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Hysteroscopy d and c polypectomy: Dilation and curettage (D&C) – Mayo Clinic

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Dilation and Curettage (D&C) | Memorial Sloan Kettering Cancer Center

This information will help you get ready for your dilation and curettage (D&C). It explains what to expect before, during, and after your procedure.

D&C is a procedure in which your cervix is dilated (slowly opened) and tissue is removed from the inside of your uterus. The tissue is removed with a thin instrument called a curette.

You may also have a hysteroscopy at the same time as your D&C. A hysteroscopy is a procedure in which a thin scope with a light and a camera on the end is inserted into your uterus through your vagina. This lets your doctor see the lining of your uterus and look for anything abnormal.

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Purpose of a D&C

Usually, a D&C is done to find the cause of abnormal uterine bleeding (bleeding from your uterus). Examples of abnormal uterine bleeding include:

  • Bleeding between periods.
  • Bleeding after vaginal intercourse, including light spots of blood.
  • Heavy, irregular, or long periods.
  • Sudden vaginal bleeding after a year or longer without getting a period.

This bleeding can be caused by:

  • Endometrial cancer. Endometrial cancer is cancer of the lining of your uterus. A D&C can help diagnose early stages of the cancer.
  • Fibroids. Fibroids are growths of your uterus that are made of connective tissue and muscle fiber. Most of the time, they’re benign (not cancer).
  • Polyps. Polyps are growths attached to the inner wall of your uterus that extend into the uterine cavity (space inside your uterus). They’re usually benign, but some can be cancerous or precancerous (lead to cancer). Polyps can be removed during a D&C.
  • Hyperplasia. Hyperplasia is abnormal growth of the lining of your uterus. Hyperplasia can be precancerous.

A D&C can also be done to diagnose or treat other conditions of the uterus. It also can be used to clear the lining of the uterus after a miscarriage or abortion.

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Before Your Procedure

Ask about your medications

You may need to stop taking some of your medications before your procedure. Talk with your doctor about which medications are safe for you to stop taking. We have included some common examples below.

  • If you take an anticoagulant (medication to thin your blood, also called a blood thinner), ask the doctor who prescribes it for you when to stop taking it. Some examples are warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), and cilostazol (Pletal®).
  • If you take insulin or other medications for diabetes, ask the doctor who prescribes the medication what you should do the morning of your procedure. You may need to change the dose.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely and report concerns to your healthcare providers, if needed. Make sure to plan this before the day of your procedure.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s usually a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you must still have a responsible care partner with you.

 

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The Day Before Your Procedure

Note the time of your procedure

A staff member from the Admitting Office will call you after 2:00 pm the day before your procedure. If your procedure is scheduled for a Monday, they will call you on the Friday before.

The staff member will tell you what time you should arrive at the hospital for your procedure. They will also tell you where to go. If you don’t get a call by 7:00 pm, please call 212-639-5014.

Instructions for eating and drinking before your procedure

  • Do not eat anything after midnight the night before your procedure. This includes hard candy and gum.

  • Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).

  • Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.

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The Day of Your Procedure

Things to remember

Take only the medications your doctor told you to take the morning of your procedure. Take them with a few sips of water.

What to expect

A staff member will bring you to a dressing room and ask you to remove all of your clothing, jewelry, dentures, and contact lenses. The staff member will give you a hospital gown to put on.

After you change into the hospital gown, you will meet your nurse. The nurse will bring you into the procedure room and help you onto the operating bed. If you feel cold, ask your nurse for some blankets.

A member of your medical team will place an intravenous (IV) catheter (thin, flexible tube) into a vein, usually in your hand or arm. At first, you will get fluids through the IV, but it will be used later to give you anesthesia (medication to make you sleep during your procedure). You will also be attached to equipment to monitor your heart rate, breathing, and blood pressure.

You will get anesthesia (medication to make you sleep) through your IV. Once you’re asleep, your doctor will start your procedure.

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After Your Procedure

In the hospital

  • You will be taken to the Post Anesthesia Care Unit (PACU). In the PACU, a nurse will monitor your temperature, heart rate, breathing, and blood pressure. You may get oxygen through a thin tube that rests beneath your nose. You will stay in the PACU until you’re fully awake.
  • Once you’re fully awake, you will be brought to a second recovery area. You will be able to drink some tea or juice, and eat a light snack.
  • You may have some dull cramping in your lower abdomen (belly). Ask your nurse for medication to relieve any pain. Your doctor may also give you a prescription for pain medication to take at home.
  • Your nurse will give you instructions on how to care for yourself at home. You must have a responsible care partner with you when you’re discharged from (leave) the recovery area.

At home

  • You may feel drowsy from the effects of the anesthesia. It’s important to have someone with you for the first 24 hours after your procedure.
  • For 2 weeks after your procedure, or as instructed by your doctor, do not:
    • Douche
    • Use tampons
    • Have vaginal intercourse
  • You can shower. Ask your doctor when you can take a bath.
  • You may have some cramping and vaginal bleeding like what you have during a menstrual period. This may last for several days after your procedure. Use sanitary pads for vaginal bleeding.
  • Call your doctor to schedule your follow-up appointment.

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Call your doctor or nurse if you have:

  • A fever of 101 °F (38.3 °C) or higher
  • Vaginal bleeding that’s heavier than your usual menstrual flow
  • Pain that isn’t relieved by the medication your doctor recommended
  • Swelling in your abdomen
  • Foul-smelling vaginal discharge

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Hysteroscopy: Procedure, Uses & Recovery

Overview

Hysteroscopy examining a uterine polyp

What is a hysteroscopy?

Hysteroscopy is a procedure that can be used to both diagnose and treat causes of abnormal bleeding. The procedure allows your doctor to look inside your uterus with a tool called a hysteroscope. This is a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus. Hysteroscopy can be a part of the diagnosis process or an operative procedure.

What is diagnostic hysteroscopy?

Diagnostic hysteroscopy is used to diagnose problems of the uterus. Diagnostic hysteroscopy is also used to confirm results of other tests, such as hysterosalpingography (HSG). HSG is an X-ray dye test used to check the uterus and fallopian tubes. Diagnostic hysteroscopy can often be done in an office setting.

Additionally, hysteroscopy can be used with other procedures, such as laparoscopy, or before procedures such as dilation and curettage (D&C). In laparoscopy, your doctor will insert an endoscope (a slender tube fitted with a fiber optic camera) into your abdomen to view the outside of your uterus, ovaries and fallopian tubes. The endoscope is inserted through an incision made through or below your navel.

What is operative hysteroscopy?

Operative hysteroscopy is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy. If an abnormal condition was detected during the diagnostic hysteroscopy, an operative hysteroscopy can be performed at the same time, avoiding the need for a second surgery. During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope.

When is operative hysteroscopy used?

Your doctor may perform hysteroscopy to correct the following uterine conditions:

  • Polyps and fibroids: Hysteroscopy is used to remove these non-cancerous growths found in the uterus.
  • Adhesions: Also known as Asherman’s Syndrome, uterine adhesions are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow as well as infertility. Hysteroscopy can help your doctor locate and remove the adhesions.
  • Septums: Hysteroscopy can help determine whether you have a uterine septum, a malformation (defect) of the uterus that is present from birth.
  • Abnormal bleeding: Hysteroscopy can help identify the cause of heavy or lengthy menstrual flow, as well as bleeding between periods or after menopause. Endometrial ablation is one procedure in which the hysteroscope, along with other instruments, is used to destroy the uterine lining in order to treat some causes of heavy bleeding.

When should hysteroscopy be performed?

Your doctor may recommend scheduling the hysteroscopy for the first week after your menstrual period. This timing will provide the doctor with the best view of the inside of your uterus. Hysteroscopy is also performed to determine the cause of unexplained bleeding or spotting in postmenopausal women.

Who is a candidate for hysteroscopy?

Although there are many benefits associated with hysteroscopy, it may not be appropriate for some patients. A doctor who specializes in this procedure will consult with your primary care physician to determine whether it is appropriate for you.

Procedure Details

How is hysteroscopy performed?

Prior to the procedure, your doctor may prescribe a sedative to help you relax. You will then be prepared for anesthesia. The procedure itself takes place in the following order:

  • The doctor will dilate (widen) your cervix to allow the hysteroscope to be inserted.
  • The hysteroscope is inserted through your vagina and cervix into the uterus.
  • Carbon dioxide gas or a liquid solution is then inserted into the uterus, through the hysteroscope, to expand it and to clear away any blood or mucus.
  • Next, a light shone through the hysteroscope allows your doctor to see your uterus and the openings of the fallopian tubes into the uterine cavity.
  • Finally, if surgery needs to be performed, small instruments are inserted into the uterus through the hysteroscope.

The time it takes to perform hysteroscopy can range from less than five minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is done at the same time. In general, however, diagnostic hysteroscopy takes less time than operative.

Risks / Benefits

What are the benefits of hysteroscopy?

Compared with other, more invasive procedures, hysteroscopy may provide the following advantages:

  • Shorter hospital stay.
  • Shorter recovery time.
  • Less pain medication needed after surgery.
  • Avoidance of hysterectomy.
  • Possible avoidance of “open” abdominal surgery.

How safe is hysteroscopy?

Hysteroscopy is a relatively safe procedure. However, as with any type of surgery, complications are possible. With hysteroscopy, complications occur in less than 1% of cases and can include:

  • Risks associated with anesthesia.
  • Infection.
  • Heavy bleeding.
  • Injury to the cervix, uterus, bowel or bladder.
  • Intrauterine scarring.
  • Reaction to the substance used to expand the uterus.

Recovery and Outlook

What can I expect after hysteroscopy?

If regional or general anesthesia is used during your hysteroscopy, you may have to be observed for several hours before going home. After the procedure, you may have some cramping or slight vaginal bleeding for one to two days. In addition, you may feel shoulder pain if gas was used during your hysteroscopy. It is also not unusual to feel somewhat faint or sick. However, if you experience any of the following symptoms, be sure to contact your doctor:

  • Fever.
  • Severe abdominal pain.
  • Heavy vaginal bleeding or discharge.

Will I have to stay in the hospital overnight after hysteroscopy?

Hysteroscopy is considered minor surgery and usually does not require an overnight stay in the hospital. However, in certain circumstances, such as if your doctor is concerned about your reaction to anesthesia, an overnight stay may be required.

Additional Details

What type of anesthesia is used for hysteroscopy?

Anesthesia for hysteroscopy may be local, regional or general:

  • Local anesthesia: The numbing of only a part of the body for a short time.
  • Regional anesthesia: The numbing of a larger portion of the body for a few hours.
  • General anesthesia: The numbing of the entire body for the entire time of the surgery.

The type of anesthesia used is determined by where the hysteroscopy is to be performed (hospital or doctor’s office) and whether other procedures will be done at the same time. If you are having general anesthesia, you will be told not to eat or drink for a certain amount of time before the hysteroscopy.

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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

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.

References

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Di Spiezio SA, Bettocchi S, Spinelli M, Guida M, Nappi L, Angioni S, Sosa Fernandez LM, Nappi C. Review of new office-based hysteroscopic procedures 2003–2009. J Minim Invasive Gynecol. 2010;17(4):436–448. doi: 10.1016/j.jmig.2010.03.014. [PubMed] [CrossRef] [Google Scholar]24. Saridogan E, Tilden D, Sykes D, Davis N, Subramanian D. Cost-analysis comparison of outpatient see-and-treat hysteroscopy service with other hysteroscopy service models. J Minim Invasive Gynecol. 2010;17(4):518–525. doi: 10.1016/j.jmig.2010.03.009. [PubMed] [CrossRef] [Google Scholar]25. Lydeards S. Commentary: avoid surveys masquerading as research. BMJ. 1996;313:733–734. doi: 10.1136/bmj.313.7059.733. [CrossRef] [Google Scholar]26. Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, Kwan I, Cooper R. Methods to increase response rates to postal questionnaires. Cochrane Database Syst Rev. 2007;2:MR000008. [PubMed] [Google Scholar]27. VanGeest JB, Johnson TP, Welch VL. 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What to Expect, WakeMed Health & Hospitals, Raleigh & Wake County, NC

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), Clopidogrel (Plavix), warfarin (Coumadin), and other blood thinners.
  • You will be scheduled to undergo the procedure after menstrual bleeding has ended and before ovulation (if you are still ovulating).
  • Ask your doctor which drugs you should still take on the day of the surgery.
  • Discuss any possible bleeding disorders or other medical conditions that you may have.
  • You will have blood samples taken in case you need a blood transfusion.
  • Do not smoke. This will help you to recover quicker.

On the Day of the Surgery

  • If you are to have general anesthesia, you will usually be asked not to drink or eat anything after midnight the night before the surgery.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

After Surgery

  • Most patients can go home the same day.
  • You may have increased cramping and vaginal bleeding for a day or two after the procedure.
  • You may experience gas pains for about a day or so due to gas administered during the procedure. This may extend into your upper abdomen and shoulder. Walking will help relieve this pressure.
  • This surgery has a quick recovery with most patients feeling much better within the first few days.

Recovery: what to expect in the next few weeks

  • Some women have some water discharge with some blood for a few weeks expect the flow to be heavy at first and then diminishing over time.
  • Most women feel better within the first week following surgery; however, do not lift, push or pull any heavy objects for a couple of weeks.
  • Do not resume sexual intercourse or douche until your doctor says it is OK.
  • Full recovery takes about two weeks to allow for internal healing.

Endometrial Polyp Removal Q&A

What does endometrial polyp removal involve?

A patient is either lightly or fully sedated. The gynecologist guides the hysteroscope into your vagina, through the cervix, and into the uterus. Gas or saline is released through the scope to inflate your uterus, allowing for better visualization. The physician will remove any polyps with special scissors, a laser, or another device that uses electricity.

How many incisions are made?

No incisions are made on the outside since the procedure is done via the vagina.

How long do I stay in the hospital?

Patients will normally be able to go home the same day, but in some cases, there may be an overnight stay.

What is the recovery time?

Most patients are fully recovered in two weeks. If you have a physically demanding job that requires lifting or pushing heavy objects, check with the doctor before returning to work.

Diagnostic hysteroscopy With or Without D&C

Diagnostic hysteroscopy is used to examine the inside of the uterus. This procedure can assist your doctor in the diagnosis of abnormal uterine conditions such as internal fibroid tumors, scarring, polyps, and congenital malformations. Therefore, hysteroscopy is an important tool in the study of infertility or abnormal uterine bleeding.

The first step of hysteroscopy involves opening the canal of the cervix with a series of dilators. Once the dilation is complete, the hysteroscope, a narrow lighted instrument similar to the laparoscope, is passed through the cervix into the lower end of the uterus. A clear solution is then injected into the uterus through the hysterosope. This solution expands the uterine cavity, clears the blood and mucus away, and enables your surgeon to directly view the internal structure of the uterus.

Diagnostic hysteroscopy is usually done on an outpatient basis with either general or local anesthesia and takes about thirty minutes to perform. Curettage or scraping of the inside of the uterine cavity may be performed after hysteroscopy; this allows a better diagnosis on the tissue.

Operative Hysteroscopy:

The technique of hysteroscopy has also been expanded to include operative hysteroscopy.

Operative hysteroscopy can treat many of the abnormalities found during diagnostic hysteroscopy at the same time as the diagnosis. This procedure is very similar to the diagnostic hysteroscopy except that operating instruments such as scissors, biopsy forceps, electrocautery instruments, and graspers can be placed into the uterine cavity through a channel. Fibroid tumors, scar tissue and polyps can be removed from inside the uterus. Congenital abnormalities, such as a uterine septum, may also be corrected.

Post Operative Care:

You can expect cramping, similar to menstrual period cramping, and possibly some vaginal bleeding for several days. Most likely, you’ll resume your regular activities within one or two days after surgery. You should avoid sexual intercourse for a few days or as long as the bleeding persists.

Notify your physician if you experience the following:

  • Increasing pelvic or abdominal pain
  • Fevers or chills (fever higher than 100.4 degrees)
  • Vaginal discharge with a bad odor
  • Excessive bleeding (soaking through one pad per hour)

Risks of Hysteroscopic Procedures:

Complications rarely occur during hysteroscopy. In a few cases, infection of the uterus or fallopian tubes can result. Occasionally a hole may be made through the back of the uterus. However, this is usually not a serious problem because the perforation spontaneously closes. Rarely an abnormal incision is required to repair the uterine perforation or to repair bowel injury.

Other possible complications include allergic reactions, bleeding, and fluid overload. Most healthy women of reproductive age can have hysteroscopy and or laparoscopy with no complications. A careful medical history and physical examination should be performed prior to any surgical procedure.

Dilation and Curettage (D&C) | Everyday Health

A D&C can help to diagnose a number of conditions, including uterine cancer or polyps.

A dilation and curettage procedure, also called a D&C, is performed to remove abnormal tissue from your uterus.

Dilation refers to opening up the cervix, and curettage (pronounced cure-eh-TAJ) means to remove the contents of the uterus.

During this surgical procedure, a woman’s cervix (the lower, narrow part of the uterus) is dilated with an instrument or medication so that the uterine lining can be scraped with a spoon-shaped instrument, called a curette.

Curettes can be sharp or use suction.

Reasons for a D&C

A D&C may be performed to diagnose or treat a uterine condition.

Your doctor may recommend the procedure if you experience any of the following:

  • Abnormal uterine bleeding
  • Bleeding after menopause
  • Abnormal endometrial cells (cells in the inner membrane of the uterus) that may indicate cancer
  • Infertility or difficulty becoming pregnant

After collecting a tissue sample from the lining of your uterus, your doctor will send the sample to a lab to be tested for one or more of the following:

If your doctor is performing a D&C for therapeutic reasons, he or she may remove the entire contents of your uterus in order to do one of the following:

  • Remove a molar pregnancy that causes a tumor to form instead of a normal pregnancy
  • Treat excessive bleeding after giving birth by clearing out parts of the placenta that remain in the uterus
  • Remove cervical or uterine polyps
  • Remove fibroid tumors
  • Clear out any tissue that remains in the uterus after a miscarriage or abortion to prevent infection or heavy bleeding. According to the American Pregnancy Association, only about half of women who miscarry require a D&C. However, if you miscarry after 10 weeks, you may be more likely to need a D&C.

Some women may have a D&C when they have a hysteroscopy, in which a doctor inserts a slim instrument holding a light and camera into your vagina, through your cervix, and up into your uterus to look around.

This procedure lets your doctor view the lining of your uterus on a screen, so he or she can identify abnormal areas and polyps, as well as take a tissue sample.

Your doctor can also remove uterine polyps and fibroid tumors during a hysteroscopy.

What to Expect

During a D&C, you’ll receive one of the following forms of anesthesia:

  • General anesthesia, which makes you unconscious so that you can’t feel pain
  • Local anesthesia, which provides light sedation or uses injections to numb only a small area of your body
  • Regional anesthesia, which provides light sedation or uses an injection to numb a larger region of your body

During the procedure, you can expect the following:

  • You’ll lie on your back with your heels in stirrups while your doctor inserts an instrument (speculum) into your vagina to hold open the vaginal walls in order to see your cervix.
  • Your doctor will insert a series of thicker rods into your cervix to slowly dilate it.
  • Once the cervix is dilated enough, your doctor will remove the rods and insert a spoon-shaped instrument with a sharp edge or a suction device to remove uterine tissue.

After a D&C

After the procedure, you may stay in the recovery room for a few hours to make sure you’re not bleeding heavily or experiencing other complications.

You’ll also need to wait for the anesthesia to wear off.

Side effects of a D&C may last a few days and can include mild cramping, spotting, or light bleeding.

To help ease cramping, your doctor may recommend taking ibuprofen (Advil, Motrin) or another medication.

To prevent infections, your doctor will most likely tell you to refrain from putting anything in your vagina until your cervix returns to normal.

After a D&C, your uterus needs to build a new lining. This means your next period may not come at its normal time.

If the D&C was required because of a miscarriage, and you want to become pregnant again, ask your doctor when it’s safe to start trying to conceive.

Risks

While dilation and curettage is usually a safe procedure, there is some risk of developing the following complications:

  • Heavy bleeding
  • Infection, in rare cases
  • Perforation of the uterus (hole poked by a surgical instrument). This happens more often in women who were recently pregnant and in women who have gone through menopause. Perforation of the bowel can also occur.
  • Development of scar tissue inside the uterus. This is rare and happens most often when a D&C is performed after a miscarriage or birth. Known as Asherman’s syndrome, this scarring can lead to abnormal, absent, or painful menstrual cycles, future miscarriages, and infertility.
  • Injury of the cervix. If this happens, your doctor can apply pressure or medicine to stop the bleeding, or can stitch the wound closed.

If you experience any of the following after a D&C, contact your doctor immediately:

  • Heavy bleeding that requires changing pads every hour
  • Light bleeding that lasts longer than 2 weeks
  • Fever
  • Cramps lasting longer than 48 hours
  • Pain that worsens
  • Foul-smelling discharge from your vagina

Removal of uterine polyp, hysteroresectoscopy – price

Hysteroscopy of the uterus: removal of polyps in MedicaMenta

A distinctive feature of modern surgery is the minimal trauma of the operated tissues. Removal of a polyp of the uterus in the clinic “MedicaMente” is carried out on modern equipment using the safest, proven techniques.The ability to precisely remove a polyp without damaging nearby healthy tissue is provided by endoscopy (all manipulations to remove uterine polyps in our clinic are controlled by hysteroscopy). The material obtained during the operation must be sent for histological examination.

Removal of the polyp of the cervical canal (cervix)

Clinics in Moscow carry out removal of the polyp of the cervical canal using various methods. Depending on the characteristics of polyps (their number, structure, size) and location in the cervical canal (near the external pharynx or deep in the cervical canal), removal can be outpatient or in a surgical hospital.

In the arsenal of gynecologists at the MedicaMente medical center in Korolyov there are modern equipment and practically all known methods of removing polyposis growths, which allow for a sparing painless treatment with a fast healing process.

How do we remove polyps of the cervix and cervical canal:
  1. Targeted radio wave removal of polyp using the “Surgitron” apparatus (on an outpatient basis, does not require anesthesia, does not leave scars on the cervix, a safe method, including for nulliparous patients) – suitable for removing single polyps, the leg of which is located on the edge of the cervix, near external pharynx.Usually, the presence of such polyps is detected during a standard gynecological examination.

  2. During hysteroscopy with endoscopic instruments. Small glandular polyps of the cervical canal can be removed on an outpatient basis under local anesthesia during office hysteroscopy. Large neoplasms, as well as dense fibrous polyps of the cervical canal, require polypectomy under anesthesia using an operating hysteroscope.
    … How is hysteroscopy performed at MedicaMenta

  3. Curettage of the mucous membrane of the cervical canal. During the procedure, the layer of the mucous membrane of the cervical canal together with the polyp is removed mechanically. It can be recommended for multiple polyposis, re-formation of polyps, or with echographic signs of changes in the endometrium (according to the results of ultrasound, there is a suspicion of an endometrial polyp, a submucous myoma node, endometrial hyperplasia, etc.).
    … hysteroscopy with WFD in MedicaMent

Removal of the endometrial polyp (uterine body). Hysteroresectoscopy

In the clinic “MedicaMente” in Korolev, removal of endometrial polyps of any category of complexity is carried out. Thanks to the skillful actions of the doctors, the patient easily recovers from the manipulation. The length of stay in the hospital depends on the volume of the surgical intervention and can range from 3 hours to 1-2 days.

Single pedunculated endometrial polyps can be removed by polypectomy (unscrewing the formations with a special clamp), followed by diagnostic curettage of the polyp location and control hysteroscopy. For removal of large endometrial polyps, fibrous and parietal polyps, as well as for dissection of synechia and septa, hysteroresectoscopy is most optimal.

Hysteroresectoscopy (a type of endoscopy) is the most gentle method of removing polyps, submucous uterine fibroids, excision of adhesions in the uterine cavity and intrauterine septa in comparison with traditional curettage.The operation is carried out in a hospital, under video control, using special miniature electrosurgical instruments. General anesthesia (anesthesia) is used for pain relief.

During the procedure, the doctor can fully control his actions on the monitor screen under multiple magnification. Operation hysteroresectoscopy “under the control of the eye” allows you to remove formations in the uterine cavity and cervical canal as accurately as possible, with minimal trauma to the healthy tissues of the uterus.Hysteroresectoscopy makes it possible to remove the endometrial polyp with aiming together “with the root” and to perform subsequent electrocoagulation (cauterization) of the polyp dislocation site, which excludes the recurrence of the disease.

* To clarify the nuances of preparation for surgery under the control of hysteroscopy, you can directly consult a doctor. You can make an appointment with our gynecologists at a time convenient for you through the website or by phone.

Hysteroscopy in Rostov-on-Don: price, contacts.Make a hysteroscopy of the uterine polyp

Hysteroscopy is used in gynecology both as a diagnosis of the uterine cavity and as a surgical method for removing polyps or benign neoplasms.

In the DAVINCHI Clinical and Diagnostic Center hysteroscopy (diagnosis and treatment) is carried out with a histological examination of the endometrium, as well as an immunohistochemical study (IHC analysis) is performed according to indications.

Hysteroscopy is performed using an optical apparatus – hysteroscope (a long probe with a miniature video camera) inserted through the vagina into the uterine cavity.The image in multiple magnification is displayed on the monitor screen and allows the doctor to carry out an accurate diagnosis or necessary surgical manipulations.

Before the appointment of a hysteroscopy, the doctor will prescribe in accordance with the tests, the list of which is determined by the order of the Ministry of Health for any type of surgical intervention, as well as an electrocardiogram and a consultation with a therapist for admission to anesthesia. The procedure is performed under intravenous anesthesia and lasts from 15 minutes to 1 hour.

Diagnostic hysteroscopy is performed under intravenous anesthesia.Has the following indications:

  • Determination of patency of the mouth of the fallopian tubes,
  • detection of pathology of the uterine cavity,
  • identification of abnormalities in the development of the uterus,
  • detection of neoplasms,
  • assessment of the state of the endometrium,
  • for biopsy tissue sampling,
  • Identifying the causes of menstrual irregularities

Hysteroscopy of polyp removal

Polyps in the endometrium – one of the main reasons for miscarriage or non-pregnancy.The embryo cannot gain a foothold in the uterine cavity. Also, polyps over time from benign can go to the oncological stage. The main method for both diagnosis and removal of polyps is hysteroscopy, with which you can determine their number, size, location and attachments to determine the method of removal.
If you have profuse uterine bleeding, cervical cancer, or genital infections, hysteroscopy is not done.

Hysteroscopy of polyp removal is performed:

  • in the first phase of the cycle,
  • outpatient,
  • under intravenous anesthesia,
  • lasts an average of half an hour.

Removal of polyps is carried out using endoscopic flexible scissors, or an electric loop. The polyp is cut off at the base of the leg, fixed with forceps and removed from the uterus.
After hysteroscopy for several days, pain in the lower abdomen and scanty spotting are possible. Symptoms disappear within a week. But in the period up to two weeks, sexual intercourse, taking baths, swimming pools, reservoirs are contraindicated; visiting saunas and using tampons.

Advantages of hysteroscopy for polyp removal :

  • Painlessness
  • Security
  • Video control of manipulation and reliability result
  • This type of operation does not require incisions
  • Short recovery period

And, perhaps, the main advantage for every woman dreaming of a child – hysteroscopy gives the chances of a successful conception.


Doctors by referral

  • Service name

    Price

  • Diagnostic hysteroscopy (with curettage of the uterine cavity)

    23850 RUB

  • Diagnostic hysteroscopy (with vacuum aspiration of the uterine cavity)

    23850 RUB

  • Diagnostic hysteroscopy

    7000 RUB

  • Office hysteroscopy

    7000 RUB

  • Hysteroscopic operative polypectomy

    6000 RUB

  • Hysteroscopic biopsy (excluding the cost of histological analysis)

    6000 RUB

Service reviews

For a long time I could not get pregnant, to which gynecologists I just did not apply, I was examined, underwent treatment, everything was unsuccessful. A friend told and advised Dr. A. G. Romanovskaya, of course I decided to visit this doctor too. I didn’t lose hope! First impression: pleasant, beautiful, disposed, professionalism and great experience are felt from the first minutes! The doctor has a very warm and pleasant aura, you trust her.I passed all the scheduled examinations at the Da Vinci clinic, very convenient! Hysteroscopy was prescribed for infertility and a polyp in the uterus. Before the operation, I passed the tests and came to the operation on the appointed day. The operation was performed under anesthesia, I was more afraid of anesthesia than the operation, but it was in vain – I slept and did not feel anything. The operation itself took about 20-30 minutes. After anesthesia, my head was spinning, but it quickly passed. After lunch they let me go home. I had no pain. After receiving the histology, I was prescribed treatment and after 2 months the long-awaited pregnancy came! I was more worried than there were really problems.It is good that there are such procedures – quick and accurate diagnoses can be made. And such doctors as Romanovskaya Alla Georgievna! Many thanks to her!
Source Prodoctorov.ru

Hysteroscopy of the uterus at an affordable price in Moscow, hysteroscopy of the endometrium of the uterus in the clinic of the Central Clinical Hospital of the Russian Academy of Sciences

Hysteroscopy of the uterus is used to examine the inner surface of the organ. The method is effective not only as a diagnostic, but also as a way to carry out some operations.Equipment is introduced into the uterine cavity through the cervix – a hysteroscope with a camera. As a result, the image is displayed on the screen and allows you to examine the tissues for diagnosis. Intrauterine pathologies, polyps, changes without incisions, stitches and rehabilitation are revealed. Hysteroscopy in gynecology can be surgical and diagnostic, as well as mixed, depending on the situation. For diagnostic purposes, the procedure is performed on an outpatient basis. Surgical hysteroscopy of the uterus involves intervention and is therefore performed under general anesthesia. After hysteroscopy of this type, the patient is monitored for some time in the hospital.

In what cases is hysteroscopy of the uterus prescribed

The procedure can be prescribed by the gynecologist in a number of cases:

  • Too profuse, irregular menstrual flow.
  • Presence or suspicion of fibroids.
  • Recurrent termination of pregnancy, infertility.
  • Malignant and other neoplasms.

Before the procedure

The preparatory stage is the examination at gynecology . This is a smear for flora, general blood and urine tests, ultrasound examination, tests for HIV infection, ECG, fluorography. The complete list of analyzes that will be required is determined individually. Also, sometimes it is necessary to consult other specialized specialists. This is a cardiologist, endocrinologist, gastroenterologist and others.

The optimal time for surgery for hysteroscopy of the uterus is a few days after menstruation.You must not eat and drink in the morning before the examination. Sexual activity is limited three days before the procedure. Medication should also be limited and the doctor should be warned about any medications being taken.

Carrying out hysteroscopy in gynecology

Surgery often involves hysteroscopy removal of polyps . For this, general anesthesia is used. Several stages follow:

  • Treatment of the external genital organs with an antiseptic.
  • Dilation of the cervical canal, introduction of a hysteroscope.
  • Examination of the tissues of the inner surface of the uterus, the mouth of the fallopian tubes and the cervical canal.
  • If polyps are present, they can be removed. Also, in addition to removal of polyps , tissue samples can be taken for further cytological examination.

After hysteroscopy

As a rule, the patient can be discharged after the procedure within a few hours.After the intervention, there may be slight pains in the lower abdomen, as well as discharge with blood impurities for a couple of days. This is due to the stretching of the uterus and some damage to the mucous membrane. If the pain becomes stronger, and the discharge becomes more intense, it is necessary to see a doctor as soon as possible.

Several guidelines will help you recover faster and with minimal risk of complications:

  • Sexual rest for three or more weeks.
  • Refusal from baths, saunas, swimming pool visits for at least three weeks.
  • Restriction of physical activity, weight lifting for a month.

Potential negative consequences

The procedure is classified as safe and rarely accompanied by complications. Despite this, the following consequences are encountered:

  • Bleeding that lasts more than three days and has an increasing character.
  • Inflammatory processes in the uterus or small pelvis.
  • Exacerbation of chronic diseases.
  • Deformation of the uterus (can be observed after removal of large fibroid nodes).

When hysteroscopy cannot be performed

Hysteroscopy is a surgical procedure, therefore there are a number of contraindications to its conduct:

  • Pregnancy.
  • Oncological formations in the area of ​​the procedure.
  • Acute infections.
  • Inflammatory diseases of the genital organs.
  • Bleeding, cervical stenosis.
  • Serious disorders of the functioning of the lungs, kidneys, liver, immune system.

Removal of polyps by hysteroscopy

In the cervix and uterine cavity, polyps are quite common. These are benign formations on the mucous membrane, which are often attached to its surface with the help of a leg.The main manifestations of polyps are:

  • Intermenstrual flow.
  • Discomfort and pain during intercourse.
  • Drawing pains in the lower abdomen.

With the timely removal of polyps in the uterus by hysteroscopy, the problem is solved quickly and without complications. With the help of a hysteroscope, the doctor finds the place of attachment of the polyp and cuts it off.

Where to do hysteroscopy of the endometrium of the uterus in Moscow

To undergo the procedure at a reasonable price offers clinic Central Clinical Hospital of the Russian Academy of Sciences in Moscow .For more information and 90,065 reviews of 90,066 patients, please visit the website. Appointment – through the online registration form or by phone.

Hysteroscopy: procedure for women | Private clinic “Medic” Cheboksary

As a real gentleman, “MEDIK”, first of all, takes care of the ladies. Using the most modern diagnostic methods, he can determine the presence of a particular disease of the genital area, even in the early stages. Particular emphasis on Topolina, 11a is placed on minimally invasive methods of diagnosis and treatment, which allow detecting and solving the problem without resorting to surgical intervention.

Over the past few years, obstetrics and gynecology have made a huge leap forward. Modern diagnostic methods make it possible to determine the presence of a particular disease, even in the early stages. And various therapeutic measures make it possible to carry out fast and high-quality treatment.

Today, many patients are prescribed a procedure called hysteroscopy. What is this technique? How is the procedure carried out? Are there any contraindications to its implementation? The answers to these questions will be interesting and useful to every woman.

How is the hysteroscopy procedure performed

Modern medicine knows many different diseases of the genital area. And in some cases, to make a final diagnosis, the doctor needs to carefully examine the inner wall of the uterus. This is exactly what hysteroscopy provides. What is this procedure?

Its essence is quite simple – a hysteroscope is inserted through the external genital organs into the uterus through the cervical canal, with illumination and a video camera, which transmit to the monitor an enlarged image of the cervical canal, the internal cavity of the uterus, which allows the doctor to carefully study the structure and, if available, pathology of the inner wall of the uterus, examining them on the big screen.

Hysteroscopy is performed under intravenous anesthesia, which is painless and comfortable for patients.

What day of the cycle is the hysteroscopy performed?

A woman is examined from the fifth to the tenth day of her menstrual cycle, since during this period the uterus is in the most suitable condition for a hysteroscopic examination. But the attending physician may prescribe an examination on other days.

How to prepare for hysteroscopy

Previously, the woman passes the necessary tests (the list of tests is provided by the attending physician).

In addition, before hysteroscopy, a woman must inform the doctor about the drugs she is taking, the presence of certain health complaints.

Before hysteroscopy, it is recommended to cleanse the intestines (this can be done in the evening with a cleansing enema or laxative), as well as to empty the bladder and remove hair from the external genitals.

What is hysteroscopy:

  • Diagnostic procedure involves examining the uterus using optical equipment.This procedure is used to detect various pathologies and neoplasms in the uterine cavity. In this case, the integrity of the tissues is not violated.

At the stage of diagnosis, the gynecologist collects initial data for a subsequent diagnosis such as:

  • Endometriosis

  • Polyps

  • Endometrial hyperplasia

  • Synechia (adhesions in the cavity)

  • Submucous myoma of the body of the uterus

  • Diagnostics of adenocarcinoma (cancer)

  • Infertility, unspecified

  • Pathology of the cervical canal

  • Habitual miscarriage

  • Uterine anomalies (in / mat.partitions)

  • Uterine bleeding of unknown etiology

  • Incorrect position of the intrauterine contraceptive

During hysteroscopy, a biopsy is performed – pinching off a small fragment for further examination in the laboratory.

  • Surgical hysteroscopy provides for the use of not only optical, but also surgical equipment. The procedure is used for the minimally traumatic treatment of various pathologies of the uterus.For example, there are some procedures with which hysteroscopy of the uterus is perfectly combined – removal of a polyp, elimination of some other benign neoplasms, curettage of the cavity, etc.

  • There is also the so-called control hysteroscopy of the uterine cavity . A similar procedure is carried out if the doctor needs to carefully monitor the treatment process, evaluate the effectiveness of the effects of drugs or procedures, and also timely determine the development of complications or relapses of the disease.

Contraindications to hysteroscopy

Despite the fact that hysteroscopy is considered one of the safest procedures, it has some contraindications:

  • For starters, it should be noted that examination or surgery is not carried out in the presence of inflammatory diseases of the external genital organs. In such cases, you first need to conduct a course of treatment.

  • Also, pregnancy is an absolute contraindication to the procedure, as this can lead to its interruption.

  • Hysteroscopy is not performed for patients suffering from any acute infectious disease. First, you need to carry out appropriate treatment and wait for the disappearance of the main symptoms.

  • Contraindications also include heavy uterine bleeding

  • Hysteroscopy is contraindicated in women with cervical cancer

Some useful tips

There are some rules to follow.Hysteroscopy of the uterus is still a surgical procedure. For some time after the examination, the first two to three days, a woman may be disturbed by small amounts of blood from the vagina. Usually these symptoms go away on their own and do not pose a threat to the patient’s health.

Pain in the lower abdomen can last up to ten days. They are felt in the lower abdomen, sometimes they can be given to the lumbosacral region. The intensity of pain is mild to moderate.In cases where the pain is severe or continues after the specified period, a doctor’s consultation is necessary.

There are restrictions, for example, women cannot take hot baths – a warm shower would be the best option. It is also strictly forbidden to visit saunas, baths and solariums, as this can lead to uterine bleeding and some other complications. For a while, it is worth giving up vaginal tampons, replacing them with sanitary napkins. Douching is also prohibited.

Among other things, after hysteroscopy, the gynecologist prescribes sexual rest. If the examination was of a diagnostic nature – several days, if there was an operation – about three weeks.

Closely monitor the state of your body. Any deterioration in health, fever, abdominal pain is a reason for a visit to the doctor. It is necessary to sound the alarm in the presence of profuse bloody and purulent discharge – in such cases, a gynecological examination is also required.

Hysteroscopy is an effective diagnostic or treatment method that is successfully used in modern gynecology. To obtain a high-quality result and prevent complications, the patient must follow all the doctor’s recommendations both before and after it.

Hysteroscopy in Cheboksary

You can sign up for a hysteroscopy by calling 8 (8352) 23-77-23 or in your Personal Account on our website. Also, self-registration is available in our MEDIK mobile application.

Go to the section of gynecology and find out the prices for services

Postoperative period after hysteroscopy – DocDoc.ru

The decision on the need for hysteroscopy is made by the attending physician gynecologist. Before the procedure, anamnesis is collected, examination, ultrasound examination of the pelvic organs. Then the doctor will talk about the preparation for hysteroscopy and appoint a day for the study. Despite the fact that hysteroscopy of the uterus is considered a minimally invasive operation, the same rules must be followed during the rehabilitation period as after the classical surgical intervention.

Postoperative period

In order for the postoperative period to proceed without complications, it is important to follow the recommendations for the regimen and care for your health. The rehabilitation period depends on the complexity of the operation, therefore, the question of how long it is discharged after hysteroscopy is decided with the attending physician on an individual basis.

If the procedure was carried out in order to establish or clarify the diagnosis, and also when it is necessary to look at the scar after a cesarean section, then you can leave the walls of the medical institution after two to three hours.The full recovery period after diagnostic hysteroscopy will last no more than three days.

In the case of hysteroscopy with curettage and removal of the endometrial polyp, the patient’s condition is monitored in the hospital from one day to three days. This is due to the risk of bleeding and other complications.

Postoperative follow-up after hysteroscopy of uterine fibroids, as well as after removal of the submucous node in the uterus, is rather long. The woman stays in the hospital ward for at least a week after the procedure.In this case, the full recovery period takes up to 1.5 months. Treatment after hysteroscopy of the endometrial polyp does not require a woman to stay in the hospital for a long time. If the operation proceeded without complications, the patient goes home the same day.

What doctors prescribe and when to go to a gynecologist for successful health recovery depends on the specific case, as a rule, it is a course of antibiotic or anti-inflammatory drugs therapy. Often prescribed candles geksikon, terzhinan and a complex of vitamins.

What should not be done after hysteroscopy?

Within a few weeks after performing hysteroresectoscopy of the endometrial polyp or uterine fibroids, the following rules must be observed:

  • exclude physical activity;
  • to observe sexual rest;
  • do not visit swimming pools, baths and saunas;
  • observe intimate hygiene and use sanitary pads instead of tampons.

When can I sleep with my husband after hysteroscopy and what the term depends on.

The danger is that the local immunity is weakened after medical intervention, and the husband can be carriers of pathogens, even those that are normally present in the woman’s vagina. Therefore, sex after surgery can cause undesirable consequences, starting with the usual thrush, ending with pelvioperitonitis. So how long can you not have sex? In the absence of complications and complaints of the patient, sexual activity is possible after three to four weeks.

Ultrasound after the procedure

It is also necessary to regularly visit the gynecologist, the doctor will inform you when to do ultrasound after hysteroscopy.Normally, ultrasound control is prescribed 1, 3 and 6 months after the operation. The purpose of the diagnosis is to track when the endometrium becomes complete and uniform. This means that the recovery has taken place and the uterus is able to perform its functions. Specialists try not to interfere with this natural process, the endometrial tissue is regenerated within a few days or weeks. If there is a problem and the endometrium does not grow after hysteroscopy, then it is very difficult to forcibly speed up this process and hormone therapy, immunotherapy, antibiotic therapy, physiotherapy, etc. are required.

If you are worried about a health problem, sign up for a diagnosis. The success of treatment depends on the correct diagnosis.

When can you get pregnant after hysteroscopy?

This question is of great concern to women of childbearing age who are faced with infertility. Excision of education is a chance for girls to experience all the delights of motherhood, therefore, hysteroscopy and pregnancy are closely related concepts. Pregnancy after hysteroscopy of the endometrial polyp is more real than before the intervention.So how long does it take to get pregnant after hysteroscopy? Doctors disagree, and it depends on many factors. First of all, on how the operation was performed. Conception can happen already in the first cycle, when sexual rest is canceled. However, this is undesirable, especially when planning a pregnancy after hysteroscopy with rdv (curettage), so doctors advise postponing conception for 4-6 months so that the uterus will fully recover. But some experts still recommend getting pregnant immediately after the first menstruation in order to prevent the appearance of a new polyp.Therefore, the question of how long it is possible to become pregnant is decided by the doctor based on observations of the woman’s condition after the procedure.

Of course, hysteroresectoscopy is performed not only for patients of childbearing age. If a woman has entered menopause, if she has unpleasant symptoms, such as bloody or spotting, or, during an ultrasound of the pelvic organs, a formation in the uterus was detected, then she will also be shown hysteroscopy. It should be noted that, in view of the difficult postoperative healing in the elderly, hysteroscopy during menopause has become a favorable finding for helping elderly patients.After all, shortening the rehabilitation period reduces the risks of complications.

This article is posted for educational purposes only, does not replace a doctor’s appointment and cannot be used for self-diagnosis.

October 31, 2019

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Treatment of polyps of the endometrium and cervical canal in gynecology at the Litfond polyclinic

Treatment of polyps of the endometrium and cervical canal consists in their mechanical removal , that is, curettage. If this is not done, pregnancy may not occur or there will be a threat of termination of pregnancy, and with prolonged existence of polyps, bleeding or malignancy may occur.

Polyps of the endometrium and cervical canal are removed under the control of hysteroscopy. First, removal of the polyp is performed, followed by a histological examination. To perform this procedure, the patient needs to spend no more than 4 hours in the clinic. Thanks to good visualization, the risk of developing complications is tenths of a percent. As a rule, everything goes without consequences for the body, with the correct preparation of the patient.

In the diagnosis and treatment of endometrial polyps , hysteroscopy plays a special role , as it allows not only to clarify the localization of pathological formations, but also to carry out their targeted removal.In addition, what is especially important, it allows you to control the completeness and thoroughness of the removal of polyps.

After removal of the endometrial polyp, further treatment depends on the structure of the polyp (results of histological examination) and the presence of metabolic endocrine diseases in the woman.

Patients (women of reproductive and premenopausal age, in whom endometrial hyperplastic processes are found along with polyps) are prescribed hormonal therapy in the postoperative period.

Before the procedure, the patient must undergo the following tests:

  • Complete blood count
  • Biochemical blood test
  • Blood group and Rh factor
  • Coagulogram (assessment of the blood coagulation system)
  • ECG
  • Tests for hepatitis B and C, RW (syphilis) and HIV
  • Vaginal swab (there should be no signs of inflammation)
  • Smear for oncocytology from the uterine cheek
Make an appointment with a gynecologist by phone +7 (495) 150-60-01
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