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Mengye Y, Yan T, Jiarong Q, Qing L, Fangfang N, Yan Z. 15 and 30 min of immobilization after IUI: a randomized control trial. HUM FERTIL 2023; 26:1354-1360. [PMID: 36942496 DOI: 10.1080/14647273.2023.2191346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/04/2022] [Indexed: 03/23/2023]
Abstract
The purpose of this study is to provide evidence for better guidance related to bed rest after intrauterine insemination (IUI). We conducted a randomized trial to compare the effect of 15 min versus 30 min of bed rest after IUI on pregnancy rate. A total of 204 couples were recruited from May 2021 to December 2021 and randomized to remain in the supine position for either 15 or 30 min after the procedure. The outcomes were the clinical pregnancy rate and comfort level after IUI. Ultimately, 198 couples were included in the analysis. The 15-min immobilization group consisted of 100 couples (226 cycles), and the 30-min immobilization group consisted of 98 couples (225 cycles). The clinical pregnancy rate per couple in the 15-min immobilization group (26 of 100) was not different from that in the 30-min immobilization group (23 of 98). With the use of discrete-time survival analysis, the cumulative probability of clinical pregnancy also showed no difference between these two groups. Based on the literature and on our study, the possible beneficial effect of 30-min immobilization after IUI is at least questionable, and a shorter time could be implemented depending on the results of a systematic review and the individual patient data from the currently executed trials.
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Affiliation(s)
- Yang Mengye
- Reproductive Genetic Center, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Tang Yan
- Reproductive Genetic Center, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qian Jiarong
- Reproductive Genetic Center, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Liu Qing
- Reproductive Genetic Center, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Niu Fangfang
- Reproductive Genetic Center, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Zhang Yan
- Reproductive Genetic Center, Suzhou Affiliated Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
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Al-Sharydah AM, AlMulhim AA, Al Shikmubarak IA, Alhussaini AA, Alehaideb RS, Salman R. Management of Pyometra Using a Novel Image-Guided Percutaneous Technique: A Case Report. Medicina (B Aires) 2023; 59:medicina59040689. [PMID: 37109647 PMCID: PMC10145810 DOI: 10.3390/medicina59040689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Pyometra is a uterine infection that causes pus to accumulate in the uterine cavity. Pyometra primarily affects postmenopausal women. Multiple aetiologies, including cervical stenosis, have been identified. Medical therapy using intravenous antibiotics and surgical evacuation are the conventional treatment options for pyometra. Here, we present a unique case of a novel therapy for pyometra in a geriatric patient; percutaneous alleviation of the causative cervical stenosis was performed using balloon dilatation, along with endometrial drainage of the infected fluid through her vagina, a natural route. This technique has overcome the need for other invasive therapies. The patient’s clinical condition improved significantly after this minimally invasive treatment. Percutaneous balloon dilatation of the cervix for stenosis or occlusion in patients with pyometra facilitates drainage of the infected endometrial fluid. This alternative management technique ensured a satisfactory postoperative course and tolerance in the short-term follow-up. Furthermore, the technique ensured good aesthetic results, with its minimally invasive approach in selected patients, compared to other means of evacuation.
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Affiliation(s)
- Abdulaziz Mohammad Al-Sharydah
- Department of Diagnostic and Interventional Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar P.O. Box: 4398 (31952), Saudi Arabia
| | | | | | - Abdulmohsen Ahmed Alhussaini
- Vascular Interventional Radiology, Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11564, Saudi Arabia
| | - Raghad Sulaiman Alehaideb
- Vascular Interventional Radiology, Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11564, Saudi Arabia
| | - Refaat Salman
- Vascular Interventional Radiology, Medical Imaging Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11564, Saudi Arabia
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Hao S, Shou M, Ma J, Shu Y, Yu Y. Correlation Analysis of Serum Pepsinogen, Interleukin, and TNF- α with Hp Infection in Patients with Gastric Cancer: A Randomized Parallel Controlled Clinical Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9277847. [PMID: 36158129 PMCID: PMC9492331 DOI: 10.1155/2022/9277847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 12/16/2022]
Abstract
Background Gastric cancer pathological biopsy and visual examination have been the gold standard for gastric cancer diagnosis, but their operation is costly, demanding, and risky, so it is especially important to find an effective examination method in clinical practice. Aims To investigate the correlation between serum pepsinogen I (PGI), pepsinogen II (PGII), pepsinogen I and II ratio (PGR), IL-6, and TNF-α and Helicobacter pylori (Hp) infection in patients with gastric cancer. Materials and Methods Fifty patients with Hp-infected gastric cancer admitted to the Department of Gastroenterology of our hospital from January 2019 to December 2021 were selected for the study as the observation group, and another 50 patients without Hp-infected gastric cancer were selected as the comparison group to compare the correlation analysis of PGI, PGII, PGR, IL-6, and TNF-α with Hp infection between the two groups after admission and treatment. Results After measurement, PGI and PGII in the observation group were significantly lower than those in the comparison group, and TNF-α, IL-18, and IL-6 in the observation group were significantly higher than those in the comparison group, and the comparative differences were all statistically significant (P < 0.05). The results of multivariate logistic regression model analysis of independent risk factors for gastric cancer showed that IL-18, hs-CRP, and tumor necrosis factor- (TNF-) α were risk factors for Hp infection in gastric cancer. Conclusion The expression of IL-18, hs-CRP, and TNF-α factors in Hp-infected gastric cancer patients is correlated. IL-6, IL-18, and TNF-α are involved in the entire process from the onset to the development of Hp-positive gastric mucosal inflammation in patients, which is of great value in the diagnosis of gastric cancer and helps to assess the degree of progression and prognosis of gastric cancer.
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Affiliation(s)
- Shunxin Hao
- Department of General Surgery, Wuhan University of Science and Technology Hospital, China 430065
| | - Minyue Shou
- The First Affiliated Hospital of Nanjing Medical University (Department of Oncology), China 210029
| | - Jing Ma
- Zhongshan Hospital Affiliated to Fudan University, China 200032
| | - Yongqian Shu
- The First Affiliated Hospital of Nanjing Medical University (Department of Oncology), China 210029
| | - Yuanyuan Yu
- Department of Geriatrics, Wuhan Hospital of Traditional Chinese Medicine, 49 Lihuangpi Road, Jiangan District, Wuhan City, Hubei Province, China
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Liao L, Peng Y, Lu J, Wang Z, Xu J, Chen X, Chen H, Zhang X. Effect of Vaginoscopy versus Conventional Hysteroscopy on Pain, Complications, and Patient Satisfaction in Patients with Endometrial Polyps. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3835941. [PMID: 35799662 PMCID: PMC9256323 DOI: 10.1155/2022/3835941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022]
Abstract
Background Hysteroscopy is considered the gold standard for diagnosing intrauterine pathology. Traditional hysteroscopy requires the placement of a vaginal speculum and cervical forceps, which are large in diameter, causing discomfort and pain to the patient and even causing vagal reflexes. Aims To investigate the impact and clinical value of vaginoscopy versus conventional hysteroscopy on pain, complications, and patient satisfaction in patients with endometrial polyps and to analyse the advantages of clinical application of vaginoscopy examination. Materials and Methods One hundred and twenty-five patients with endometrial polyps treated in our hospital from May 2021 to December 2021 were selected for this study and divided into 52 cases in the hysteroscopy group and 73 cases in the vaginoscopy group according to the random remainder grouping method. Conventional hysteroscopy was used, and in the vaginoscopy group, vaginoscopy was performed. The impact of pain, complications, patient satisfaction, and clinical value of the two groups was observed and compared. Results The time taken for the examination varied between the different hysteroscopic methods, with the hysteroscopy group taking the longest time compared to the vaginoscopy group (P < 0.01). The VAS scores immediately after the examination and 30 minutes after the examination were both significantly higher in the hysteroscopy group than in the vaginoscopy group (P < 0.01). The difference in NPY, PGE2, and 5-HT after the pain-causing mediator intervention was significantly better in the vaginoscopy group than in the hysteroscopy group. The difference in the incidence of complications such as abortion syndrome, cervical laceration, uterine perforation, and haemorrhage after treatment was significantly lower in the vaginoscopy group than in the hysteroscopy group. In the vaginoscopy group, the satisfaction rate was 91% significantly higher than that of the hysteroscopy group (P < 0.05). Conclusion The vaginoscopy technique shortens the examination and treatment time, reduces patient pain, improves patient compliance, reduces the use of preintervention drugs and anaesthetics, and reduces complications.
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Affiliation(s)
- Liyun Liao
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, China 310006
- Xiangshan First People's Hospital Medical and Health Group, 315700, China
| | - Yangying Peng
- Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, 318020, China
| | - Jianshuo Lu
- Xiangshan First People's Hospital Medical and Health Group, 315700, China
| | - Zhiying Wang
- Xiangshan First People's Hospital Medical and Health Group, 315700, China
| | - Jinyue Xu
- Xiangshan First People's Hospital Medical and Health Group, 315700, China
| | - Xuefeng Chen
- Xiangshan First People's Hospital Medical and Health Group, 315700, China
| | - HaiYing Chen
- Xiangshan First People's Hospital Medical and Health Group, 315700, China
| | - Xinmei Zhang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, China 310006
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Guraslan H, Senturk MB, Dogan K, Yuksel B, Kaya C, Karacan T, Karabay Akgul O, Ceylan Y. Diagnostic office hysteroscopy; why is it still painful procedure despite the surgical experience and mini-hysteroscope? J Obstet Gynaecol Res 2022; 48:1418-1425. [PMID: 35274418 DOI: 10.1111/jog.15219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/16/2021] [Accepted: 02/28/2022] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the effect of cervical canal features on pain during outpatient hysteroscopy performed by experienced surgeons using mini-hysteroscope. METHODS A prospective observational study was conducted on 303 women undergoing diagnostic hysteroscopy without anesthesia. Pain intensity was evaluated using the visual analog scale (VAS) when the cervical canal was passed. The patients were divided into two groups according to the VAS score: painless or mild pain (VAS <4) and moderate or severe pain (VAS ≥ 4). The relationship between cervical canal characteristics (length, version, and flexion positions, history of cervical intervention, stenosis, synechiae), obstetric and gynecological history, preoperative anxiety level, procedure duration, and pain intensity was examined. RESULTS Moderate pain (4 ≤ VAS < 7) was observed in 38% of patients (n = 117) and 14 patients (5%) experienced severe pain (VAS ≥ 7). In multivariate analysis, nulliparity (p = 0.01; OR, 4.6; 95% CI, 1.7-13.2), postmenopausal state (p = 0.02; OR, 2.2; 95% CI, 1.2-4.3), excessive flexion of the cervix and retroverted uterus (p <0.001; OR, 4.1; 95% CI, 2.0-8.5) were identified as risk factors for a painful procedure. Diagnostic hysteroscopy was successful in 98% of the patients. The pain was the primary cause of the failed hysteroscopy. CONCLUSION In addition to nulliparity and postmenopausal status, unfavorable features of the cervical canal, such as the excessive flexion position of the cervix and uterine retroversion are significant causes of pain during outpatient hysteroscopy.
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Affiliation(s)
- Hakan Guraslan
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet B Senturk
- Department of Obstetrics and Gynecology, Tekirdag Namik Kemal University, Tekirdag /, Turkey
| | - Keziban Dogan
- Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Berkay Yuksel
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Acibadem Bakirkoy Hospital, Istanbul, Turkey
| | - Tolga Karacan
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Karabay Akgul
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yasin Ceylan
- Department of Obstetrics and Gynecology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Maior MDCFS, Souza ASR, Souza GFDA, da Costa AAR. Comparison between 200 μg and 800 μg of vaginal misoprostol for cervical ripening before operative hysteroscopy: A randomized controlled trial. Int J Gynaecol Obstet 2021; 158:205-212. [PMID: 34695232 DOI: 10.1002/ijgo.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/17/2021] [Accepted: 10/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare between 200 and 800 μg of vaginal misoprostol for cervical ripening before operative hysteroscopy. METHODS Quadruple-blind randomized clinical trial conducted between November 2019 and September 2020 involving 76 patients undergoing cervical dilatation before surgical hysteroscopy at teaching hospitals in Pernambuco, Brazil. Women received the vaginal misoprostol dosage of 200 or 800 μg,10-12 h before operative hysteroscopy. The cervical width was the primary outcome, and secondary outcomes were patient satisfaction, adverse effects, surgical complications, and duration of cervical dilatation. Chi-square tests of association, Fisher's exact and Mann-Whitney U tests were used with an α error of <5%. RESULTS There was no statistical difference between the groups in the mean of the cervical width (800 μg: 6.5 ± 1.6 mm vs 200 μg: 5.8 ± 1.8 mm, P = 0.055), patient satisfaction, and surgical findings, but the duration of cervical dilatation was lower in the 800-μg group (28.16 ± 28.5 s vs 41.97 ± 31.0 s, P = 0.035). Among the adverse effects, diarrhea was more frequent in the 800-μg group with statistical difference (100% vs 0%; P = 0.01). CONCLUSION For cervical ripening, 200 μg misoprostol is equally effective with fewer adverse effects than 800 μg before operative hysteroscopy. ClinicalTrials.gov: NCT04152317. https://clinicaltrials.gov/ct2/show/NCT04152317.
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Affiliation(s)
- Maria da Conceição Farias Souto Maior
- Postgraduate Program in Integral Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Biological Sciences and Health Center, Catholic University Pernambuco (UNICAP), Recife, Pernambuco, Brazil.,Department of Health Science, University Center Maurício de Nassau (UNINASSAU), Recife, Pernambuco, Brazil.,Department of Gynecology, Hospital Agamenon Magalhães (HAM), Recife, Pernambuco, Brazil
| | - Alex Sandro Rolland Souza
- Postgraduate Program in Integral Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Biological Sciences and Health Center, Catholic University Pernambuco (UNICAP), Recife, Pernambuco, Brazil.,Department of Maternal and Child Healthcare, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Aurélio Antônio Ribeiro da Costa
- Postgraduate Program in Integral Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.,Department of Maternal and Child Healthcare, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
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7
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Ludwin A, Lindheim SR, Booth R, Ludwin I. Removal of uterine polyps: clinical management and surgical approach. Climacteric 2021; 23:388-396. [PMID: 32648824 DOI: 10.1080/13697137.2020.1784870] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endometrial polyps have a reported prevalence from 7.8% up to 30% and are one of the most cost-consuming gynecological conditions for our specialty. There are strong practitioner beliefs that surgical removal of endometrial polyps is highly beneficial, particularly for those with abnormal uterine bleeding and infertility. Additionally, polypectomy is indicated to reduce the risk of malignancy. Transvaginal ultrasound is the first-line diagnostic option for detection of endometrial polyps, while sonohysterography has similar accuracy as hysteroscopy in the diagnostic confirmation. Blind dilatation and curettage is not recommended for polyp removal; rather, hysteroscopy in the operating room and office setting using small-diameter hysteroscopic equipment is the standard approach. This can be performed without anesthesia in most women. While hysteroscopy is an effective method for polypectomy with a low complication rate, it is unknown whether this is truly beneficial for reproductive-age women with infertility and prior assisted reproduction therapy. The risk of malignancy in women with postmenopausal bleeding justifies the necessity of polypectomy with histologic tissue examination. In asymptomatic women, the risk of malignancy is low, and there are no known benefits of polyp removal in the prevention of malignant transformation. Cost-effective studies remain to be done to provide us with the optimal approach to endometrial polyps including the management of asymptomatic and/or infertile women, ideal location including office-based or the operating room setting, complication prevention including intrauterine adhesions, and recurrence issues.
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Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.,Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland.,Centermed - Private Hospital and Clinic, Krakow, Poland
| | - S R Lindheim
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, USA
| | - R Booth
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, USA
| | - I Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.,Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland.,Centermed - Private Hospital and Clinic, Krakow, Poland
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Abstract
Ultrasound is a readily available, safe and portable imaging modality that is widely applied in gynecology. However, there is limited guidance for its use intra-operatively especially with complex gynecological procedures. This narrative review examines the existing literature published on the use of intraoperative ultrasound (IOUS) in benign gynecology and in gynecological oncology. We searched for the following terms: ‘intraoperative,’ ‘ultrasonography,’ ‘gynecology’ and ‘oncology’ using Pubmed/Medline. IOUS can minimize complications and facilitate difficult benign gynecological procedures. There is also a role for its use in gynecological oncology surgery and fertility-sparing surgery. The use of IOUS in gynecological surgery is an emerging field which improves visualization in the surgical field and aids completion of minimally invasive techniques. Ultrasound (US) is a portable and safe imaging method that uses high frequency sound waves to visualize structures within the body. While most US examinations are done outside the body there is an emerging field which uses US devices within the body during surgery to aid complex procedures. This review examines the published literature on this technique in benign gynecology and in gynecological oncology. This review demonstrates the use of intraoperative US improves visualization and minimizes surgical complications.
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Zizolfi B, Foreste V, Cammarota A, Manzi A, Gallo A, DI Spiezio Sardo A. Hysteroscopic approach to uterine cervical canal stenosis. Minerva Obstet Gynecol 2020; 73:185-192. [PMID: 33249822 DOI: 10.23736/s2724-606x.20.04729-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cervical stenosis is defined as an adhesion process of variable degree, producing narrowing, distortion, or complete obliteration of the cervix. Several techniques have been defined to access to the uterine cavity and nowadays hysteroscopy seems to be the best option. In this manuscript, we review all the hysteroscopic modalities to overcome a cervical stenosis and access to the uterine cavity.
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Affiliation(s)
- Brunella Zizolfi
- Department of Neuroscience Reproductive Sciences and Dentistry School of Medicine, Federico II University, Naples, Italy
| | - Virginia Foreste
- Department of Neuroscience Reproductive Sciences and Dentistry School of Medicine, Federico II University, Naples, Italy -
| | - Antonella Cammarota
- Department of Neuroscience Reproductive Sciences and Dentistry School of Medicine, Federico II University, Naples, Italy
| | - Alfonso Manzi
- Department of Neuroscience Reproductive Sciences and Dentistry School of Medicine, Federico II University, Naples, Italy
| | - Alessandra Gallo
- Department of Public Health, Federico II University, Naples, Italy
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Nohuz E, Chêne G, Maréchal C, Atallah A, Chabert P, Michy T, Lamblin G. [How I do… to find the cervical canal in the event of an impassable stenosis of the cervix before a hysteroscopy]. ACTA ACUST UNITED AC 2020; 49:632-634. [PMID: 33276134 DOI: 10.1016/j.gofs.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- E Nohuz
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France.
| | - G Chêne
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France; Université Claude Bernard Lyon 1, EMR 3738, 69000 Lyon, France
| | - C Maréchal
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - A Atallah
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - P Chabert
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - T Michy
- Service de gynécologie-obstétrique, hôpital Couple-Enfant, CHU de Grenoble-Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - G Lamblin
- Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, 59, boulevard Pinel, 69000 Lyon, France
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11
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Engels V, Medina M, Antolín E, Ros C, Amaro A, De-Guirior C, Manzour N, Sotillo L, De la Cuesta R, Rodríguez R, San-Frutos L, Peralta S, Martin-Martínez A, Alcázar JL. Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study. J Gynecol Obstet Hum Reprod 2020; 50:102004. [PMID: 33242678 DOI: 10.1016/j.jogoh.2020.102004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. METHODS This was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. RESULTS Nine hundred fifteen women were included in the final analysis. Median age was 34 (range, 21-45) years and median body mass index was 23 (range, 16-41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1-16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0-10), and only 17 (1.9 %) of women reported severe pain (VAS ≥ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. CONCLUSION HYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.
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Affiliation(s)
- V Engels
- Hospital Universitario Puerta de Hierro Majadahonda, Spain.
| | - M Medina
- Hospital Materno Infantil Las Palmas de Gran Canaria, Spain
| | - E Antolín
- Hospital Materno Infantil La Paz, Spain
| | - C Ros
- Hospital Clinic Barcelona, Spain
| | - A Amaro
- Hospital Materno Infantil Las Palmas de Gran Canaria, Spain
| | - C De-Guirior
- Hospital Materno Infantil La Paz, Spain; Hospital Clinic Barcelona, Spain
| | - N Manzour
- Clínica Universitaria De Navarra, Spain
| | - L Sotillo
- Hospital Materno Infantil La Paz, Spain
| | - R De la Cuesta
- Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | | | - L San-Frutos
- Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - S Peralta
- Hospital Materno Infantil Las Palmas de Gran Canaria, Spain
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Kent L, Mallen A, Hoffman M. Suspicion of Cervical or Uterine Pathology in Patients with a Distorted Cervix: Case Series. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laura Kent
- Department of Gynecologic Oncology, Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Adrianne Mallen
- Department of Gynecologic Oncology, Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Mitchel Hoffman
- Department of Gynecologic Oncology, Moffitt Cancer Center, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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Calzolari S, Comito C, Pavone D, Sorbi F, Castellacci E, Giarrè G, Andersson KL, Dubini V, Petraglia F. Extending cervicoplastic surgery: an alternative technique to overcome the limitation of office hysteroscopy. ACTA ACUST UNITED AC 2020. [DOI: 10.1186/s10397-020-01076-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AbstractOur objective is to show a feasible approach to the hysteroscopic procedures when the cervical canal has a diameter smaller than the lesion. Our study is designed as a case series and illustration of the surgical hysteroscopic technique. A group of patients (n = 37) underwent office hysteroscopy in Regional Reference Center for Hysteroscopy Service at Palagi Hospital, Florence, Italy, to see and treat an endometrial polyp with unfavorable cervical conditions between January 2019 and December 2019. An office hysteroscopy in outpatient setting with vaginoscopic approach was performed in women with unfavorable cervical conditions. Fiber-based 3.5-mm hysteroscope, with 5F electrosurgery unit and 5F bipolar electrode, was used to perform the cervicoplasty in order to enlarge the cervical canal from internal to external os, following by the removal of the endometrial polyp with the excision of the base only without slicing. After 90 days, a follow-up hysteroscopy was performed. The procedure was performed successfully in 89.2% of patients.The surgical technique of cervicoplastic allows to perform an operative procedure without analgesia/sedation or anesthesia or blind cervical dilation, reducing the risk of complications and costs. Furthermore, cervicoplasty allowed the removal en bloc of the endocavitary lesion in all cases. At the follow-up hysteroscopy, the cervical passage was straight and smooth, without lesions repaired in all patients. Cervicoplasty is a technique which allows to perfume an ease and comfortable hysteroscopic procedure even in patients with unfavorable cervical canal. Due to the widening of the diameter of the cervical canal, intracavitary lesions are removed intact resulting in an optimal pathological evaluation.
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Funada R, Adachi K, Yamamoto Y, Nakamichi I. Usefulness of Disposable Skin Biopsy Punch for Cervical Occlusion after Cervical Conization. Gynecol Minim Invasive Ther 2020; 9:95-97. [PMID: 32676288 PMCID: PMC7354756 DOI: 10.4103/gmit.gmit_65_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 06/27/2019] [Accepted: 12/02/2019] [Indexed: 12/04/2022] Open
Abstract
Cervical occlusion is a rare but serious complication after conization of the uterine cervix. We report on a 69-year-old woman with cervical intraepithelial neoplasia (CIN) 2, who successfully underwent follow-up biopsy of an occluded cervical canal after conization using a disposable skin biopsy punch. The disposable skin biopsy punch was inserted into a slight dimple, which was considered a uterine os, in the direction of the cervical canal, and a sample of tissue was obtained from the occluded portion. This procedure was performed without anesthesia and was completed uneventfully. Histological examination of the excised tissue revealed CIN 3. In addition, the procedure resulted in recanalization of the occluded cervical canal. The occlusion was limited in the external portion of the cervical os and attributed to adhesion of scar tissue during the healing process. Our experience suggests that a disposable skin biopsy punch can be used for follow-up biopsy and recanalization in patients with cervical occlusion after conization as a less invasive approach.
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Affiliation(s)
- Rina Funada
- Department of Obstetrics and Gynecology, Minoh City Hospital, Osaka, Japan
| | - Kazushige Adachi
- Department of Obstetrics and Gynecology, Minoh City Hospital, Osaka, Japan
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15
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Parry JP, Isaacson KB. Hysteroscopy and why macroscopic uterine factors matter for fertility. Fertil Steril 2019; 112:203-210. [DOI: 10.1016/j.fertnstert.2019.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
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