Hysteroscopy of the uterus - what is it? Hysteroscopy of the uterus: the types, indications, the cost of the procedure

At present, there are quite a few types of diagnosis of female diseases, among which, along with ultrasound and tomography (magnetic resonance and computer) is the hysteroscopy of the uterus. What is this procedure? What indications for its conduct exist and how much does it cost? This we will try to tell in this article.

What is hysteroscopy?

From the Greek language this word is translated as "inspecting 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 within without punctures and cuts. In addition, this technique makes it possible to eliminate small pathological formations in the body cavity, fallopian tubes or neck.

It should immediately be stipulated that the hysteroscopy of the uterus and curettage are not the same procedure, although often they are combined. The main difference between this method of therapy and diagnostic research from others is that the epithelial layer of the uterus during manipulation is practically not damaged. In addition, ultrasound in some cases does not allow you to clearly identify some of the nuances of a woman's pathological processes taking place in the genital organs. Suffice it 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 was performed with a laparoscope. But this method also had drawbacks, because to inspect 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 makes it possible to do without any incisions and punctures of the abdominal wall and uterus. This is considered an advantage, because any violation of the integrity of the skin and muscles is open to bacteria and viruses by the gate.

So, we found out what is the hysteroscopy of the uterus. What is this in terms of medical workers and patients? Read more about this.

Types of hysteroscopy of the uterus

To date, in the medical environment, there are two types of hysteroscopy: diagnostic and therapeutic (hysteroresectoscopy). Hysteroscopy of the uterine cavity, conducted with the aim of establishing (confirming or refuting) a previously diagnosed disease, is diagnostic. The main difference of this type of procedure is that different types of anesthesia are not applied to the patient. The fact that the diagnostic hysteroscopy of the uterus even causes discomfort in a woman, but at the same time does not act as a source of severe pain.

Medical hysteroscopy of the uterus (removal of polyps, fibroids, adhesions, etc.) is carried out in the case of a high probability of a patient having pathologies that require surgical intervention. This type of procedure is performed under general anesthesia and requires the participation of a group of specialists: an anesthesiologist, surgeon, etc. This is the main similarity between hysteroresectoscopy and a minimally invasive surgical procedure known as laparoscopy.

Depending on the type of procedure, the cost varies. Hysteroscopy of the uterus, which is carried out for diagnostic purposes, is somewhat cheaper than hysteroresectoscopy.

Indication for the diagnostic procedure

Hysteroscopy of the uterine cavity for the purpose of confirming or refuting an earlier diagnosed diagnosis is performed in the following cases:

• With suspected endometriosis and uterine myoma (submucosa);
• When suspicion of the remains of the fetal membranes present in the body cavity;
• To identify various anatomical defects of the uterus, appendages and cervical canal;
• To establish the causes of regularly recurring intermenstrual bleeding, profuse and prolonged menstruation;
• With repeated miscarriages (habitual) and infertility;
• To establish the effectiveness of prolonged hormonal treatment.

Despite the high information content of the hysteroscopy of the uterus, it is often prescribed only if the diagnosis is controversial, and materials obtained during other diagnostic procedures did not help clarify the picture of the disease.

Indications for the treatment of hysteroscopy

Consider the main indications for the procedure, known as therapeutic hysteroscopy of the uterus. What is it, we considered above, so it is not difficult to understand what is the testimony to it. So, in what cases is a woman referred for hysteroresectoscopy?

• Polyps of the endometrium present in the uterine cavity .
• When the endometrial layer thickens (hyperplasia).
• If there is a uterine myoma located under the endometrium.
• With constantly appearing abundant bleeding from the body.
• If there are intrauterine septa and fissures of the walls of the organ.
• To remove a contraceptive type IUD from the uterine cavity.

Hysteroscopy of the uterus (polyp removal, 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 diagnosing or treating with a hysteroscope refers to minimally invasive operations, there are a number of factors that prevent this method from being used. Serious contraindications to the implementation of diagnostic hysteroscopy are:

1. Inflammatory processes in the genitourinary organs, including urethritis, vulvovaginitis, cystitis and much more.
2. Infectious diseases in acute stage.
3. Normally developing pregnancy.
4. Abundant bleeding from the uterus at the time of the procedure.
5. Neck stenosis.
6. Cancer on the cervix (last stage).
7. Severe somatic condition after a heart attack.
8. Severe degree of renal or heart failure (regardless of the stage of the disease).
9. Diseases that caused a clotting disorder.

In some cases, for a procedure using a hysteroscope, a woman needs to undergo treatment for the underlying disease. But sometimes this is not enough, so specialists select another method of diagnosis or conduct operations using other technologies.

Preparation for hysteroscopy of the uterus

In order for a diagnostic or therapeutic process using a hysteroscope to pass with the least negative consequences, it must be properly prepared. The first thing you need to do to any patient is to visit the attending physician who will send it to the examination, which is to take the tests. As a rule, the list of compulsory studies includes:

• General blood and urine tests;
• Gynecological smears on flora and gonorrhea;
• Biochemical analyzes of blood and urine;
• electrocardiogram;
• Blood on the Rh factor and group;
• Cytological smear from the cervix;
• Pictures of ultrasound of the pelvic organs;
• The conclusion of the therapist;
• fluorography.

To hand over all analyzes and to pass additional researches it is necessary for 10-14 days prior to prospective date of carrying out of operation. If more time elapses after receiving the results, they must be resubmitted.

It is worth remembering that women who have a hysteroscopy for the uterus, that this will require a certain mood from them. After all, not every patient is ready to suffer discomfort during medical procedures. This especially applies to those who are directed to diagnostic hysteroscopy, during which general anesthesia is not applied .

The day before the procedure, women are advised to limit 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, a so-called premedication is performed, the essence of which is to introduce a sedative into the patient. If there is a hysteroresectoscopy, the woman will need to install a catheter through which she will be given a special anesthetic drug. In total, the preparation for hysteroscopy of the uterus takes no more than thirty minutes. During this time, the woman is also measured blood pressure and body temperature.

Under what conditions can hysteroscopy be performed?

So, let's move on to the main thing. How is hysteroscopy performed? At once it is necessary to tell, that the given procedure can be made in out-patient or stationary conditions. 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 can perform simultaneous diagnostic operations such as hysteroscopy of the uterus and scraping. It should be noted immediately that the specialist will not be able to carry out a separate diagnostic tissue taking (scraping) from the uterus in connection with the lack of anesthesia, as this procedure is very painful and not every woman can withstand it. The advantage of outpatient intervention is its speed, as well as a lower cost. Hysteroscopy of the uterus in this case is carried out solely as a diagnostic procedure.

Hysteroresectoscopy can be carried out only in a hospital. 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 to take for the subsequent analysis the mucous membrane particles from the organ itself, the tubes, and also to make the tissue in the cervix of the uterus. Hysteroscopy in this case is somewhat more expensive than that performed on an outpatient basis. It should be noted that the risk of complications in the stationary procedure is reduced several times. In addition, this type of surgical intervention is absolutely painless for a woman.

How is the procedure performed?

Let's move on to the main point: conducting diagnostic hysteroscopy. After the patient is placed in a gynecological chair, the doctor opens the cervix with special tools and injects liquid into her cavity. This manipulation allows the cavity of the organ to open to carry out further diagnostic actions in it. Since hysteroscopy of the uterus is done without local anesthesia, a woman can feel a tangible discomfort or even pain.

After the introduction of a hysteroscope into the uterine cavity, the physician begins a step-by-step examination of the organ, cervical canal and the ovaries of the fallopian tubes. After the expert is convinced of the absence of polyps, myomas and other neoplasms, he curette takes 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. A little longer the body cavity is examined - 15-20 minutes.

In the event that a woman was referred 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 sophisticated device, the gynecologist removes polypous lesions from the uterine cavity, myomas located under the endometrium, and also divides the fused walls of the uterus (synechia). In addition, a hysteroresectoscope is used to take tissues for histological examination. How long does the hysteroscopy of the uterus last? Operations of this type usually take no more than 30 minutes. The patient does not feel pain during the procedure and regains consciousness in the postoperative ward.

What can happen after the procedure

So, the operation is over. What can a woman feel after? Hysteroscopy of the uterus, even under general anesthesia, can cause a significant 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).

Virtually all patients after this type of intervention there are small bloody discharge from the vagina. If we take into account that instruments and instruments were introduced into the uterus, the source of bleeding becomes clear. Probes, camera and LED light bulbs, despite their small size, injure the epithelium. In addition, it should be borne in mind that in most cases hysteroscopy implies a violation of the integrity of the mucosa for the purpose of tissue sampling for histological studies. The intensity of pain and the number of secretions does not depend on how much the uterine hysteroscopy costs. First of all, this affects the state of the organs of a woman at the time of the operation, her individual characteristics (blood coagulability, pain threshold , etc.).

For preventive purposes, a doctor can prescribe a course of antibiotics for a woman. This helps to avoid the occurrence of an inflammatory process in the pelvic organs. In addition, there are a number of recommendations regarding personal hygiene. First, it is not recommended to visit saunas and baths. Secondly, the bath should be replaced with a shower, and it is better to refuse douching for a month at all. During menstruation, a woman is recommended to use gaskets, since tampons can also cause infection. Before the onset of menstruation as a contraceptive should be used so-called barrier methods, that is, condoms.

Since hysteroscopy refers to surgical interventions, there are a number of symptoms that may indicate complications that have begun. When they appear, a woman should immediately consult a doctor who conducted the procedure. Such characteristics include:

• Intense and prolonged pain in the pelvic region, which are unable to remove OTC painkillers;
• Copious bleeding from the vagina with or without pus;
• Increase in body temperature from subfebrile to critical.

Despite the minor traumatic nature of the procedure, such as hysteroscopy of the uterus, complications can occur. That's why a woman after a treatment or examination by this method needs to closely monitor her condition.

Complications after hysteroscopy

Those who have suffered such interference as hysteroscopy of the uterus, the consequences (reviews of specialists and patients confirm this) can be both positive and negative. The most common complication is the perforation of the uterus or perforation. The cause of this damage may be the careless handling of a specialist with the device. However, most often the rupture occurs due to the fact that the cervical canal widens very slightly, as a result of which the instruments introduced into it exert increased pressure on the walls of the organ.

Consider what may cause hysteroscopy of the uterus consequences. Reviews suggest that often women develop endometritis. This phenomenon occurs because of 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 genito-urinary organs that took place 6 months before contacting the clinic. Eliminate endometritis by prolonged therapy with antibiotics.

A detailed examination will help to avoid complications such as a hematometer, the essence of which is the accumulation of blood in the uterine cavity due to a violation of the process of clotting. Symptom of this complication is severe pain in the lower abdomen. When hematomas appear, repeated cleaning of the uterine cavity is recommended in order to remove blood clots from it.

Less often, hysteroscopy is complicated by excessive scraping, when in the course of tissue sampling histological damage to the growth layer. Unfortunately, this pathology does not respond to treatment.

Despite the complications in practice after hysteroscopy, talking about this procedure as a carrier of danger does not make sense. First of all, it is worth considering that it is carried out to eliminate serious pathologies, which in themselves can threaten the life of a woman.

How much does the hysteroscopy of the uterus

The cost of diagnostic or therapeutic procedures with the use of a hysteroscope varies depending on the location of the medical institution and on exactly what manipulations will be carried out. Hysteroscopy of the uterus, whose price is somewhat lower than hysteroresectoscopy, is considered more affordable. Its value is about 14-18 thousand rubles. An order of magnitude more expensive, for example, removal of the polyp of the uterus (hysteroscopy). The price of this procedure starts from 22 thousand rubles. The given sums are formed, first of all, from what medicines are used during an operative intervention. Also the cost of the procedure includes the payment of the working time of the doctor and other medical personnel participating in the 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 they do not require a specially equipped office for their implementation.

Be healthy!