Rapid Lidocaine Infusion Sonohysterography and Biopsy

Sonohysterography is an attractive alternative to hysteroscopy to detect intrauterine pathology. It is appropriate when sonography suggests pathology or is equivocal. Although it gives less information than hysteroscopy, it can be performed as part of the day's routine, requiring approximately 15 minutes. Two modifications are suggested, one for patient comfort and the other to improve diagnostic capability without altering the basic performance of the procedure. First, instead of normal saline, 1% lidocaine is the distention and contrast medium. Image enhancement is the same, and it provides a degree of analgesia for endometrial biopsy, if performed. Second, instead of an infusion catheter, any standard endometrial biopsy catheter may be used (in this case, the Milex suction endometrial biopsy vacurette). It is suitable for infusion and, while in place, may be used for a directed aspiration biopsy. The procedure was performed in 12 women and was technically satisfactory in 10. Findings necessitating tissue diagnosis were visualized in six patients, in five of whom a satisfactory (positive or exclusionary) diagnosis was obtained. Sonohysterography with lidocaine distention medium using a suction endometrial biopsy curette is a safe procedure for the diagnosis of postmenopausal bleeding and dysfunctional uterine bleeding.