002 hysteroscopic sterilization was introduced in the Netherlands. This technique was set in a “see-and-treat” setting with the use of 5 Fr working channel instruments. The use of this technique has probably had a positive influence on implementation of outpatient hysteroscopy for other indications. Third, literature shows that outpatient hysteroscopy is the most cost-effective method of hysteroscopy [24].

This progress in outpatient hysteroscopic polypectomy in the Netherlands is an advantage in medical practice. Literature shows that the best method of pain control for women undergoing traditional hysteroscopy is local anesthesia [30, 31]. However, a recent systematic review reported less pain during hysteroscopy in case of vaginoscopic approach (no anesthesia) compared with traditional hysteroscopic techniques, even with use of local anesthesia [32]. We showed a significant increase in the number of gynecologists using no anesthesia in 2009 compared with 2003. This makes the vaginoscopic approach of hysteroscopy more favorable.

Conclusion

In conclusion, this study shows that although hysteroscopy without anesthesia [32] and outpatient hysteroscopic polypectomy [19, 21–23] have been described in the literature to be highly successful, it is still not practiced on a large scale in the Netherlands. However, there is progress in outpatient hysteroscopic polypectomy. This implies that daily practice is catching up with the situation described in the literature.

Acknowledgment

We thank all gynecologists, who completed the questionnaire, for their cooperation.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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Current practice in the removal of benign endometrial polyps: a Dutch survey

Gynecol Surg. 2012; 9(2): 163–168.

,¹,^1,2,³,² and ²

Lotte J. E. W. van Dijk

¹Department of Obstetrics & Gynecology, TweeSteden Hospital, Tilburg, The Netherlands

Maria C. Breijer

¹Department of Obstetrics & Gynecology, TweeSteden Hospital, Tilburg, The Netherlands

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

Sebastiaan Veersema

³Department of Obstetrics & Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands

Ben W. J. Mol

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

Anne Timmermans

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

¹Department of Obstetrics & Gynecology, TweeSteden Hospital, Tilburg, The Netherlands

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

³Department of Obstetrics & Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands

Corresponding author.

Received 2011 Aug 15; Accepted 2011 Oct 1.

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

This article has been cited by other articles in PMC.

Abstract

The purpose of this study is to evaluate the current practice of Dutch gynecologists in the removal of benign endometrial polyps and compare these results with the results of a previous study from 2003. In 2009 Dutch gynecologists were surveyed by a mailed questionnaire about polypectomy. Gynecologists answered questions about their individual performance of polypectomy: setting, form of anesthesia, method, and instrument use. The results were compared with the results from the previous survey. The response rate was 70% (585 of 837 gynecologists). Among the respondents, 455 (78%) stated to remove endometrial polyps themselves. Polyps were mostly removed in an inpatient setting (337; 74%) under general or regional anesthesia (247; 54%) and under direct hysteroscopic vision (411; 91%). Gynecologists working in a teaching hospital removed polyps more often in an outpatient setting compared with gynecologists working in a nonteaching hospital [118 (43%) vs. 35 (19%) p < 0.001]. These results are in accordance with the results from 2003. Compared to 2003 there was an increase in the number of gynecologists performing polypectomies with local or no anesthesia [211 (46%) vs. 98 (22%), p < 0.001]. An increase was also noted in the number of gynecologists using direct hysteroscopic vision [411 (91%) vs. 290 (64%), p < 0.001] and 5 Fr electrosurgical instruments [181 (44%) vs. 56 (19%), p < 0.001]. Compared to the situation in 2003, there is an increase in removal under direct hysteroscopic vision, with 5 Fr electrosurgical instruments, using local or no anesthesia. This implies there is progress in outpatient hysteroscopic polypectomy in the Netherlands.

Keywords: Polypectomy, Hysteroscopy, Inpatient, Outpatient

Background

Benign endometrial polyps are frequently associated with abnormal uterine bleeding [1–4]. Endometrial polyps have a low potential for (pre)malignancy. However age and postmenopausal bleeding are factors which are associated with malignancy [3, 5–7]. Most gynecologists (up to 93%) will remove endometrial polyps in patients with abnormal uterine bleeding symptoms [8]. Although case series, cohort studies, and retrospective studies on this subject exist, few studies address this question prospectively in a comparative cohort study or a randomized controlled trial [9, 10]. Removing endometrial polyps is thought to improve symptoms of abnormal uterine bleeding and increase satisfaction rate in women with endometrial polyps [11, 12]. The evidence that justifies the removal of endometrial polyps however is limited.

Traditionally, endometrial polyps were removed by dilatation and curettage (D&C). However, in approximately 57% of the D&C procedures endometrial polyps are not detected and D&C fails to extract endometrial polyps in 60–87% of the cases [13, 14]. Former surveys have demonstrated that D&C for polyp removal has not been completely abandoned: 2% of gynecologists in the UK removed polyps with D&C and 56% removed polyps with D&C following hysteroscopy [8]. In 2003, in the Netherlands, 4% of the gynecologists removed polyps with D&C and 27% used D&C following hysteroscopic localization. The preferred method of Dutch gynecologists is hysteroscopic removal (69%) [15]. Moreover, hysteroscopic polypectomy is the most performed hysteroscopic procedure in the Netherlands [16].

Large prospective cohort studies and randomized controlled trials have demonstrated that outpatient hysteroscopy and polypectomy are feasible, safe, and effective with high patient satisfaction rates [17–23]. Compared to the inpatient setting, patients treated in the outpatient setting recover faster, leading to a decrease in time away from home and work [24]. Nevertheless, our previous study revealed that in 2003, outpatient hysteroscopic polypectomy in the Netherlands was not practiced on a large scale (29% of gynecologists). However, we saw that outpatient hysteroscopic polyp removal was more often practiced in teaching hospitals compared with nonteaching hospitals. We therefore hypothesized that there might be a tendency towards outpatient hysteroscopic polypectomy. To evaluate this hypothesis, we conducted the current survey.

Materials and methods

All practicing gynecologists, holding membership of the Dutch association of obstetrics and gynecology (NVOG), in 2009 were identified from the national database. Gynecologists in training were not included. All gynecologists were approached by mail and received a questionnaire with a cover letter and prepaid return envelope. Different criteria were met to achieve the best response rate: the questionnaire was brief, fitting on one page; was explicit; and had a structured format consisting of three items subdivided in closed questions. To assure a higher response rate, a reminder was sent to the nonresponders after 8 weeks and a second reminder was sent by mail and email after another 12 weeks.

The questionnaire concerned questions about the medical practice of gynecologists, when a benign polyp was suspected following ultrasound or endometrial biopsy. Recipients were asked in what type of hospital they were working: a teaching hospital, with a residency program for gynecology, or a nonteaching hospital. Subsequently, gynecologists were asked to report whether they performed endometrial polypectomy themselves. Only those who did were then requested to report about setting (inpatient, day care, outpatient), form of anesthesia (general, regional, local or none), method of polyp removal (D&C, D&C after hysteroscopic localization or under direct hysteroscopic visualization), and type of hysteroscopic instrument used (5 Fr mechanical instruments, 5 Fr electrosurgical instruments, resectoscope, or morcellator).

Respondents were asked to report whether they performed the different modalities as a standard method, incidentally or never at all. The options that were chosen as a standard were used for further analysis. It was possible to leave questions unanswered or give multiple answers to one question (e.g., general and regional anesthesia as a standard method).

An inpatient setting was considered an operating theater with an anesthesiologist present for general or regional anesthesia and at least one night stay in the hospital. A day care setting was considered an operating theater with an anesthesiologist present, but discharge from the hospital the same day. A “walk-in-walk-out” procedure, without the presence of an anesthesiologist and without hospital admission, was considered an outpatient setting. Since the inpatient setting and day care setting both require hospital admission and use of an operating theater, they were analyzed together as one category. The same was applied to the form of anesthesia: general and regional anesthesia both require an anesthesiologist and were analyzed as one category. Local anesthesia is administered by a gynecologist and was therefore analyzed together with no anesthesia as one category. These categories enabled comparison of the current results with the results from 2003.

Statistical analysis

All data were processed anonymously. The information was collected, and descriptive statistical analyses were performed with SPSS for Windows® Release 15.0 Standard Version (Chicago, IL, USA). Answers given by gynecologists working in teaching hospitals were compared to answers given by gynecologists working in nonteaching hospitals. The data from this study were also compared to the data from our survey conducted in 2003 [15]. The chi-square test was used to compare proportions. Differences between groups were considered statistically significant at p < 0.05. All p values were two sided.

Findings

In 2009 a total of 837 gynecologists were registered in the Netherlands. After the first mailing, 409 questionnaires were returned. Another 87 gynecologists responded after the first reminder. A second reminder was sent, with a response of 89. In total a number of 585 (70%) gynecologists participated. Not all respondents answered all items of the questionnaire. Therefore subcalculations with different denominators were made.

Current practice

Of the 585 participating gynecologists, 455 (78%) performed polypectomy for endometrial polyps themselves. Table  shows the current practice of removing endometrial polyps. An inpatient or day care setting was used routinely by 337 (74%) gynecologists, with general or regional anesthesia by 247 (54%) gynecologists. Removal under direct hysteroscopic vision was the most used method of polypectomy, used by 411 (91%) respondents. Removal under direct hysteroscopic visualization was practiced routinely with 5 Fr mechanical instruments, 5 Fr electrosurgical instruments, or resectoscope by 166 (40%), 181 (44%), and 174 (42%) respondents, respectively.

Table 1

Current practice in 2009 concerning removal of endometrial polyps

Outpatient polypectomy was carried out by 153 (34%) of the respondents, and 211 (46%) used local or no anesthesia. Separating this last group, it shows that 76 gynecologists (17%) used local anesthesia vs. 145 (32%) no anesthesia (p < 0.001). Table  shows the method of polyp removal vs. form of anesthesia. In case of D&C after hysteroscopic localization, more gynecologists used general or regional anesthesia than local or no anesthesia (13% vs. 1%, p < 0.001).

Table 2

Method of polyp removal versus form of anesthesia

Teaching vs. nonteaching hospitals

In teaching hospitals, gynecologists removed polyps significantly more in an outpatient setting compared with gynecologists in nonteaching hospitals (43% vs. 19%, p < 0.001; Table ). Local or no anesthesia was more often used in teaching hospitals compared with nonteaching hospitals (55% vs. 33%, p < 0.001). Direct hysteroscopic vision was the most common method of polypectomy in both types of hospitals.

Comparison with practice in 2003

In 2003 and in 2009, an equal number of gynecologists (455) reported to remove endometrial polyps themselves. These results turned out this way by chance. In both years the majority of Dutch gynecologists performed polypectomy in an inpatient setting under general or regional anesthesia (Table ). Though, significantly less general or regional anesthesia (54% vs. 72%, p < 0.001) and more local or no anesthesia (46% vs. 22%, p < 0.001) is used in 2009 compared with 2003. This applies both for teaching and nonteaching hospitals (numbers not shown separately). In 2009, 145 gynecologists (32%) used no anesthesia vs. 21 (5%) in 2003 (p < 0.001). A shift towards the removal under direct hysteroscopic vision is seen in 2009 compared with 2003 (91% vs. 64%, p < 0.001), with a decrease in use of D&C (9% vs. 29%, p < 0.001). The 5 Fr electrosurgical instruments are more frequently used in 2009 compared with 2003 (44% vs. 19%, p < 0.001).

Table 3

Comparison numbers of 2009 with 2003

Discussion

Our survey shows that the majority of gynecologists in the Netherlands remove endometrial polyps in an inpatient setting, under direct hysteroscopic vision. More gynecologists in teaching hospitals perform polypectomy in an outpatient setting compared with nonteaching hospitals. Comparing current practice to the situation in 2003, we found an increase in hysteroscopic polyp removal with a decrease in D&C removal. Furthermore, we noted a decrease in the use of general or regional anesthesia and an increase in the number of gynecologists performing hysteroscopy with local or no anesthesia; no difference in the use of outpatient setting was noted. We also found an increase in the number of gynecologists using 5 French electrosurgical instruments.

There are two limitations that need to be addressed regarding the present study. First, our response rate is marginal. Our results should however be considered valid as a response rate of 70% is a level where the impact of nonresponse bias is negligible [25]. Moreover, the questionnaires were concise and met different criteria to achieve the best response rate. We met these criteria by using a short one-page questionnaire with return envelopes and reminders [26, 27].

The second limitation concerns the fact that we only considered the number of gynecologists removing polyps, and we did not display the number of polypectomies they performed. This could mean that few gynecologists perform polypectomies in an outpatient setting, but the major part of the number of polypectomies in the Netherlands (by a minor group of gynecologists) is performed outpatient. To get an impression of the number of uterine polypectomies per year, we sent all departments of gynecology in the Netherlands a letter and asked for the annual report of their department. However, the annual reports of the various hospitals differed in layout and classification. Some hospitals classified their therapeutic hysteroscopies in subcategories like hysteroscopic polypectomy, while others grouped them under the same denominator, without separation in numbers of polypectomies. We could therefore not include this information in our current survey.

In 2003 we hypothesized a tendency towards outpatient hysteroscopic removal of polyps for the future. Although we could not show such an increase directly in the number of gynecologists performing outpatient hysteroscopic polypectomy, our results imply that there is a tendency towards outpatient hysteroscopic polypectomy. We found an increase in the number of gynecologists performing polypectomy under direct hysteroscopic vision with local or no anesthesia and a decrease in D&C after hysteroscopy and the use of general or regional anesthesia. Considering the fact that an increase in local and no anesthesia was observed, it can only be concluded that more gynecologists are performing hysteroscopy as a “walk-in-walk-out” office procedure.

Hysteroscopic polypectomy seems to be integrated in the daily practice of most hospitals in the Netherlands [16]. Possible explanations for the shift towards outpatient hysteroscopic polypectomy can be mentioned on a speculative basis. First, the Dutch obstetrics and gynecology residency curriculum requires hysteroscopic polypectomy for graduation. The curriculum includes a basic surgical skill course with additionally the possibility to attend advanced courses and congresses on hysteroscopy. Each year many residents and gynecologists participate in these courses, which enhance the implementation of basic minimally invasive surgery skills training into the residency curriculum [28, 29]. Second, in 2002 hysteroscopic sterilization was introduced in the Netherlands. This technique was set in a “see-and-treat” setting with the use of 5 Fr working channel instruments. The use of this technique has probably had a positive influence on implementation of outpatient hysteroscopy for other indications. Third, literature shows that outpatient hysteroscopy is the most cost-effective method of hysteroscopy [24].

This progress in outpatient hysteroscopic polypectomy in the Netherlands is an advantage in medical practice. Literature shows that the best method of pain control for women undergoing traditional hysteroscopy is local anesthesia [30, 31]. However, a recent systematic review reported less pain during hysteroscopy in case of vaginoscopic approach (no anesthesia) compared with traditional hysteroscopic techniques, even with use of local anesthesia [32]. We showed a significant increase in the number of gynecologists using no anesthesia in 2009 compared with 2003. This makes the vaginoscopic approach of hysteroscopy more favorable.

Conclusion

In conclusion, this study shows that although hysteroscopy without anesthesia [32] and outpatient hysteroscopic polypectomy [19, 21–23] have been described in the literature to be highly successful, it is still not practiced on a large scale in the Netherlands. However, there is progress in outpatient hysteroscopic polypectomy. This implies that daily practice is catching up with the situation described in the literature.

Acknowledgment

We thank all gynecologists, who completed the questionnaire, for their cooperation.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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Current practice in the removal of benign endometrial polyps: a Dutch survey

Gynecol Surg. 2012; 9(2): 163–168.

,¹,^1,2,³,² and ²

Lotte J. E. W. van Dijk

¹Department of Obstetrics & Gynecology, TweeSteden Hospital, Tilburg, The Netherlands

Maria C. Breijer

¹Department of Obstetrics & Gynecology, TweeSteden Hospital, Tilburg, The Netherlands

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

Sebastiaan Veersema

³Department of Obstetrics & Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands

Ben W. J. Mol

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

Anne Timmermans

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

¹Department of Obstetrics & Gynecology, TweeSteden Hospital, Tilburg, The Netherlands

²Department of Obstetrics & Gynecology, Academic Medical Center, Amsterdam, The Netherlands

³Department of Obstetrics & Gynecology, St. Antonius Hospital, Nieuwegein, The Netherlands

Corresponding author.

Received 2011 Aug 15; Accepted 2011 Oct 1.

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

This article has been cited by other articles in PMC.

Abstract

The purpose of this study is to evaluate the current practice of Dutch gynecologists in the removal of benign endometrial polyps and compare these results with the results of a previous study from 2003. In 2009 Dutch gynecologists were surveyed by a mailed questionnaire about polypectomy. Gynecologists answered questions about their individual performance of polypectomy: setting, form of anesthesia, method, and instrument use. The results were compared with the results from the previous survey. The response rate was 70% (585 of 837 gynecologists). Among the respondents, 455 (78%) stated to remove endometrial polyps themselves. Polyps were mostly removed in an inpatient setting (337; 74%) under general or regional anesthesia (247; 54%) and under direct hysteroscopic vision (411; 91%). Gynecologists working in a teaching hospital removed polyps more often in an outpatient setting compared with gynecologists working in a nonteaching hospital [118 (43%) vs. 35 (19%) p < 0.001]. These results are in accordance with the results from 2003. Compared to 2003 there was an increase in the number of gynecologists performing polypectomies with local or no anesthesia [211 (46%) vs. 98 (22%), p < 0.001]. An increase was also noted in the number of gynecologists using direct hysteroscopic vision [411 (91%) vs. 290 (64%), p < 0.001] and 5 Fr electrosurgical instruments [181 (44%) vs. 56 (19%), p < 0.001]. Compared to the situation in 2003, there is an increase in removal under direct hysteroscopic vision, with 5 Fr electrosurgical instruments, using local or no anesthesia. This implies there is progress in outpatient hysteroscopic polypectomy in the Netherlands.

Keywords: Polypectomy, Hysteroscopy, Inpatient, Outpatient

Background

Benign endometrial polyps are frequently associated with abnormal uterine bleeding [1–4]. Endometrial polyps have a low potential for (pre)malignancy. However age and postmenopausal bleeding are factors which are associated with malignancy [3, 5–7]. Most gynecologists (up to 93%) will remove endometrial polyps in patients with abnormal uterine bleeding symptoms [8]. Although case series, cohort studies, and retrospective studies on this subject exist, few studies address this question prospectively in a comparative cohort study or a randomized controlled trial [9, 10]. Removing endometrial polyps is thought to improve symptoms of abnormal uterine bleeding and increase satisfaction rate in women with endometrial polyps [11, 12]. The evidence that justifies the removal of endometrial polyps however is limited.

Traditionally, endometrial polyps were removed by dilatation and curettage (D&C). However, in approximately 57% of the D&C procedures endometrial polyps are not detected and D&C fails to extract endometrial polyps in 60–87% of the cases [13, 14]. Former surveys have demonstrated that D&C for polyp removal has not been completely abandoned: 2% of gynecologists in the UK removed polyps with D&C and 56% removed polyps with D&C following hysteroscopy [8]. In 2003, in the Netherlands, 4% of the gynecologists removed polyps with D&C and 27% used D&C following hysteroscopic localization. The preferred method of Dutch gynecologists is hysteroscopic removal (69%) [15]. Moreover, hysteroscopic polypectomy is the most performed hysteroscopic procedure in the Netherlands [16].

Large prospective cohort studies and randomized controlled trials have demonstrated that outpatient hysteroscopy and polypectomy are feasible, safe, and effective with high patient satisfaction rates [17–23]. Compared to the inpatient setting, patients treated in the outpatient setting recover faster, leading to a decrease in time away from home and work [24]. Nevertheless, our previous study revealed that in 2003, outpatient hysteroscopic polypectomy in the Netherlands was not practiced on a large scale (29% of gynecologists). However, we saw that outpatient hysteroscopic polyp removal was more often practiced in teaching hospitals compared with nonteaching hospitals. We therefore hypothesized that there might be a tendency towards outpatient hysteroscopic polypectomy. To evaluate this hypothesis, we conducted the current survey.

Materials and methods

All practicing gynecologists, holding membership of the Dutch association of obstetrics and gynecology (NVOG), in 2009 were identified from the national database. Gynecologists in training were not included. All gynecologists were approached by mail and received a questionnaire with a cover letter and prepaid return envelope. Different criteria were met to achieve the best response rate: the questionnaire was brief, fitting on one page; was explicit; and had a structured format consisting of three items subdivided in closed questions. To assure a higher response rate, a reminder was sent to the nonresponders after 8 weeks and a second reminder was sent by mail and email after another 12 weeks.

The questionnaire concerned questions about the medical practice of gynecologists, when a benign polyp was suspected following ultrasound or endometrial biopsy. Recipients were asked in what type of hospital they were working: a teaching hospital, with a residency program for gynecology, or a nonteaching hospital. Subsequently, gynecologists were asked to report whether they performed endometrial polypectomy themselves. Only those who did were then requested to report about setting (inpatient, day care, outpatient), form of anesthesia (general, regional, local or none), method of polyp removal (D&C, D&C after hysteroscopic localization or under direct hysteroscopic visualization), and type of hysteroscopic instrument used (5 Fr mechanical instruments, 5 Fr electrosurgical instruments, resectoscope, or morcellator).

Respondents were asked to report whether they performed the different modalities as a standard method, incidentally or never at all. The options that were chosen as a standard were used for further analysis. It was possible to leave questions unanswered or give multiple answers to one question (e.g., general and regional anesthesia as a standard method).

An inpatient setting was considered an operating theater with an anesthesiologist present for general or regional anesthesia and at least one night stay in the hospital. A day care setting was considered an operating theater with an anesthesiologist present, but discharge from the hospital the same day. A “walk-in-walk-out” procedure, without the presence of an anesthesiologist and without hospital admission, was considered an outpatient setting. Since the inpatient setting and day care setting both require hospital admission and use of an operating theater, they were analyzed together as one category. The same was applied to the form of anesthesia: general and regional anesthesia both require an anesthesiologist and were analyzed as one category. Local anesthesia is administered by a gynecologist and was therefore analyzed together with no anesthesia as one category. These categories enabled comparison of the current results with the results from 2003.

Statistical analysis

All data were processed anonymously. The information was collected, and descriptive statistical analyses were performed with SPSS for Windows® Release 15.0 Standard Version (Chicago, IL, USA). Answers given by gynecologists working in teaching hospitals were compared to answers given by gynecologists working in nonteaching hospitals. The data from this study were also compared to the data from our survey conducted in 2003 [15]. The chi-square test was used to compare proportions. Differences between groups were considered statistically significant at p < 0.05. All p values were two sided.

Findings

In 2009 a total of 837 gynecologists were registered in the Netherlands. After the first mailing, 409 questionnaires were returned. Another 87 gynecologists responded after the first reminder. A second reminder was sent, with a response of 89. In total a number of 585 (70%) gynecologists participated. Not all respondents answered all items of the questionnaire. Therefore subcalculations with different denominators were made.

Current practice

Of the 585 participating gynecologists, 455 (78%) performed polypectomy for endometrial polyps themselves. Table  shows the current practice of removing endometrial polyps. An inpatient or day care setting was used routinely by 337 (74%) gynecologists, with general or regional anesthesia by 247 (54%) gynecologists. Removal under direct hysteroscopic vision was the most used method of polypectomy, used by 411 (91%) respondents. Removal under direct hysteroscopic visualization was practiced routinely with 5 Fr mechanical instruments, 5 Fr electrosurgical instruments, or resectoscope by 166 (40%), 181 (44%), and 174 (42%) respondents, respectively.

Table 1

Current practice in 2009 concerning removal of endometrial polyps

Outpatient polypectomy was carried out by 153 (34%) of the respondents, and 211 (46%) used local or no anesthesia. Separating this last group, it shows that 76 gynecologists (17%) used local anesthesia vs. 145 (32%) no anesthesia (p < 0.001). Table  shows the method of polyp removal vs. form of anesthesia. In case of D&C after hysteroscopic localization, more gynecologists used general or regional anesthesia than local or no anesthesia (13% vs. 1%, p < 0.001).

Table 2

Method of polyp removal versus form of anesthesia

Teaching vs. nonteaching hospitals

In teaching hospitals, gynecologists removed polyps significantly more in an outpatient setting compared with gynecologists in nonteaching hospitals (43% vs. 19%, p < 0.001; Table ). Local or no anesthesia was more often used in teaching hospitals compared with nonteaching hospitals (55% vs. 33%, p < 0.001). Direct hysteroscopic vision was the most common method of polypectomy in both types of hospitals.

Comparison with practice in 2003

In 2003 and in 2009, an equal number of gynecologists (455) reported to remove endometrial polyps themselves. These results turned out this way by chance. In both years the majority of Dutch gynecologists performed polypectomy in an inpatient setting under general or regional anesthesia (Table ). Though, significantly less general or regional anesthesia (54% vs. 72%, p < 0.001) and more local or no anesthesia (46% vs. 22%, p < 0.001) is used in 2009 compared with 2003. This applies both for teaching and nonteaching hospitals (numbers not shown separately). In 2009, 145 gynecologists (32%) used no anesthesia vs. 21 (5%) in 2003 (p < 0.001). A shift towards the removal under direct hysteroscopic vision is seen in 2009 compared with 2003 (91% vs. 64%, p < 0.001), with a decrease in use of D&C (9% vs. 29%, p < 0.001). The 5 Fr electrosurgical instruments are more frequently used in 2009 compared with 2003 (44% vs. 19%, p < 0.001).

Table 3

Comparison numbers of 2009 with 2003

Discussion

Our survey shows that the majority of gynecologists in the Netherlands remove endometrial polyps in an inpatient setting, under direct hysteroscopic vision. More gynecologists in teaching hospitals perform polypectomy in an outpatient setting compared with nonteaching hospitals. Comparing current practice to the situation in 2003, we found an increase in hysteroscopic polyp removal with a decrease in D&C removal. Furthermore, we noted a decrease in the use of general or regional anesthesia and an increase in the number of gynecologists performing hysteroscopy with local or no anesthesia; no difference in the use of outpatient setting was noted. We also found an increase in the number of gynecologists using 5 French electrosurgical instruments.

There are two limitations that need to be addressed regarding the present study. First, our response rate is marginal. Our results should however be considered valid as a response rate of 70% is a level where the impact of nonresponse bias is negligible [25]. Moreover, the questionnaires were concise and met different criteria to achieve the best response rate. We met these criteria by using a short one-page questionnaire with return envelopes and reminders [26, 27].

The second limitation concerns the fact that we only considered the number of gynecologists removing polyps, and we did not display the number of polypectomies they performed. This could mean that few gynecologists perform polypectomies in an outpatient setting, but the major part of the number of polypectomies in the Netherlands (by a minor group of gynecologists) is performed outpatient. To get an impression of the number of uterine polypectomies per year, we sent all departments of gynecology in the Netherlands a letter and asked for the annual report of their department. However, the annual reports of the various hospitals differed in layout and classification. Some hospitals classified their therapeutic hysteroscopies in subcategories like hysteroscopic polypectomy, while others grouped them under the same denominator, without separation in numbers of polypectomies. We could therefore not include this information in our current survey.

In 2003 we hypothesized a tendency towards outpatient hysteroscopic removal of polyps for the future. Although we could not show such an increase directly in the number of gynecologists performing outpatient hysteroscopic polypectomy, our results imply that there is a tendency towards outpatient hysteroscopic polypectomy. We found an increase in the number of gynecologists performing polypectomy under direct hysteroscopic vision with local or no anesthesia and a decrease in D&C after hysteroscopy and the use of general or regional anesthesia. Considering the fact that an increase in local and no anesthesia was observed, it can only be concluded that more gynecologists are performing hysteroscopy as a “walk-in-walk-out” office procedure.

Hysteroscopic polypectomy seems to be integrated in the daily practice of most hospitals in the Netherlands [16]. Possible explanations for the shift towards outpatient hysteroscopic polypectomy can be mentioned on a speculative basis. First, the Dutch obstetrics and gynecology residency curriculum requires hysteroscopic polypectomy for graduation. The curriculum includes a basic surgical skill course with additionally the possibility to attend advanced courses and congresses on hysteroscopy. Each year many residents and gynecologists participate in these courses, which enhance the implementation of basic minimally invasive surgery skills training into the residency curriculum [28, 29]. Second, in 2002 hysteroscopic sterilization was introduced in the Netherlands. This technique was set in a “see-and-treat” setting with the use of 5 Fr working channel instruments. The use of this technique has probably had a positive influence on implementation of outpatient hysteroscopy for other indications. Third, literature shows that outpatient hysteroscopy is the most cost-effective method of hysteroscopy [24].

This progress in outpatient hysteroscopic polypectomy in the Netherlands is an advantage in medical practice. Literature shows that the best method of pain control for women undergoing traditional hysteroscopy is local anesthesia [30, 31]. However, a recent systematic review reported less pain during hysteroscopy in case of vaginoscopic approach (no anesthesia) compared with traditional hysteroscopic techniques, even with use of local anesthesia [32]. We showed a significant increase in the number of gynecologists using no anesthesia in 2009 compared with 2003. This makes the vaginoscopic approach of hysteroscopy more favorable.

Conclusion

In conclusion, this study shows that although hysteroscopy without anesthesia [32] and outpatient hysteroscopic polypectomy [19, 21–23] have been described in the literature to be highly successful, it is still not practiced on a large scale in the Netherlands. However, there is progress in outpatient hysteroscopic polypectomy. This implies that daily practice is catching up with the situation described in the literature.

Acknowledgment

We thank all gynecologists, who completed the questionnaire, for their cooperation.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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D&C (Dilation and Curettage) Procedure: Surgery and Recovery

Dilation and curettage (D&C) is a brief surgical procedure in which the cervix is dilated and a special instrument is used to scrape the uterine lining. Knowing what to expect before, during, and after a D&C may help ease your worries and make the process go more smoothly. Here’s what you need to know.

Reasons for a D&C

You may need a D&C for one of several reasons. It’s done to:

• Remove tissue in the uterus during or after a miscarriage or abortion or to remove small pieces of placenta after childbirth. This helps prevent infection or heavy bleeding.
• Diagnose or treat abnormal uterine bleeding. A D&C may help diagnose or treat growths such as fibroids, polyps, hormonal imbalances, or uterine cancer. A sample of uterine tissue is viewed under a microscope to check for abnormal cells.

What to Expect When Having a D&C

You can have a D&C in your doctor’s office, an outpatient clinic, or the hospital. It usually takes only 10 to 15 minutes, but you may stay in the office, clinic, or hospital for up to five hours.

Before a D&C, you will have a complete history taken and sign a consent form. Ask your doctor any questions you have about the D&C. Be sure to tell the doctor if:

• You suspect you are pregnant.
• You are sensitive or allergic to any medications, iodine, or latex.
• You have a history of bleeding disorders or are taking any blood-thinning drugs.

You will receive anesthesia, which your doctor will discuss with you. The type you have depends on the procedure you need.

• If you have general anesthesia, you will not be awake during the procedure.
• If you have spinal or epidural (regional) anesthesia, you will not have feeling from the waist down.
• If you have local anesthesia, you will be awake and the area around you cervix will be numbed.

Before the D&C, you may need to remove clothing, put on a gown, and empty your bladder.

During a D&C, you lie on your back and place your legs in stirrups like during a pelvic exam. Then the doctor inserts a speculum into the vagina and holds the cervix in place with a clamp. Although the D&C involves no stitches or cuts, the doctor cleanses the cervix with an antiseptic solution.

A D&C involves two main steps:

• Dilation involves widening the opening of the lower part of the uterus (the cervix) to allow insertion of an instrument. The doctor may insert a slender rod (laminaria) into the opening beforehand or use a medication before the procedure to soften the cervix and cause it to widen.
• Curettage involves scraping the lining and removing uterine contents with a long, spoon-shaped instrument (a curette). The doctor may also use a cannula to suction any remaining contents from the uterus. This can cause some cramping. A tissue sample then goes to a lab for examination.

Sometimes other procedures are performed along with a D&C. For example, your doctor may insert a slender device to view the inside of the uterus (called hysteroscopy). They may remove a polyp or fibroid.

After a D&C, there are possible side effects and risks. Common side effects include:

• Cramping
• Spotting or light bleeding

Complications such as a damaged cervix and perforated uterus or bladder and blood vessels are rare. But be sure to contact your doctor if you have any of the following symptoms after a D&C:

• Heavy or prolonged bleeding or blood clots
• Fever
• Pain
• Abdominal tenderness
• Foul-smelling discharge from the vagina

In very rare cases, scar tissue (adhesions) may form inside the uterus. Called Asherman’s syndrome, this may cause infertility and changes in menstrual flow. Surgery can repair this problem, so be sure to report any abnormal menstrual changes after a D&C.

Recovery After a D&C

After a D&C, you will need someone to take you home. If you had general anesthesia, you may feel groggy for a while and have some brief nausea and vomiting. You can return to regular activities within one or two days. In the meantime, ask your doctor about any needed restrictions. You may also have mild cramping and light spotting for a few days. This is normal. You may want to wear a sanitary pad for spotting and take pain relievers for pain.

You can expect a change in the timing of your next menstrual period. It may come either early or late. To prevent bacteria from entering your uterus, delay sex and use of tampons until your doctor says it’s OK.

See your doctor for a follow-up visit and schedule any further treatment that’s needed. If any tissue was sent for a biopsy, ask your doctor when to expect results. They are usually available within several days.

Uterine Polyps Treatment | Tennessee Reproductive Medicine

Uterine polyps at a glance

• Uterine polyps, also known as endometrial polyps, are bulb-shaped growths of endometrial tissue that develop in the uterus, attaching to the uterine lining by a stalk.
• Polyps can also develop in the cervix or inside the cervical canal, as well as slip down through the uterus opening into the vagina.
• Polyps are usually noncancerous, but may become cancerous over time.
• The exact cause of these polyps is unknown, but the hormone estrogen seems to promote their growth.
• Uterine polyps are most often seen in women who have gone through menopause, but can develop in younger women, sometimes causing infertility. It is not clear if they cause recurrent miscarriage.
• Polyps often do not show symptoms, but abnormal uterine bleeding is the most common symptom.
• Some polyps do not require treatment; symptomatic polyps can be treated through medication or removal, and do not usually return after treatment.

Causes of these polyps

Uterine (endometrial) polyps are similar to uterine fibroids, most likely developing due to an imbalance of the hormone estrogen. Excess endometrial tissue develops in response to estrogen, causing soft uterine polyps to grow from the uterine lining. Polyps are more frequently seen in perimenopausal or postmenopausal women, but can occur in younger women as well.

Endometrial polyps are more common in women with high blood pressure (hypertension), who are overweight, or who are taking tamoxifen (a medication used for treating breast cancer).

Could polyps be causing conception problems?

Tennessee Reproductive Medicine can help you with expert diagnosis and treatment.
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Symptoms

Many women with polyps do not experience symptoms, but the most common symptoms include:

• Irregular periods or menstrual bleeding
• Heavy menstrual bleeding
• Vaginal bleeding after menopause
• Bleeding between periods
• Bleeding after sex

When these symptoms are severe, the woman should visit her doctor, as these may also indicate endometrial cancer.

These polyps can also cause infertility or, possibly, miscarriages by preventing the fertilized egg from implanting in the uterine wall correctly. Research published by the National Institutes of Health indicates that endometrial (uterine) polyps are a factor in about 35% of female infertility.

Treatment of uterine polyps

Treatment for uterine polyps ranges from observation of the polyps (to make sure they do not develop worrisome features) to surgical removal. Hormonal medication such as progestin may relieve symptoms and shrink the polyp, but symptoms generally return once the medication is stopped.

Surgical treatment

A few minimally invasive surgical techniques can treat polyps in the uterus. The preferred method to treat polyps is hysteroscopy, a surgical procedure in which a tube connected to a camera (hysteroscope) is inserted through the cervix and into the uterus so that the polyp can be visualized directly and removed with precision. This procedure does not involve any incisions and can be completed as an outpatient with minimal recovery time needed.

A physician may also perform cervical dilation and curettage, also known as a D&C, by using a long metal tool to scrape the uterine lining, either to obtain a sample for diagnosis or remove the polyp. A D&C is not the preferred method of treatment, because it is possible to incompletely remove the polyp. Incomplete removal can result in recurrence. In addition, a D&C can create scar tissue within the uterus, which can lead to infertility.

Removed polyps may also be tested for cancer cells to determine if further treatment is necessary. Once removed, polyps generally do not resurface.

Hysteroscopy – NHS

A hysteroscopy is a procedure used to examine the inside of the womb (uterus).

It’s carried out using a hysteroscope, which is a narrow telescope with a light and camera at the end. Images are sent to a monitor so your doctor or specialist nurse can see inside your womb.

The hysteroscope is passed into your womb through your vagina and cervix (entrance to the womb), which means no cuts need to be made in your skin.

When a hysteroscopy may be carried out

A hysteroscopy can be used to:

A procedure called dilatation and curettage (D&C) used to be common to examine the womb and remove abnormal growths, but now hysteroscopies are carried out instead.

What happens during a hysteroscopy

A hysteroscopy is usually carried out on an outpatient or day-case basis. This means you do not have to stay in hospital overnight.

It may not be necessary to use anaesthetic for the procedure, although local anaesthetic (where medication is used to numb your cervix) is sometimes used.

General anaesthetic may be used if you’re having treatment during the procedure or you would prefer to be asleep while it’s carried out.

A hysteroscopy can take up to 30 minutes in total, although it may only last around 5 to 10 minutes if it’s just being done to diagnose a condition or investigate symptoms.

Read more about what happens during a hysteroscopy.

Is a hysteroscopy painful?

This seems to vary considerably between women. Some women feel no or only mild pain during a hysteroscopy, but for others the pain can be severe.

If you find it too uncomfortable, tell the doctor or nurse. They can stop the procedure at any time.

If you’re worried, speak to the doctor or nurse before having the procedure about what to expect and ask them about pain relief options.

Recovering from a hysteroscopy

Most women feel able to return to their normal activities the following day, although some women return to work the same day.

You may wish to have a few days off to rest if general anaesthetic was used.

While you’re recovering:

• you can eat and drink as normal straight away
• you may experience cramping that’s similar to period pain and some spotting or bleeding for a few days – this is normal and nothing to worry about unless it’s heavy
• you should avoid having sex for a week, or until any bleeding has stopped, to reduce the risk of infection (see below)

Your doctor or nurse will discuss the findings of the procedure with you before you leave hospital.

Read more about what happens after a hysteroscopy.

Risks of a hysteroscopy

A hysteroscopy is generally very safe but, like any procedure, there is a small risk of complications. The risk is higher for women who have treatment during a hysteroscopy. 

Some of the main risks associated with a hysteroscopy are:

• accidental damage to the womb – this is uncommon but may require treatment with antibiotics in hospital or, in rare cases, another operation to repair it
• accidental damage to the cervix – this is rare and can usually be easily repaired
• excessive bleeding during or after surgery – this can occur if you had treatment under general anaesthetic and can be treated with medication or another procedure; very rarely, it may be necessary to remove the womb (hysterectomy)
• infection of the womb – this can cause smelly vaginal discharge, a fever and heavy bleeding; it can usually be treated with a short course of antibiotics from your GP
• feeling faint – this affects 1 in every 200 women who have a hysteroscopy carried out without an anaesthetic or just a local anaesthetic

A hysteroscopy will only be carried out if the benefits are thought to outweigh the risks.

Alternatives to hysteroscopy

Your womb could also be examined by using a:

• pelvic ultrasound – where a small probe is inserted in the vagina and uses sound waves to produce an image of the inside of your womb
• endometrial biopsy – when a narrow tube is passed through your cervix into your womb, with suction used to remove a sample of your womb’s lining

These alternatives may be performed alongside a hysteroscopy, but do not provide as much information and can’t be used to treat problems in the same way as a hysteroscopy.

Page last reviewed: 05 December 2018
Next review due: 05 December 2021

Uterine Cancer: Diagnosis | Cancer.Net

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They do tests to learn whether cancer has spread to a different part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests such as CT scans (see below) can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This section describes options for diagnosing uterine cancer. Not all tests listed will be used for every woman. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of previous medical tests

In addition to a physical examination, the following tests may be used to diagnose uterine cancer:

• Pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done with a pelvic examination, is primarily used to check for cervical cancer. Sometimes a Pap test may find abnormal glandular cells, which are caused by uterine cancer.

• Endometrial biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells and tissue samples to diagnose disease.

  For an endometrial biopsy, the doctor removes a small sample of tissue with a very thin tube. The tube is inserted into the uterus through the cervix, and the tissue is removed with suction. This process takes a few minutes. Afterward, the woman may have cramps and vaginal bleeding. These symptoms should go away soon and can be reduced by taking a nonsteroidal anti-inflammatory drug (NSAID) as directed by the doctor. Endometrial biopsy is often a very accurate way to diagnose uterine cancer. People who have abnormal vaginal bleeding before the test may still need a dilation and curettage (D&C; see below), even if no abnormal cells are found during the biopsy.

• Dilation and curettage (D&C). A D&C is a procedure to remove tissue samples from the uterus. A woman is given anesthesia during the procedure to block the awareness of pain. A D&C is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure. During a hysteroscopy, the doctor inserts a thin, flexible tube with a light on it through the cervix into the vagina and uterus. After endometrial tissue has been removed, during a biopsy or D&C, the sample is checked by a pathologist for cancer cells, endometrial hyperplasia, and other conditions.

• Transvaginal ultrasound. An ultrasound uses sound waves to create a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus to take pictures. If the endometrium looks too thick, the doctor may decide to perform a biopsy (see above).

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. Like with a CT scan, a special dye called a contrast medium can be given intravenously or orally before the scan to create a clearer picture. MRI is very useful for getting detailed images if the treatment plan will include hormone management (see Types of Treatment). MRI is often used in women with low-grade uterine cancer (see Stages and Grades) to see how far the cancer has grown into the wall of the uterus. Knowing this can help determine whether a woman’s fertility can be preserved.

• Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests can help determine your treatment options.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, additional testing will be performed to discover how far the disease has grown. This helps to categorize the disease by stage and grade and directs the type of treatment that will be needed.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Polyp of the cervical canal

Polyp of the cervical canal disrupts the functioning of the cervix, contributes to the formation of a chronic focus of infection and the appearance of spotting in the intermenstrual periods. Such benign neoplasms are found in 20-25% of women, including during pregnancy. At the same time, timely diagnostics and a correctly selected treatment plan guarantee a cure.

In our clinics you can:

For more details and for any questions, please contact the number indicated on the website

Do you suspect you have symptoms of polyps? Do you want to undergo a comprehensive diagnosis of the reproductive system? Family Medical Center “Imma” will take care of your health.Make an appointment with our specialists at a convenient time – we work from 9.00 to 21.00.

What is a polyp of the cervical canal and how is it dangerous?

This is a benign neoplasm that appears in the lumen of the cervix from the connective tissue. Outside, polyps are covered with flat or tall cylindrical growths of the epithelium. They are attached to the cervical canal with a thin or thick leg closer to the external os of the cervix and rarely polyps are visible in the vaginal lumen (tumors on a long leg are visible).

Symptoms of the polyp of the cervical canal

As a rule, the disease has no characteristic symptoms. If the neoplasms are small and grow on a thick low leg, they are not felt by the patient and are not visible to the doctor during a standard examination. Polyps are detected in the diagnosis of other diseases of the reproductive system – according to statistics, in more than 70 cases of the formation of polyps of the cervical canal, a woman also exhibits other diseases.

Symptoms of the disease are manifested in each woman in different ways – this is influenced not only by the physiological features, but also by the structure of the formations.

• Fibrous neoplasms have virtually no symptoms. All due to the fact that such polyps do not have glands, which means they do not secrete mucus. Their dense and poorly vascularized structure is quite difficult to injure, respectively, the risk of bleeding is reduced to almost zero.
• Glandular polyps of the cervical canal, on the contrary, produce mucus and even increase intermenstrual bleeding. At the same time, all the discharge is rather scanty in nature – all because of their small size (up to 10 mm).

Glandular fibrous polyps of the cervical canal are mixed formations, so their symptoms are especially pronounced. The woman feels pain, bleeding appears after intercourse, characteristic intermenstrual bleeding.

What provokes the disease: the causes of the polyp of the cervical canal

• Channel trauma

Any damage to the cervical canal can change the structural composition of its epithelium – abortions, improperly installed intrauterine devices.In order for a polyp to form on the membrane, it is not necessary to receive a major injury – even a microscopic wound can cause a neoplasm to form.

• Changes in the surface of the cervix

True and false erosion, leukoplakia.

• Sexual infections

Trichomoniasis, gonorrhea, chlamydia and other STIs weaken a woman’s immune system and affect the cervical canal, disrupt the natural composition of the mucus found there.As a result, local inflammation forms, the mucous membrane becomes loose, prone to injury. In some cases, for protection, it can begin to increase its own area, as a result of forming a polyp or a group of them.

• Non-specific infections

Vulvovaginitis, vaginitis, cervicitis, endometritis, endomyometritis.

• Violation of the vaginal microflora

An imbalance of bacteria leads to fluctuations in the level of acidity, a favorable environment is formed for the growth of the epithelial layer of the cervical canal.

• Ovarian dysfunction

An excess of estrogen accumulates, there is a powerful stimulation of the growth of the epithelium, which lines the cervical zone. Often, the disease is accompanied by fibroids, endometrium and endometriosis.

• External factors and endocrine processes

Obesity, diabetes mellitus, overwork and stress.

• Physiological processes

Hormonal surges during adolescence, pregnancy, lactation and menopause.

What is the danger of the disease: the consequences of the polyp of the cervical canal

• Polyps can transform into benign formations.
• The risk of developing uterine bleeding increases.
• If a polyp is found during pregnancy, and the treatment was not prescribed correctly, a spontaneous abortion is possible.
• Necrosis of a tumor or neglect of treatment can cause death of adjacent tissues, blood poisoning.

Should a cervical polyp be removed? Polyps are subject to mandatory removal.The exception is small neoplasms. In any case, polyps cannot be eliminated on their own; at least drug treatment of the tumor is necessary.

Warn, do not heal!

Get diagnostics of cervical canal polyps in our medical center. We perform colposcopy, ultrasound, knife biopsy of the cervix. After a gynecological examination with a mirror and taking an anamnesis, the doctor will determine the necessary list of examinations and, based on their results, select therapy.

Make an appointment – we will be glad to see you in any of the six Imma clinics in Moscow.

Removal of polyp of the cervical canal and cervix

Removal of the polyp of the cervical canal and cervix with simultaneous curettage of the mucous membrane of the cervical canal and uterine cavity in Operating room No. 1, Alexandrov

The anatomical structure of the cervical canal defines the organ as an elongated cavity that connects the uterus and vagina.Polyps are benign growths – an abnormal proliferation of cells and tissues under the mucous membranes. Polyps of the cervical canal statically account for about a third of all benign neoplasms in women, but one should not be afraid of such a diagnosis. Modern methods of surgical treatment allow painless and safe removal of polypous growths.

Readings

Removal of a polyp in the uterus is prescribed in case of ineffectiveness of conservative treatment, with an increase in the clinical picture or an increase in the size of the formation – the diameter of the polyp becomes more than 5 mm.

Contraindications

There are a number of conditions in which removal of polyps is not carried out for medical reasons:

• detection of various inflammatory processes in the genitals – vaginitis, vulvitis, endometritis;
• pregnancy, breastfeeding – it is not recommended to carry out surgical interventions before the end of lactation;
• menstruation – you must wait 7-8 days of the cycle;
• oncological diseases – if a malignant proliferation of cells is determined by histological examination, it is necessary to start treating this neoplasm;
• high risks of uterine bleeding – with various concomitant diseases of the uterus or during menopause.

Also, some chronic diseases raise a number of concerns. Diabetes mellitus, renal failure, liver dysfunction and other systemic pathologies are considered relative contraindications for surgery.

Preparation

Preparation for surgery includes various stages of general and special examination. First, it is necessary to carry out standard diagnostic measures to determine the safety of the intervention, then the gynecologist prescribes specific diagnostic methods to determine risk factors from the genital organs:

• vaginal smear for the determination of pathogenic microorganisms;
• PCR reaction for accurate detection of HIV, herpes simplex virus, papilloma;
• Ultrasound examination using a vaginal probe;
• hysteroscopy – endoscopic examination of the uterine cavity.

Immediately before the operation, you should take hygienic measures, shave off the hair in the area of ​​the external genital organs, and on the day of the operation, refuse to eat and drink.

Procedure

The operation is performed under local anesthesia with a small amount of education and under general anesthesia in case of severe polyposis. The hysteroscope allows you to accurately determine the localization of the polyp, then a special attachment safely removes it. After that, curettage is performed – a procedure for the diagnostic assessment of the contents of the uterine cavity.The removed tissue is examined to determine the cellular composition of the polyp.

Recovery

Rehabilitation is quick and easy, it is important to take antibacterial and anti-inflammatory drugs, if necessary, pain relievers. The doctor can prescribe physiotherapy, as well as draw up an examination plan to assess the result of the operation.

Rehabilitation lasts about 4 weeks. During this period, you need to take care of your own health as much as possible.

What is the danger of refusal from operation

Some women prefer non-traditional or drug-based methods for removing polyps, but herbal treatment, vaginal suppositories or psychotherapy are not able to get rid of pathological formation, and the clinical effectiveness of these methods has not been proven.By itself, the polyp is not dangerous, but it can grow, causing bleeding, making intercourse difficult and identifying difficulties with conception and childbirth.

Complications

Also, postponing the moment of surgery can lead to serious complications – common inflammatory processes, severe bleeding and mucosal atrophy, which may subsequently become the reason for the need to remove the uterus.

Advantages of the operation with us

Although cervical polypectomy surgery is considered safe and relatively easy to perform, it is important to find a medical center whose doctors can be trusted with their reproductive health.”Operating room number 1″ clinic “Paracelsus” in the city of Aleksandrov is a multidisciplinary surgery center that provides quality medical care. Comfortable conditions for patients, powerful high-tech equipment, an emphasis on minimally invasive interventions and a team of experts in all areas of surgery – these and other advantages distinguish our institution. Sign up to us by phone or online.

Removal of polyps (polypectomy) of the uterine cavity and cervix in Samara

Removal of polyps on the cervix and in the uterine cavity itself is a fairly common procedure.A polyp is a pathological proliferation of mucous membranes in a separate area. This can become a serious obstacle to a possible pregnancy and cause discomfort in everyday life.

Cost of services …

Small polyps usually don’t cause any problems. Many patients before the examination did not even know about their existence. They can be small and disappear. for example, if their growth was caused by hormonal imbalance, which was corrected by treatment.

However, if the polyp is large or troublesome (pain, discharge, irregularities in cycles), it should be removed. We also recommend a preventive examination and polypectomy in preparation for pregnancy.

Preparation for the procedure

Preparation for the removal of uterine polyps is simple and is needed to reduce all possible risks.

After consultation and examination, the doctor may prescribe additional tests and diagnostics. for example:

• general blood test;
• blood clotting test;
• Ultrasound OMT;
• cytological analysis of scrapings from the cervical canal and uterus.

It is recommended to refuse food intake 12 hours before the start of polypectomy.

How is polyp removal performed

In the “CLINIC OF FIVE BLAGS” in Samara, polypectomy is performed by the most modern and reliable method – radio wave surgery.

It has a number of undeniable advantages:

• low injury rate;
• does not affect fertility;
• without bleeding;
• great accuracy and the ability to very thoroughly remove the damaged area.

If you have already found a polyp, make an appointment and consultation with a gynecologist at our clinic. An experienced doctor will examine and analyze your situation individually. He can order additional tests and give recommendations. In some cases, it is necessary to remove polyps, but sometimes therapy and observation can be dispensed with (if the polyp is small and does not grow further).

REMOVING POLYPS / Services / Medical and Diagnostic Center MedExpert Saratov / Engels

Rectal polyps are benign formations that are outgrowths on the intestinal mucosa.There is a possibility of their degeneration into malignant tumors.

Polyps of the rectum (anal canal) do not respond to conservative treatment, therefore, if such polyps are found (even if they do not cause the patient any discomfort), they must be removed.

In the Department of Proctology of the Medical Center Medexpert, the removal of polyps of the anal canal and rectum is carried out by the method of radio wave surgery using the Surgitron apparatus.

HOW DOES THE POLYPS BE DELETED?

The doctor uses the electrode of the apparatus instead of a scalpel and the separation of the tissue of the formation is carried out not with the help of mechanical action, but thanks to the directed flux of high-frequency radio waves.The technique is highly effective and safe, therefore it can be used in patients of any age.

WHAT ARE THE ADVANTAGES OF POLYPS REMOVAL BY RADIO WAVE METHOD?

This method of performing the operation has its advantages:

• Almost complete absence of pain;
• Safety – burns when using a radio electrode are excluded;
• Short recovery period, the patient returns to normal life as quickly as possible, no scars remain after the procedure;
• No hospital stay or general anesthesia is required;
• Blood loss is minimized;
• Low risk of complications in the postoperative period – wounds on the mucous membrane rarely become infected and heal quickly.
• Absence of relapses of the disease.

Radio wave removal of rectal polyps is a minimally invasive technique and is easily tolerated by patients, therefore it is a good alternative to other methods of treatment.

There are contraindications for this procedure, therefore, a specialist consultation is required.

In our center, removal of rectal polyps is performed by a coloproctologist, oncologist, Candidate of Medical Sciences OLGA VLADIMIROVNA KOCHENKOVA.

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Removal of uterine polyps, treatment and diagnosis, treatment and diagnosis in Kazan – “Scandinavia” Kazan

Polyps in the uterus are benign neoplasms that are attached to the inner wall of the uterus with “legs” or a wide base.The size of a polyp is from a few millimeters to 3-4 centimeters. Polyps can invade the vagina through the cervical canal. Polyps are diagnosed in women of all ages, starting from 10-11 years old.

An endometrial polyp is not dangerous if it is a benign formation and their number is small. In such cases, they can dissolve on their own. However, atypical, or adenomatous, polyps have a high likelihood of developing into a malignant tumor.More often this disease occurs in women in adulthood.

Symptoms of polyps in the uterus

The presence of polyps can be indicated by irregularities in the cycle of menstruation and bleeding outside their period. Also indirect symptoms of polyps are bleeding after menopause, discomfort during sex, leucorrhoea and pain in the lower abdomen.

Symptoms are also typical for endometriosis, fibroids and other gynecological diseases, so it is important to diagnose the pathology in time and prescribe treatment.

Causes of polyps in the uterus

The formation of polyps in the uterus is associated with irregularities in the work of the ovaries – too much estrogen enters the bloodstream, which causes the endometrium to grow.

The causes of uterine polyps can be:

• Hormonal disorders;
• Erosion of the cervix;
• Chronic infections;
• Inflammatory processes;
• Genetic pathologies;
• Abortion, gynecological operations.

Also at risk are women suffering from obesity, hypertension and diabetes mellitus.

Polyps during pregnancy

Placental polyps, which have formed from the placenta after a frozen pregnancy, abortion or complicated labor, are accompanied by profuse bleeding.

Benign formations can provoke infections and inflammation, and the proliferation of polyps can lead to miscarriage.Any type of polyp reduces the likelihood of a fertilized egg fixing in the uterus.

Polyps are removed only after childbirth. But the polyps detected during pregnancy will not affect the condition of the fetus and the expectant mother with quality control over the patient’s condition.

Treatment of polyps in the uterus

Treatment is carried out in a hospital setting

If symptoms are present, the patient should consult a gynecologist. To accurately diagnose polyps and establish their causes, the doctor prescribes an ultrasound of the pelvic organs, coloscopy and an x-ray examination of the uterine cavity.Also, a woman needs to pass smears for flora, oncocytology and infections.

Scandinavia (Ava-Kazan) has its own laboratory, so all tests can be taken in one place, and their results will be ready in a few days. In addition, there is no need to make a separate appointment for an expert-level ultrasound scan – the gynecologist conducts an ultrasound examination right in the office at the first appointment.

To determine the number, size and location of polyps, the doctor performs hysteroscopy with diagnostic curettage, after which a small piece of the polyp is sent for histological examination.

If the polyps are several millimeters long and it turns out to be not a cancerous tumor, the patient is prescribed conservative treatment without surgery – medication or hormonal therapy. After normalization of hormonal levels and the production of estrogen, small polyps dry out and are excreted with menstruation. However, even in this case, the patient needs constant observation by a gynecologist and regular ultrasound. In other cases, the polyps are scraped out, their bases are cauterized by the radio wave method.With a large number of polyps, the entire uterus is removed.

Since polyps are more often formed without pronounced symptoms, constant observation by a gynecologist and preventive examinations once a year is important.

A consultation with a gynecologist “Scandinavia” (“Ava-Kazan”) lasts 45 minutes, a minimum examination during the initial admission to a multidisciplinary clinic allows detecting pathologies in the early stages, and a general smear for oncocytology is hardly the only way to recognize cancer in the initial stages.

90,000 Removal of a polyp in the stomach in St. Petersburg

A polyp is a benign neoplasm that grows from the epithelial tissue of the stomach. These formations can be presented in a single or plural number, have different localization and sizes. In some cases, this disease can transform into malignant tumors, so doctors usually recommend removing the polyp in the stomach.

Causes of the appearance of polyps in the stomach

Several of the most common factors that can lead to the formation of polyps can be noted:

• inflammatory diseases of the stomach;

90,019 old age;

• infection with Helicobacter pylori or other microorganisms;
• hereditary predisposition;
• long-term use of certain groups of drugs.

Therefore, those people who have a history of one or more of the provoking factors described above should pay maximum attention to their stomach and regularly visit a gastroenterologist.

Clinical picture

The reason for a visit to a specialist may be specific symptoms that indicate the appearance of polyps in the stomach. These symptoms include:

• painful sensations in the stomach of varying severity;
• poor digestion;
• nausea and vomiting;

90,019 poor appetite;

• bad breath.

Not always polyps can manifest themselves. Very often, formations can exist hidden, and they are discovered by chance during fibrogastroscopy.

How to remove polyps

As noted earlier, sometimes polyps can develop into stomach cancer, so they need to be removed. Some patients refuse surgery to remove a polyp of the stomach, citing the fact that the disease does not bother them in any way. In such cases, careful and regular monitoring of the dynamics of the process is necessary.As a result, the polyp will still have to be removed, so it is best to do it right away and not expose yourself to unnecessary risks.

Currently, several methods of removing gastric polyps remain relevant:

• Endoscopic technique. It is a minimally invasive procedure and is performed without incisions. With the help of endoscopic equipment, which enters the stomach through the oral cavity, the doctor finds the polyp and removes it with an electrocoagulator or a loop. This method is simple and quick, does not require general anesthesia and rarely leads to the development of serious complications.However, it can be used to remove small and single polyps.
• Laser removal. It is a kind of endoscopic method. In this case, the polyp is vaporized by a laser. The advantage of this method is the ability to accurately control the depth of exposure, high accuracy, no bleeding, and a short rehabilitation period. Again, laser removal is only used for single, small polyps.
• Abdominal surgery. It is a complete surgical procedure performed under general anesthesia. The scope of the operation is determined individually and may include the removal of some part of the stomach or the entire organ as a whole. Such a radical method is used in cases where there is a suspicion of stomach cancer or multiple polyposis is noted. In modern surgery, preference is given to low-traumatic techniques, therefore, instead of abdominal surgery, which involves a large incision of the anterior abdominal wall, in some cases, laparoscopic removal of the polyp can be used.

After removal of a polyp in the stomach, relapses of the disease may occur, therefore it is necessary to periodically undergo examination by a gastroenterologist. In addition, after the treatment, the doctor will draw up an individual list of dietary and lifestyle recommendations, which must be strictly observed.