The Influence of Solution Temperature on Fluid Deficit During Hysteroscopy

Warm distension media have been introduced in office hysteroscopy to reduce procedure-related pain, yet concerns persist that vasodilation from warmed fluid may accelerate intravasation and increase fluid deficit. Evidence linking irrigation fluid temperature with intravasation risk is limited and largely theoretical. The aim of this study was to evaluate the association between the irrigation fluid temperature on the fluid deficit during hysteroscopic procedures. This is a randomized controlled study conducted at a medical center, including all women scheduled for operative hysteroscopy due to preoperative diagnoses of polyps, endometrial thickening, or uterine fibroids (FIGO classification: type 0, 1, or 2). Participants were randomized to receive irrigation fluid at either room temperature (24 °C) or body temperature (37 °C) and were blinded to allocation. The primary outcome was the time to reach a 250 mL fluid deficit. A total of 91 women met inclusion criteria, of whom 44(48%) were in the room temperature group and 47(52%) were in the body temperature group. Indications, age, BMI, device type, and tissue-shaver use were similar between groups. No significant difference was observed in the time to reach a 250 mL fluid deficit [155 (67-314) vs. 219 (83-444) seconds for the room temperature and body temperature groups, respectively; p = 0.25]. Exploratory analyses at higher fluid deficit thresholds similarly showed no significant differences between groups. A trend of a higher visual analog pain score (VAS) was reported by the women in the room temperature group compared to the warmed fluid group [4(0-6) vs. 1(0-6); p = 0.38]. Irrigation fluid temperature did not significantly impact fluid deficit during hysteroscopy. Warmed fluid may offer improved patient comfort without increasing intravasation risk. SYNOPSIS: Warm distension fluid is used in office hysteroscopy to reduce pain, but it may limit procedure duration due to increased vascular expansion and fluid deficit. This study compared fluid deficits at 24 °C (room temperature) and 37 °C (body temperature) during hysteroscopy. Results showed no significant impact of fluid temperature on deficits, regardless of the procedure indication.