Hysteroscopy: a clinical experience with 320 patients

Hysteroscopy has added a new dimension to the management of patients with common clinical problems, increasing the accuracy of diagnosis and serving as an adjunct in treatment of intrauterine conditions. This report summarizes the hysteroscopic experience with 320 selected patients, 104 in the reproductive age group with abnormal uterine bleeding, 91 who underwent hysteroscopy for location and retrieval of intrauterine contraceptive devices, 36 with primary or secondary infertility, 36 with postmenopausal bleeding, and 15 with uterine leiomyomas. Paracervical block anesthesia was used successfully in 214 patients. General anesthesia was used in the remainder because of planned additional surgical intervention. Uterine distention was achieved with D5W in 270 patients, with dextran 32% in 30 patients, and with CO2 gas insufflation in 20 patients. In 71.6 per cent of the patients,visually recognizable or pathologically suspicious intrauterine abnormalities were found. This study further demonstrated the utility of hysteroscopy in diagnosis of endometrial polyps, uterine submucous leiomyomas, uterine malformations, and intrauterine adhesions. Hysteroscopy was also helpful in taking directed biopsies of selected areas of the endometrium in patients with adenomatous hyperplasia and early adenocarcinoma of the endometrium and helpful in removal of intrauterine foreign bodies and evaluation of the recently pregnant uterus when there was a question of persistent pregnancy. Hysteroscopy is a safe ambulatory procedure that is appealing to both patient and gynecologist in its economy and simplicity.