Modern diagnostic procedures and treatment in geneacology

Hysteroscopy

Hysteroscopy is very important part in examination of infertility, repeated miscarriages and/or abnormal bleeding from uterus. It can be diagnostic and operative. Hysteroscopy is an intervention where hysteroscope (a narrow telescope, 3 to 9 mm) is passed through vagina and cervix into the uterine cavity. Modern telescopes are so thin that they pass through the cervix with no dilatation thereto. Inside of uterus consists of two layers of endometrium (uterine mucous membrane) closely attached to each other. They can be examined when separated and that is frequently carried out by introducing liquid between them.

 

Hysteroscopy is usually carried out immediately after menstrual bleeding as the most suitable period for direct visualization of uterine cavity.

 

Diagnostic hysteroscopy is direct visualization of the inside of uterus, i.e. uterine cavity and mucous membrane, possible septum and/or pelvic adhesions, polyps, myomas or other abnormalities.

Operative hysteroscopy is often a continuation of the diagnostic hysteroscopy. In operative hysteroscopy abnormalities can be directly removed (adhesions or tumours in the uterus, polyps, myomas) some undefined changes passing into uterine cavity and preventing conception, pregnancy and causing some other difficulties during periods. This intervention corrects the shape of uterine cavity. Taking the samples deep inside the mucous membrane of uterus (deep biopsy of endometrium) and hystopathological analysis of these samples indicates the morphology of uterine mucous membrane and the influence of hormones on the membrane. Microbiological testing of these samples can reveal possible so called hidden infections, i.e. infections, although present in the tissue, cannot be detected with any other method. These give no latent difficulties but can cause sterility and infertility problems.

 

Many women of mature reproductive age have heavy menstrual bleeding. When these heavy bleedings give no reaction to hormone therapy, the choice would be hysterectomy or hysteroscopy. Certainly, hysteroscopy has many advantages, as the patient avoids a difficult operation, removal of the uterus and the Fallopian tubes as well as numerous potential dangers that such an operation carries along. This operation is known as endometrium ablation. Electrical ablation of mucous membrane is carried out by means of hysteroscopy and therefore repeated menstrual and inter-menstrual bleeding is prevented.

Hysteroscopy risks

Complications of diagnostic hysteroscopy are very rare. Statistically, these happen with 2 % of carried out interventions and those are:

• Uterine wall perforation. With regard to the width of instruments these perforations are very small and in most cases they scar spontaneously
• Complications with regard to the liquid used for widening uterine cavity are leaking of the liquid into the abdominal cavity and blood vessels, all that can induce problems with arterial pressure and electrolytic disbalance....

Great majority of patients feel no difficulties during and upon the intervention. However, there exist certain difficulties that can happen during intervention. The most common difficulty is a pain that patients feel upon the hysteroscopy. The pain can be compared to somehow stronger pains during menstrual pains and is not disturbing.

There are serious risks, and even though these are rare we have to mention them:

• heavy bleeding
• infection
• risks related to anesthesia

Laparoscopy

Sometimes clinical examination, ultrasound or roentgen examinations are not sufficient to determine the condition or inner organs. With some women there are problems that can be diagnosed and /or removed by laparoscopy method. In those cases laparoscopy, diagnostical and operative as well is of great significance.

 

Laparoscopy is a minimally invasive surgical intervention where through the incisions (smaller than 1 cm) optical instruments are introduced into the abdominal cavity for direct visualization and operation of internal organs and other tissues. The most frequent reasons for laparoscopy are testing and eventual removing of some of the causes of sterility, ambiguous abdominal pains, diagnostic and/or surgical removal of endometriosis, ectopic pregnancy, cysts and tumors.

 

Laparoscopy enables us to:

• see the organs of true pelvis and detect possible anomalies
• examine the patency of the Fallopian tubes in the scope of sterility testing
• remove the existing adhesions
• carry out biopsy (taking the sample of tissue which we want to examine)
• remove the existing cysts and tumors
• removal of ectopic pregnancy which is one of the most urgent conditions in medicine