Intrauterine cavity assesment prior an infertility treatment; the comparison of transvaginal sonography and office hysteroscopy

Year 2009, Volume: 40 Issue: 4, 167 - 171, 01.05.2009

Gazi Yıldırım Cem Fıçıcıoğlu Rukset Attar Ateş Karateke Narter Yeşildağlar

Abstract

: Hysteroscopy is a gold standart to detect the intrauterine pathologies. Thus, it has been argued to be a part of a routine infertility testing. We designed this study to demonstrate the importance of routine ofice hysteroscopic examination and the comparision of transvaginal ultrasonography with hysteroscopic findings. Materials and Methods: Routine transvaginal ultras onograpic examination was performed all patients younger than 38 years old who want to conceive. Only 136 of204 patients who has been suspected an intrauterine abnormality in the transvaginal ultrasonography were accepted to be applied diagnostic hysteroscopy. One hundred and eight patients who has been diagnosed normal with ultrasonography were accepted to applied the hysteroscopic examination with informed consent. One hundred and twelve of these 244 patients were required intravenous sedation, and 90 of244 needed cervical dilatation. Endol supp 100 mg was performed to the all patients just 20 minutes before procedure and none of them developed a complication. Wolf 5 mm working channel hysteroscop was applied during the procedure. Results: The detection rates of intrauterine pathologies with transvaginal ultrasonography were comparable with literature (Sensitivity: 82.8%, Spesifisity: 80.8%, False pozitive: 14.7%, False negative: 22.2%, Pozitive predictive value: 85.3%, Negative predictive value: 77.8%). Twenty patients of 136 who had a intrauterine pathologic findings with ultrasonography were revealed as a normal with hysteroscopy. But 24 patients 108 (22.2Vo) showed a intrauterine pathology with hysteroscopy beside their ultrasonograhy were assessed normal (12 polyp, 3 hyperplastic endometrium, 5 adhesion, 4 a uterine anomaly like arcuat, subseptus and septus). Discussion: Currently hysteroscopy can be applied as an office procedure without anesthesia in paralel to the development of optical technology and the small size of telescopic instruments. So it can be use as an routine infertility screening tool even in asymptomatic patients.

Keywords

Infertility, Ultrasonography, Hysteroscopy, Sensitivity and Specificity

İnfertilite tedavileri öncesi uterin kavite değerlendirilmesinde transvajinal ultrasonografi ve ofis histeroskopinin karşılaştırılması

Abstract

Giriş: Histeroskopi uterin kavite patolojilerini saptamada altın standart bir yöntemdir. Bu nedenle temel infertilite araştırmalarının bir parçası olması gerektiği tartışılagelmiştir. Biz bu çalışmamızda ofis histeroskopinin temel infertilite araştırması içinde yer almasını vurgulamak için planladık. Gereç ve Yöntem: Merkezimize iki yıl içersinde başvuran 38 yaşından küçük, ilk tedavisini olacak hastalara rutin transvajinal ultrasonografi uygulandı. Ultrasonografide patolojik bir bulgu saptanan hastalardan 204 tanesine ofis histeroskopi önerildi ancak 136 vaka işleme onam verdiği için müdahaleye alındı. Ultrasonografide hiçbir patolojisi olmayan hastalarımıza da bu projeden bahsedildi ve onam verenlerin 108 tanesine ofis prosedürü olarak histeroskopi uygulandı. 244 hastadan sadece 112 tanesine sedasyon ve 90 tanesinde de servikal dilatasyon gerekti. Hastalara işlemden 20 dk öncesi Endol supp 100 mg pr uygulandı. Uygulama Wolf 5 mm Working Channel histeroskopi sitemi ile yapıldı. Herhangi bir komplikasy on ile karşılaşılmadı. Bulgular: Transvajinal ultrasonografinin uterin kavite patolojilerini belirlemedeki parametreleri literatür ile karşılaştırılabilir oranlarda idi (Sensitivite: %82.8, Spesifîsite: %80.8, Yalancı Pozitiflik: %14.7, Yalancı Negatiftik: %22.2, PPV: %85.3, NPV: %77,8). Uterin kavitede patolojiden şüphelenilen 136 vakanın 20 tanesinde histeroskopide herhangi bir problem izlenmedi. Fakat ultrasonografide normal denilen 108 vakanın 24 tanesinde (%22) sinde histeroskopide bir patoloji izlenmekte idi (12 tanesinde polip, 3 tanesinde hiperplastik endometriyum, 5 tanesinde adezyon, 4 tanesinde de arcuat, subseptus veya septum uteri gibi bir uterin anomali). Sonuç: Invazif bir yöntem olmasına karşın günümüzde optik teknolojideki gelişmelere paralel olarak teleskop çaplarının küçülmesi ve hekimlerin tecrübelerinin artması histeroskopi uygulamalarını anestezi vermeden analjezi uygulayarak ofis şartlarında yapılabilir hale getirmiştir.

Keywords

Kısırlık, Ultrasonografi, Histeroskopi, Duyarlılık ve özgüllük

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