Currently, there are quite a few types of diagnosis of female diseases, including hysteroscopy of the uterus, along with ultrasound and tomography (magnetic resonance and computed). What is this procedure? What indications for its implementation exist and how much does it cost? We will try to talk about this in this article.
What is hysteroscopy
From the Greek language, this word translates as "inspect the uterus." In fact, hysteroscopy is a gynecological examination using a special device called a hysteroscope. It allows you to visually examine the mucous membrane of the uterus from the inside without punctures and incisions. In addition, this technique makes it possible to eliminate small pathological formations in the organ cavity, fallopian tubes or neck.
It should immediately be noted that hysteroscopy of the uterus and curettage are not the same procedure, although they are often combined. The main difference between this method of therapy and diagnostic research from others is that the epithelial layer of the uterus during the manipulation is practically not damaged. In addition, ultrasound in some cases does not allow us to clearly identify some of the nuances of pathological processes in the female genital organs. It is enough to recall that just ten years ago, for a visual examination of the inner epithelial layer of the uterus, it was necessary to make a large incision on the woman’s stomach and directly on the organ. After some time, the examination began to be carried out using a laparoscope. But this method also had drawbacks, because to examine the uterine cavity it was necessary to make a puncture in its wall. All these manipulations could cause the formation of adhesions or cause infertility. The hysteroscope allows you to do without any incisions and punctures of the abdominal wall and uterus at all. This is considered an advantage, because any violation of the integrity of the skin and muscles is an open gate for bacteria and viruses.
So, we learned what hysteroscopy of the uterus consists of. What is it from the point of view of medical workers and patients? Read about it later.
Types of uterine hysteroscopy
To date, in the medical environment, two types of hysteroscopy are distinguished: diagnostic and therapeutic (hysteroresectoscopy). Hysteroscopy of the uterine cavity, carried out in order to establish (confirm or refute) a previously made diagnosis, is diagnostic. The main difference between this type of procedure is that different types of anesthesia are not applied to the patient. The fact is that diagnostic hysteroscopy of the uterus, although it causes discomfort in a woman, but at the same time does not act as a source of severe pain.
Therapeutic hysteroscopy of the uterus (removal of the polyp, myoma, adhesions, etc.) is performed if there is a high probability that the patient will have pathologies requiring surgical intervention. This type of procedure is performed under general anesthesia and requires the participation of a team of specialists: an anesthesiologist, surgeon, etc. This is the main similarity of hysteroresectoscopy with minimally invasive surgery, known as laparoscopy.
Depending on the type of procedure, the cost also varies. Hysteroscopy of the uterus, which is carried out for diagnostic purposes, is somewhat cheaper than hysteroresectoscopy.
Indications for the diagnostic procedure
Hysteroscopy of the uterine cavity in order to confirm or refute a previously diagnosed diagnosis is carried out in the following cases:
- with suspected endometriosis and uterine fibroids (submucosal);
- if it is suspected that the remains of the membranes of the fetus are in the body cavity;
- to identify various anatomical malformations of the uterus, appendages and cervical canal;
- to establish the causes of regularly recurring intermenstrual bleeding, heavy and prolonged menstruation;
- with repeated miscarriages (habitual) and infertility;
- to establish the effectiveness of long-term hormonal treatment.
Despite the high informativeness of uterine hysteroscopy, it is often prescribed only if the diagnosis is controversial, and the materials obtained during other diagnostic procedures did not help clarify the picture of the disease.
Indications for therapeutic hysteroscopy
Consider the main indications for the procedure, known as therapeutic hysteroscopy of the uterus. What is this, we considered above, so to understand what is the evidence for her, it will be easy. So, in what cases is a woman referred for hysterectectoscopy?
- With endometrial polyps present in the uterine cavity.
- With a thickening of the endometrial layer (hyperplasia).
- In the presence of uterine fibroids located under the endometrium.
- With constantly appearing heavy bleeding from the organ.
- In the presence of intrauterine septa and organ wall adhesions.
- For removal of a contraceptive type IUD from the uterine cavity.
Hysteroscopy of the uterus (removal of the polyp, diagnostic separate curettage, and much more) is carried out only if there are no serious contraindications. What concerns them, we will tell further.
Contraindications
Since the procedure for diagnosis or treatment with the use of a hysteroscope refers to minimally invasive operations, there are a number of factors that do not allow the use of this method. Serious contraindications to the implementation of diagnostic hysteroscopy are:
- Inflammatory processes in the genitourinary organs, including urethritis, vulvovaginitis, cystitis and much more.
- Infectious diseases in the acute stage.
- Normally developing pregnancy.
- Heavy bleeding from the uterus at the time of the procedure.
- Cervical stenosis.
- Cancer on the cervix (last stage).
- Severe somatic state after a heart attack.
- Severe degree of renal or heart failure (regardless of the stage of the disease).
- Diseases that cause a bleeding disorder.
In some cases, for a procedure using a hysteroscope, a woman needs to undergo a course of treatment for the underlying disease. But sometimes this is not enough, so experts choose a different diagnostic method or conduct operations using other technologies.
Preparation for hysteroscopy of the uterus
In order for the diagnostic or treatment process using the hysteroscope to go through with the least negative consequences, it is necessary to properly prepare for it. The first thing that any patient needs to do is to visit the attending physician, who will direct her to the examination, which consists in passing tests. As a rule, the list of required studies includes:
- general blood and urine tests;
- gynecological smears on flora and gonorrhea;
- biochemical blood and urine tests;
- electrocardiogram;
- blood on the Rh factor and group;
- cytological smear from the cervix;
- ultrasound images of the pelvic organs;
- therapist's opinion;
- fluorography.
It is necessary to pass all analyzes and undergo additional studies 10-14 days before the expected date of the operation. If more time has passed since the results were received, they must be submitted again.
It is worth remembering that women who have hysteroscopy of the uterus, that this will require them to have a certain attitude. After all, not every patient is ready to endure discomfort during medical procedures. This is especially true for those who are aimed at diagnostic hysteroscopy, during which general anesthesia is not used.
One day before the procedure, women are advised to limit their fluid intake. The last portion of water is allowed to drink at least twelve hours before the start of the operation. During the last 50-60 minutes before the procedure of hysteroscopy of the uterus, the so-called premedication is carried out, the essence of which is the introduction of a sedative to the patient. If there is a hysteroresectoscopy, a woman will need to install a catheter through which she will be given a special anesthetic drug. In total, preparation for hysteroscopy of the uterus takes no more than thirty minutes. During this time, the woman also measures blood pressure and body temperature.
Under what conditions can hysteroscopy be performed?
So, let's move on to the main thing. How is uterine hysteroscopy performed? It should be said right away that this procedure can be done on an outpatient or inpatient basis. In the first case, the intervention is carried out in the gynecologist's office and does not require the introduction of anesthesia. In some situations, the doctor may simultaneously perform diagnostic operations such as hysteroscopy of the uterus and curettage. It is worth noting immediately that the specialist will not be able to carry out separate diagnostic tissue sampling (curettage) from the uterus due to the lack of anesthesia, since this procedure is very painful and not every woman can withstand it. The advantage of ambulatory intervention is its speed, as well as lower cost. Hysteroscopy of the uterus in this case is carried out exclusively as a diagnostic procedure.
Hysteroresectoscopy can only be done in a hospital setting. In this case, the patient is hospitalized for up to two days. In such conditions, the doctor can not only inspect the uterine cavity and fallopian tubes, but also take particles of the mucous membrane from the organ itself, the tubes for subsequent analysis, and also pluck the tissues in the cervix. Hysteroscopy in this case is slightly more expensive than performed on an outpatient basis. It should be borne in mind that the risk of complications during inpatient procedure is reduced significantly. In addition, this type of surgical intervention is completely painless for a woman.
How is the procedure
Let's move on to the main point: conducting diagnostic hysteroscopy. After the patient is placed in the gynecological chair, the doctor using special tools opens the cervix and introduces fluid into its cavity. This manipulation allows the cavity of the organ to open for further diagnostic actions. Since hysteroscopy of the uterus is done without local anesthesia, a woman may feel significant discomfort or even pain.
After introducing a hysteroscope into the uterine cavity, the doctor begins a phased examination of the organ, cervical canal and the mouths of the fallopian tubes. After the specialist is convinced of the absence of polyps, fibroids and other neoplasms, he takes a curette to take a small amount of tissue for further research. The smallest period of time that hysteroscopy of the cervix can take is about 5-10 minutes. The organ cavity is examined a little longer - 15-20 minutes.
In the event that a woman was sent to a hospital to remove polyps in the uterus, hysteroscopy is performed under general anesthesia. After a preliminary examination of the organ with a hysteroscope, it is replaced with a hysteroresectoscope. With the help of this more complex device, the gynecologist removes polypous formations, myomas located under the endometrium from the uterine cavity, and also separates the fused uterine walls (synechia). In addition, a hysteroresectoscope implements tissue sampling for histological examination. How long does uterine hysteroscopy last? This type of surgery usually takes no more than 30 minutes. The patient does not feel pain during the procedure and comes to life already in the postoperative ward.
What can happen after the procedure
So, the operation is behind. What can a woman feel after? Hysteroscopy of the uterus, even under general anesthesia, can cause tangible discomfort, which is manifested in the appearance of pulling pains in the lower abdomen. This is a consequence of a violation of the integrity of the mucosa and some stretching of the walls of the uterus and cervical canal. Within a few days, a woman can take painkillers (antispasmodics).
In almost all patients, after this type of intervention, small spotting of the vagina is observed. If we take into account that instruments and devices were introduced into the uterine cavity, the source of bleeding becomes clear. Probes, a camera and LED bulbs, despite their small size, injure the epithelium. In addition, it is worth considering that in most cases, hysteroscopy involves a violation of the integrity of the mucosa in order to take tissues for histological studies. The intensity of the pain and the amount of discharge does not depend on how much the hysteroscopy of the uterus costs. First of all, this is affected by the state of the organs of the woman at the time of the operation, her individual characteristics (blood coagulation, pain threshold , etc.).
For preventive purposes, the doctor can prescribe a woman a course of antibiotics. This helps to avoid the appearance of an inflammatory process in the pelvic organs. In addition, there are a number of recommendations regarding personal hygiene. Firstly, it is not recommended to visit saunas and baths. Secondly, baths should be replaced with a shower, and it is better to completely abandon douching for a month. During menstruation, a woman is recommended to use pads, since tampons can also cause infection. Before the onset of menstruation, the so-called barrier methods, that is, condoms, should be used as a contraceptive.
Since hysteroscopy refers to surgical interventions, there are a number of signs that can indicate complications that have begun. When they appear, a woman should immediately consult a doctor who performed the procedure. These signs include:
- intense and prolonged pain in the pelvic area, which over-the-counter pain medications are unable to relieve;
- copious spotting from the vagina with or without pus;
- an increase in body temperature from subfebrile to critical.
Despite the slight trauma during a procedure such as hysteroscopy of the uterus, complications can occur. That is why a woman after treatment or examination with this method, it is especially necessary to carefully monitor her condition.
Complications after hysteroscopy
For those who have undergone such an intervention as hysteroscopy of the uterus, the consequences (reviews of specialists and patients confirm this) can be both positive and negative. Most rarely, a complication such as uterine perforation or perforation is recorded. The cause of this damage may be careless handling by a specialist with the device. However, most often the rupture occurs due to the fact that the cervical canal dilates very slightly, as a result of which the instruments inserted into it exert increased pressure on the walls of the organ.
Consider the consequences of hysteroscopy of the uterus. Reviews indicate that often women develop endometritis. This phenomenon occurs due to the latent inflammatory processes in the uterus, against which the operation was performed. To avoid this complication, it is enough to undergo a detailed examination before the procedure. In addition, it is important to inform the doctor about all the inflammatory processes in the genitourinary organs that took place 6 months before going to the clinic. Endometritis can be eliminated through prolonged therapy with antibiotics.
A detailed examination will help to avoid such a complication as a hematometer, the essence of which is the accumulation of blood in the uterine cavity due to a violation of the coagulation process. Symptom of this complication is severe pain in the lower abdomen. When hematometers appear, it is recommended to re-clean the uterine cavity in order to remove blood clots from it.
Most rarely, hysteroscopy is complicated by excessive curettage, when the germ layer is damaged during tissue sampling for histology. Such a pathology, unfortunately, is not amenable to treatment.
Despite the complications after hysteroscopy existing in the practice of specialists, it makes no sense to talk about this procedure as a dangerous one. First of all, it is worth considering that it is carried out to eliminate serious pathologies that, in themselves, can threaten a woman's life.
How much is hysteroscopy of the uterus
The cost of diagnostic or therapeutic procedures using a hysteroscope varies depending on the location of the medical institution and on what kind of manipulations will be performed.Hysteroscopy of the uterus, the price of which is slightly lower than hysteroresectoscopy, is considered more affordable. Its cost is about 14-18 thousand rubles. An order of magnitude more expensive, for example, removal of the uterine polyp (hysteroscopy). The price of this procedure starts from 22 thousand rubles. These amounts are composed, first of all, of which drugs are used during surgery. Also, the cost of the procedure includes payment for the working hours of the doctor and other medical personnel involved in hysteroscopy. An important role in the pricing of this type of medical services is played by the conditions of the operation. The lower cost is observed in the so-called office hysteroscopic procedures, since their implementation does not require a specially equipped office.
Be healthy!