[Benign uterine pathology in premenopause and transvaginal sonohysterography: personal experience]

In this study we report our experience about hysterosonography and its use for the diagnosis of benign uterine pathology in premenopausal women referred to our Hospital.

From May to October 2000, 58 patients underwent transvaginal sonohysterography. They referred to our Ultrasonography Center because of sterility, intermenstrual bleedings, menometrorrhagias or anomalous endometrial echopatterns which had been found by basal transvaginal ultrasound examination. All patients were in fertile age and were examined during the follicular phase of the ovarian cycle. The hysterosonographic examination consisted in introducing 20 cc of a physiological solution by catheter with inflating balloon for hysterosalpingography and assessment of the uterine cavity was possible thanks to the acoustic window created by the fluid which gradually distended the cavity itself. We considered as failures of the techniques those cases in which the profile of endometrial cavity was not clearly visualized.

Sonohysterography was performable in 52 of the 58 patients. The failure of examination in 3 cases was due to inadequate distention of the uterine cavity, in 2 cases to cervical stenosis and in 1 case to the reflux of the contrast medium. Diagnosis effected with sonohysterography revealed 3 uterus bicornis, 16 endometrial polyps and 9 submucosal myomas. No ultrasound anomalies were found in 23 patients. All the women underwent a subsequent hysteroscopy which confirmed our ultrasound diagnosis.

Our study shows that sonohysterography allows to obtain a precise diagnosis of benign uterine pathology, which generally basal transvaginal ultrasonography can only suspect. The applicability of positive and negative predictive values, of the sensitivity and specificity is limited by the small number of cases included in the study. The role of sonohysterography is more difficult to define when compared to hysteroscopy. The conclusion is drawn that this new method offers an important aid for gynecological diagnosis of benign pathology.