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Evaluating the Effectiveness of Pharmacological Strategies and Further Measures for Pain Relief during Hysterosonosalpingography: A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12123185. [PMID: 36553192 PMCID: PMC9777723 DOI: 10.3390/diagnostics12123185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/19/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
This systematic review aims to evaluate the effectiveness of pharmacological and non-pharmacological strategies for pain relief in women during contrast-enhanced ultrasound for the assessment of tubal patency and uterine disease, compared with placebo or no intervention. In December 2021, we searched the electronic databases (Pubmed, Embase, Sciencedirect, the Cochrane library and Clinicaltrials.gov) without date restriction: We identified 10 randomized control trials (RCTs) (2098 women) eligible for this systematic review, after applying our inclusion and exclusion criteria. Among these, five studies compared the use of painkillers with the placebo, two studies compared different catheter positions in the cervix or in the uterine cavity, and two others considered different temperatures of the contrast medium, as a method to reduce pain. Topical lidocaine applied before the procedure may be associated with effective pain relief during hysterosonography, though the quality of this evidence is low. New echogenic contrast agents and their temperature at 37 °C ensure a less painful procedure. There is insufficient evidence to draw conclusions on the efficacy of other analgesics or strategies.
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Rashwan ASSA, Alalfy M, Elkomaty SA, Helal OM, Hussein EA. Diclofenac Potassium Alone Versus Diclofenac Potassium with Hyoscine-N-butyl Bromide (HBB) in Reduction of Pain in Women Undergoing Office Hysteroscopy: A Double Blind Randomized, Placebo-Controlled Trial. J Obstet Gynaecol India 2022; 72:340-345. [PMID: 35928098 PMCID: PMC9343497 DOI: 10.1007/s13224-022-01648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
Study Objective To compare between oral diclofenac potassium alone versus a combination of it with hyoscine-N-butyl bromide (HBB) in reduction of pain in women undergoing office hysteroscopy. Design Randomized, double-blind controlled trial. Setting Kasralainy hospital (a tertiary hospital). Intervention Sixty-Four patients undergoing office hysteroscopy were randomly divided into 2 groups (study group and placebo group) in the ratio of 1:1. Group 1 (study group = 32 participants) received two oral HBB tablets and one tablet of diclofenac potassium and group 2 (placebo group = 32 participants) received two oral placebo tablet similar in size, structure and color to buscopan in addition to the diclofenac tablet. The patient was given the drugs 30-60 min before the procedure. Results There was statistically significant difference between the two groups in the pain score immediately during entry (p value = 0.001) and after 30 min of the procedure (p value = < 0.001). And there was a statistically significant difference as regards the side effects (gastric irritation) of the medications (p value = 0.04) between the women participating in the two groups. Conclusion The combination of diclofenac potassium and HBB helps a lot in decreasing the pain and discomfort during and after performing office hysteroscopy but with more gastric side effects.
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Marchand GJ, Kurdi W, Sainz K, Maarouf H, Ware K, Masoud AT, King A, Ruther S, Brazil G, Cieminski K, Calteux N, Ulibarri H, Parise J, Arroyo A, Chen D, Pierson M, Rafie R, Shareef MA. Efficacy of hyoscine in pain management during hysteroscopy: a systematic review and meta-analysis. J Turk Ger Gynecol Assoc 2022; 23:51-57. [PMID: 34866373 PMCID: PMC8907440 DOI: 10.4274/jtgga.galenos.2021.2021-0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We conducted a systematic review and meta-analysis of relevant clinical trials from full-text, scientific journal archives to assess the efficacy of hyoscine for the management of pain during in-office hysteroscopy (OH) procedures. Cochrane CENTRAL, ClinicalTrials.Gov, MEDLINE, PubMed, SCOPUS and the Web of Science were searched for all clinical trials that matched our search criteria. A full assessment of bias was made using the Cochrane Group tool-set. The following outcomes were included: visual analogue scale (VAS) score for postoperative pain, postoperative need for analgesia, and procedure time. In the case of homogeneous data, the analysis was performed using a fixed effects system, and the random effects system was used with heterogeneous data. Inclusion criteria included only randomized clinical trials, and interventions that included patients receiving hyoscine-N-Butyl Bromide during OH, regardless of dose or mode of administration, and compared this with placebo. Three clinical trials were included. The actual mean difference (MD) of the VAS pain score showed no significant difference between hyoscine or placebo [MD: -0.28 (-1.08, 0.52), (p=0.49)]. For postoperative analgesia, the overall MD showed no significant difference between hyoscine or placebo [MD: 0.43 (0.16, 1.14), (p=0.09)]. For procedure time, the combined effect estimate failed to show any significant difference between hyoscine and placebo [MD: -0.66 (-2.77, 1.44) (p=0.54)]. Contrary to previously published data, our meta-analysis using the latest available RCTs fails to show hyoscine as being effective in reducing pain or the need for other forms of anesthesia in OH.
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Affiliation(s)
- Greg J. Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Wesam Kurdi
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Hiba Maarouf
- REProVita Fertility Center, Recklinghausen, Germany
| | - Kelly Ware
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America,International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis
| | - Ahmed Taher Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America,Fayoum University Faculty of Medicine, Fayoum, Egypt
| | - Alexa King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Nicolas Calteux
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Hollie Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Julia Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Amanda Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, United States of America
| | - Diana Chen
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, United States of America
| | - Maria Pierson
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, United States of America
| | - Rasa Rafie
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, United States of America
| | - Mohammad Abrar Shareef
- Department of Internal Medicine, Sebasticook Valley Hospital, Pittsfield, ME, United States of America
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Boned-López J, Alcázar JL, Errasti T, Ruiz-Zambrana A, Rodriguez I, Pascual MA, Guerriero S. Severe pain during hysterosalpingo-contrast sonography (HyCoSy): a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 304:1389-1398. [PMID: 34417840 DOI: 10.1007/s00404-021-06188-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the frequency of severe pain perception during hysterosalpingo-contrast sonography (HyCoSy) in infertile women and to assess whether there are differences in the frequency of associated pain according to the contrast used. DESIGN Systematic review and meta-analysis. PATIENTS Women undergoing HyCoSy due to infertility. INTERVENTIONS Searches were carried out in two databases (Pubmed and Web of Science). We included prospective or retrospective cohort observational studies that specified the type of contrast used during HyCoSy and reported data regarding the number of patients who perceived severe pain during the procedure and the scale used for pain perception score. MAIN OUTCOME MEASURES Pooled frequency of severe pain perception during HyCoSy and the pooled frequency of severe pain perception based on the contrast used. RESULTS Twenty-nine studies were included in this meta-analysis including a total of 7139 patients. In 10 studies, Saline solution with air was used as contrast EchoVist™ was used in ten studies, in five studies, SonoVue™ was used and in four studies, ExEm-Foam™ was used as contrast. Pooled estimated frequency of severe pain perception during HyCoSy was 6% (95% CI 4-9). No statistically significant differences have been described regarding frequency of severe pain perception in relation to the different contrasts used. CONCLUSIONS HyCoSy is a tolerable outpatient procedure. We did not find any evidence that one specific contrast was better tolerated than any other was.
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Affiliation(s)
- Jordi Boned-López
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain.
| | - Tania Errasti
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain
| | - Alvaro Ruiz-Zambrana
- Department of Obstetrics, Gynecology and Reproductive Medicine, Clínica Universitaria De Navarra, Avenida Pío XII 36, 3110, Pamplona, Spain
| | - Ignacio Rodriguez
- Epidemiology and Statistics Unit, Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - María Angela Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
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Aboshama RA, Shareef MA, AlAmodi AA, Kurdi W, Al-Tuhaifi MM, Bintalib MG, Sileem SA, Abdelazem O, Abdelhakim AM, Sobh AMA, Elbaradie SMY. The effect of hyoscine-N-butylbromide on pain perception during and after hysterosalpingography in infertile women: a systematic review and meta-analysis of randomised controlled trials. HUM FERTIL 2020; 25:422-429. [PMID: 33140669 DOI: 10.1080/14647273.2020.1842915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper reports a systematic review and meta-analysis of the effectiveness of hyoscine-N-butylbromide (HBB) administration in hysterosalpingography (HSG). Four electronic databases were searched for randomised controlled trials (RCTs) that compared HBB versus placebo or no intervention in infertile women undergoing HSG. Pain during and after HSG and different adverse events including nausea, vomiting, and dizziness were evaluated. Three RCTs with 335 patients were included. The analysis showed HBB was significantly effective in reducing pain during and after HSG (MD = -0.76 mm, 95% CI [-1.35, -0.17], p = 0.01) and (MD = -0.81 mm, 95% CI [-1.07, -0.56], p < 0.001), respectively. There were no significant differences in adverse events between HBB and control groups. The methodological evidence quality was high as evaluated by GRADEpro. In conclusion, this review provides good evidence that prior administration of HBB is effective in reducing induced pain during and after HSG with tolerable side effects.
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Affiliation(s)
| | | | - Abdulhadi A AlAmodi
- Department of Epidemiology and Biostatistics, School of Public Health, Jackson State University, Jackson, MS, USA
| | - Wesam Kurdi
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | | | - Sileem Ahmed Sileem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Osama Abdelazem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | | | - Ahmed M A Sobh
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Sahar M Y Elbaradie
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Gokmen Karasu AF, Aydin S, Ates S, Takmaz T, Comba C. Administration of rectal cytotec versus rectal buscopan before hysteroscopy. MINIM INVASIV THER 2020; 31:94-98. [PMID: 32491923 DOI: 10.1080/13645706.2020.1748059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Our objective was to compare the effect of rectal misoprostol (Cytotec) versus rectal hyoscine-n-butyl bromide (Buscopan) on patients undergoing hysteroscopy. We hypothesised that HBB may have a role in cervical priming.Material and methods: This trial was conducted at Bezmialem Vakif University Hospital. Women of reproductive age between 18-50 years who were scheduled for operative hysteroscopy indicated by type 1 submucous myoma or endometrial polyps were recruited for the study. Ninety patients were divided randomly into three groups. Group 1 received placebo treatment. Group 2 received rectal 200 mcg misoprostol and Group 3 received rectal 20 mg hyoscine-n-butyl bromide two hours before the procedure. Procedures were performed using a bipolar 26 F (9 mm) continuous-flow rigid resectoscope with a 30° lens. The outcome measures included cervical dilation width and time, ease of cervical dilation, procedure time and operative complications. Postoperative self-rated pain was assessed one hour after the procedure.Results: Thirteen patients (43. 3%) in the placebo treatment group, 11 patients (36.7%) in the misoprostol group and four patients (13.3%) in the hyoscine-n-butyl bromide group needed analgesics postoperatively (p = .02). The mean duration of cervical dilation time was longest in Group 1 and shortest in Group 3, however this difference did not reach statistical significance (p=.11). There was no difference with regard to other studied parameters.Summary: HBB reduced the need for pain medication compared to placebo. Larger studies are needed to further investigate the role of HBB in facilitating pre-operative cervical priming.
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Affiliation(s)
- Ayse Filiz Gokmen Karasu
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Serdar Aydin
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Seda Ates
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Taha Takmaz
- Department of Obstetrics and Gynecology, Bezmialem Vakif University Medical Faculty, Istanbul, Turkey
| | - Cihan Comba
- Department of Gynecologic Oncology, Bakirkoy Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Liang N, Wu QQ, Li JH, Gao FY, Sun FL, Guo CX. Causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2019; 65:1055-1060. [PMID: 31531601 DOI: 10.1590/1806-9282.65.8.1055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/02/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aims to investigate the causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy), in order to improve the diagnostic efficiency of TVS RT-3D-HyCoSy. METHODS A total of 162 oviducts of 83 infertility patients were examined by TVS RT-3D-HyCoSy. These results were compared with the gold standard for laparoscopic dye studies, and the misdiagnosed cases were analyzed. RESULTS TVS RT-3D-HyCoSy revealed that 68 oviducts were unobstructed and 94 obstructed. The results for the 144 oviducts were in line with the gold standard, while those for 18 oviducts were not. The accuracy rate of the TVS RT-3D-HyCoSy was 88.9%, and the misdiagnosis rate was 11.1%. The main causes of misdiagnosis included contrast medium countercurrent and diffusion, oviduct spasm, abnormal shape or position of the oviduct, pelvic adhesion, and poor imaging operation. CONCLUSION TVS RT-3D-HyCoSy can well-evaluate tubal patency, and understand and improve the cause of misdiagnosis. Furthermore, the diagnostic efficiency of TVS RT-3D-HyCoSy can still be further improved.
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Affiliation(s)
- Na Liang
- . Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Beijing 100026, China
| | - Qing-Qing Wu
- . Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Beijing 100026, China
| | - Jing-Hua Li
- . Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Beijing 100026, China
| | - Feng-Yun Gao
- . Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Beijing 100026, China
| | - Fu-Li Sun
- . Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Beijing 100026, China
| | - Cui-Xia Guo
- . Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital of Capital Medical University, Beijing 100026, China
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Safi F, Kamali A, Rezaei M, Rezaei M, Rafiei M. Effect of intramuscular hyoscine-n-butyl bromide on fallopian tube spasm and pain perception during and after hysterosalpingography in infertile women: A randomized single-blind controlled clinical trial. Med J Islam Repub Iran 2019; 33:31. [PMID: 31456955 PMCID: PMC6708101 DOI: 10.34171/mjiri.33.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Indexed: 11/05/2022] Open
Abstract
Background: Hysterosalpingography plays an important role in diagnostic work-up and treatment planning for infertile women. This procedure is usually uncomfortable and painful. The present study plans to investigate the effect of intramuscular Hyoscine-N-Butyl Bromide (HBB) on fallopian tube spasm and pain perception during and after hysterosalpingography (HSG) in infertile women.
Methods: This randomized single-blind controlled clinical trial (IRCT2017021132455N2) was conducted on infertile women scheduled for HSG in one radiology clinic affiliated to Arak University of Medical Sciences between July and August 2017. Patients were selected by convenience sampling and were randomly assigned to HBB (n=50) and a control group (n=50). Women received 20 mg/1cc HBB intramuscularly in the intervention group, 30 minutes before the procedure. Women in the control group did not receive any medication. The patients were requested to complete the Numeric Pain Rating Scale after injection of the dye, and also 30 minutes following the end of the HSG. Presence or absence of tubal spasm was determined after checking the radiographic images. For the data analysis using SPSS version 18, descriptive statistics, and analytical tests such as independent sample t-test, Mann- Whitney test, chi-square or Fisher’s exact tests and logistic regression and ANCOVA were used.
Results: Statistically significant differences were not observed in pain scores between the HBB and the control groups at the point of dye injection and 30 minutes after ending the HSG (p>0.05). Also, tubal spasm in the HBB group was lower than in the control group, but the differences were not statistically significant between the two groups (p=0.37).
Conclusion: The use of intramuscular HBB before HSG has no advantage in reducing tubal spasm and the induced pain during dye injection and 30 minutes after the HSG procedure. Thus, we don’t recommend HBB use before the HSG in order to relief from pain and spasm.
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Affiliation(s)
- Fatemeh Safi
- Department of Radiology and Radiotherapy, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Alireza Kamali
- Department of Anesthesiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Marzieh Rezaei
- Department of Radiology and Radiotherapy, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Mahboubeh Rezaei
- Autoimmune Disease Research Center, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Rafiei
- Department of Biostatistics and Epidemiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
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Exalto N, Emanuel MH. Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4827376. [PMID: 31360713 PMCID: PMC6644241 DOI: 10.1155/2019/4827376] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/04/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Tubal patency testing is an essential part of female subfertility evaluation. Traditionally, hysterosalpingography (HSG) was the first step to evaluate tubal patency. However, during the past decade Hysterosalpingo-Contrast Sonography (HyCoSy) was introduced in order to avoid radiation exposure and Hysterosalpingo-Foam Sonography (HyFoSy) has been developed as a safe and less painful alternative. OBJECTIVES AND RATIONALE The aim of this narrative review is to provide an overview of the currently available HyFoSy literature and related clinical aspects. SEARCH METHODS A literature search was conducted using PubMed and Embase from the introduction of HyFoSy to March 2019. Unfortunately, a meta-analysis was not possible due to a too small number of studies, being mutually incomparable for the various subjects of clinical aspects, even for the reliability as a test for tubal patency. OUTCOMES Nine small studies concluded that the accuracy and effectiveness as a test for tubal patency of 2D- and 3D-HyFoSy are comparable or even better than HSG or HyCoSy. With or without using Doppler techniques, 3D-HyFoSy does not seem to offer benefits above real-time 2D-HyFoSy. Five studies reported on pain and discomfort during HyFoSy, concluding that HyFoSy is a well-tolerated, less painful procedure compared to HSG, without a need for the use of analgesics. There are suggestions about an increased pregnancy rate in the first three cycles after the procedure but in no studies pregnancy outcome after HyFoSy was compared with other or no intervention. WIDER IMPLICATIONS HyFoSy is a promising and safe alternative for HSG with regard to accuracy and effectiveness. HyFoSy lacks radiation and iodine exposure and is a well-tolerated and less painful procedure than HSG, without the need for analgesics. However more research is needed to make clear statements regarding a therapeutic effect of HyFoSy.
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Affiliation(s)
- Niek Exalto
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Mark Hans Emanuel
- Division of Woman and Baby, Department of Gynaecology and Reproductive Medicine, University Medical Centre, Utrecht, Netherlands
- Department of (Uro)gynaecology, University Hospital, Ghent, Belgium
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Abbas AM, Elzargha AM, Ahmed AGM, Mohamed II, Altraigey A, Abdelbadee AY. Oral Diclofenac Potassium Versus Hyoscine-N-Butyl Bromide in Reducing Pain Perception during Office Hysteroscopy: ARandomized Double-blind Placebo-controlled Trial. J Minim Invasive Gynecol 2019; 26:709-716. [DOI: 10.1016/j.jmig.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/29/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
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Abbas AM, Abo-Elela NA, Mosa EM. Effect of oral hyoscine-N-butyl bromide on pain perception during hysterosalpingography: A randomized, double-blind, placebo controlled trial. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ma Y, Du L, Li F, Zhu Z. Use of atropine in four-dimensional hysterosalpingo-contrast sonography: Does it suppress pain during infertility examination? Clin Exp Pharmacol Physiol 2018; 45:1334-1340. [PMID: 29381225 DOI: 10.1111/1440-1681.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 11/30/2022]
Abstract
This study aimed to ascertain if atropine is useful for suppressing the pain suffered during four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) when assessing infertility in women. A total of 252 patients were divided into 2 groups to receive or not receive atropine (0.5 mg) injection 30 minutes before 4D-HyCoSy. Pain was evaluated using a numerical rating scale (NRS): during 4D-HyCoSy; upon 2-dimensional transvaginal sonography; before catheter insertion; upon insertion and fixation of the catheter into the uterine cavity; 30 minutes after 4D-HyCoSy. According to the degree of patency of Fallopian tubes, the 6 patterns observed were integrated further into 3 patient groups: all-negative (both Fallopian tubes were negative), positive-and-negative (one Fallopian tube showed patency and the other showed stenosis or non-patency), and all-positive (both Fallopian tubes showed stenosis or non-patency). We compared the NRS scores and prevalence of side-effects other than pain between the atropine-injection and non-atropine-injection groups within the three groups mentioned above. The NRS score showed no significant differences among the groups at any time point (all P > .05). The different prevalence of side-effects other than pain was significant between the atropine-injection and atropine-non-injection groups (P = .012). These data suggest that atropine does not reduce pain in patients during 4D-HyCoSy. However, atropine may reduce the prevalence of other side-effects during 4D-HyCoSy, which needs a further, large, prospective, multi-cohort study to verify.
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Affiliation(s)
- Yunfei Ma
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Ultrasound, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Ultrasound, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fan Li
- Department of Ultrasound, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhengqiu Zhu
- Department of Ultrasound, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu, China
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Li H, Zhang M, Qiang Y, Ma Y, Mao S, Zhang H. Pain and side effects associated with 4-dimensional hysterosalpingo-contrast sonography for evaluating of the fallopian tubes patency. Comput Assist Surg (Abingdon) 2017; 22:93-99. [PMID: 28937288 DOI: 10.1080/24699322.2017.1379229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Hongbo Li
- Key Laboratory of Modern Acoustics (MOE), Department of Physics, Collaborative Innovation Center of Advanced Microstructure, Nanjing University, Nanjing, China
- Department of Ultrasonography, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - MeiMei Zhang
- Department of Ultrasonography, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ye Qiang
- Department of Ultrasonography, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - YunFei Ma
- Department of Ultrasonography, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - ShuXia Mao
- Department of Ultrasonography, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hao Zhang
- Department of Ultrasonography, the Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Ludwin I, Martins WP, Nastri CO, Ludwin A. Pain Intensity During Ultrasound Assessment of Uterine Cavity and Tubal Patency With and Without Painkillers: Prospective Observational Study. J Minim Invasive Gynecol 2017; 24:599-608. [DOI: 10.1016/j.jmig.2017.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/08/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
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Seshadri S, Khalil M, Osman A, Clough A, Jayaprakasan K, Khalaf Y. The evolving role of saline infusion sonography (SIS) in infertility. Eur J Obstet Gynecol Reprod Biol 2014; 185:66-73. [PMID: 25528732 DOI: 10.1016/j.ejogrb.2014.11.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/19/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
Saline infusion sonography (SIS) has become a valuable diagnostic modality in gynaecology over the last three decades. SIS is now commonly employed for detailed evaluation of the uterine cavity as part of pre-treatment assessment in infertile women. The objective of this paper is review the scientific literature on SIS in infertility. Medline, Ovid and Cochrane databases were searched for relevant articles. The indications, technical aspects and the potential advantages of SIS are discussed. The efficacy and sensitivity of SIS are compared to hysteroscopy in the evaluation of uterine polyps, fibroids, intrauterine adhesions and uterine anomalies. Increasing evidence suggests the use of SIS prior to an in-vitro fertilization (IVF) cycle as it has increased sensitivity in the detection of intrauterine pathology. SIS is cost-effective and results in better patient satisfaction scores than hysteroscopy.
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Affiliation(s)
- S Seshadri
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom.
| | - M Khalil
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom
| | - A Osman
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom
| | - A Clough
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom
| | - K Jayaprakasan
- Royal Derby Hospital, Derby & NURTURE, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Y Khalaf
- Assisted Conception Unit, Guys Hospital, 11th Floor, Tower Wing, Great Maze Pond, London SE1 9RT, United Kingdom
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Contrast Ultrasonography for Tubal Patency. J Minim Invasive Gynecol 2014; 21:994-8. [DOI: 10.1016/j.jmig.2014.05.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 11/18/2022]
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Lo Monte G, Capobianco G, Piva I, Caserta D, Dessole S, Marci R. Hysterosalpingo contrast sonography (HyCoSy): let’s make the point! Arch Gynecol Obstet 2014; 291:19-30. [DOI: 10.1007/s00404-014-3465-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/09/2014] [Indexed: 11/28/2022]
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Marci R, Marcucci I, Marcucci AA, Pacini N, Salacone P, Sebastianelli A, Caponecchia L, Lo Monte G, Rago R. Hysterosalpingocontrast sonography (HyCoSy): evaluation of the pain perception, side effects and complications. BMC Med Imaging 2013; 13:28. [PMID: 23968513 PMCID: PMC3765383 DOI: 10.1186/1471-2342-13-28] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 08/05/2013] [Indexed: 11/10/2022] Open
Abstract
Background Tubal and uterine cavity diseases commonly compromise female fertility. At the present time, hysteroscopy, laparoscopy with chromopertubation and RX-Hysterosalpingography (RX-HSG) are widely accepted screening procedures enabling the effective assessment of both tubal patency and uterine cavity. Nevertheless, consistent evidence supports the reliability of Hysterosalpingocontrast sonography (HyCoSy) in uterine cavity and tubal patency investigation, as a part of the standard infertility work-up. This prospective study was aimed at evaluating the tolerability of the technique as well as the incidence of related side effects and complications in a large series of infertile patients. Methods Pain perception of 632 infertile women was measured by means of an 11-point numeric rating scale. Side effects and late complications were also recorded. Results The mean numeric rating scale was 2.15 ± 2.0 SD. Most of the patients (374/632, 59.17%) rated HyCoSy as a non-painful procedure, whereas 24.36% (154/632) women reported mild pelvic pain and 9.96% (63/632) classified the discomfort as “moderate”. Only 6.48% (41/632) of the patient population experienced severe pelvic pain. Fifteen (2.37%) patients required drug administration for pain relief. Twenty-six patients (4.11%) showed mild vaso-vagal reactions that resolved without atropine administration. No severe vaso-vagal reactions or late complications were observed. Conclusions HyCoSy is a well-tolerated examination and the associated vagal effects are unusual and generally mild. Consequently, we support its introduction as a first-line procedure for tubal patency and uterine cavity investigation in infertile women.
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Affiliation(s)
- Roberto Marci
- Department of Morphology, Surgery and Experimental medicine, University of Ferrara, Via Aldo Moro 8, Ferrara, Cona 44124, Italy.
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Graziano A, Lo Monte G, Soave I, Caserta D, Moscarini M, Marci R. Sonohysterosalpingography: a suitable choice in infertility workup. J Med Ultrason (2001) 2012; 40:225-9. [PMID: 27277240 DOI: 10.1007/s10396-012-0417-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 10/22/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the efficacy, compliance, and cost effectiveness of sonohysterosalpingography (HyCoSy) compared with hysteroscopy for uterine cavity evaluation and compared with RX-hysterosalpingography (RX-HSG) for tubal patency determination. METHODS Three hundred and eight infertile patients underwent HyCoSy, hysteroscopy, and RX-HSG. We compared sensitivity, specificity, positive and negative predictive values (PPV and NPV), discomfort level, and cost of all three procedures. RESULTS Sensitivity, specificity, PPV, and NPV were higher for HyCoSy than for hysteroscopy but the differences were not significant. HyCoSy also has the same accuracy as RX-HSG. Pain perception and cost were higher for RX-HSG and hysteroscopy than for HyCoSy. CONCLUSIONS HyCoSy can be regarded as a procedure for initial evaluation of the uterine cavity and of tubal patency in infertile patients.
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Affiliation(s)
- Angela Graziano
- Section of Obstetrics and Gynaecology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Corso Giovecca n. 203, 44121, Ferrara, Italy
| | - Giuseppe Lo Monte
- Section of Obstetrics and Gynaecology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Corso Giovecca n. 203, 44121, Ferrara, Italy
| | - Ilaria Soave
- Section of Obstetrics and Gynaecology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Corso Giovecca n. 203, 44121, Ferrara, Italy
| | - Donatella Caserta
- Department of Woman Health and Territory's Medicine, University of Rome Sapienza, S. Andrea Hospital, Rome, Italy
| | - Massimo Moscarini
- Department of Woman Health and Territory's Medicine, University of Rome Sapienza, S. Andrea Hospital, Rome, Italy
| | - Roberto Marci
- Section of Obstetrics and Gynaecology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Corso Giovecca n. 203, 44121, Ferrara, Italy.
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Tur-Kaspa I. Fear no pain: uterine cavity and tubal patency assessment tests should be pain free. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:247-251. [PMID: 22535627 DOI: 10.1002/uog.11128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- I Tur-Kaspa
- Institute for Human Reproduction, Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL 60657, USA.
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