Monopolar versus bipolar electrosurgery in hysteroscopic polypectomy

The aim of this study is to compare in random manner the intraoperative feasibility, effectiveness and safety of monopolar and bipolar electrosurgery in hysteroscopic polypectomy. 36 Symptomatic patients attending at outpatient clinics and diagnosed to have intrauterine polyps by HSG, transvaginal sonography or Diagnostic hysteroscopy were included. Patients were randomly assigned to two groups to have hysteroscopic polypectomy using either bipolar [Group A] or monopolar [Group B] electrosurgery under general anesthesia. Intraoperatively, the following parameters were noted and recorded: time of start of anesthesia, time of introduction of the resectoscope, time of end of the procedures, time of recovery, amount of fluid used, amount of fluid Collected in the graduated suction, postoperative serum sodium was measured. Sociodemographic data for patients in both groups were comparable. The mean duration of operation was comparable in both group [14.76 +/- 2.95 minutes in bipolar group versus 14.79 +/- 2.94 minutes in monopolar group]. Fluid inflow, fluid outflow and fluid deficit were significantly higher in the monopolar group than in bipolar group. Bipolar electrosurgery seems effective, feasible and safe alternative to conventional monopolar system in hysteroscopic management of intrauterine pathologies

Sonographic, hysteroscopic, and pathologic findings in patients with abnormal uterine bleeding

Abnormal uterine bleeding AUB is the cause of gynecological referral in about 50% of perimenopausal women. The main aim in investigating this condition is to exclude focal, premalignant, or malignant endometrial disease. This is achieved via sonographic, hysteroscopic, and pathologic examinations. To evaluate the sonographic, hysteroscopic, and pathologic findings in women with AUB in a new one stop clinic. Prospective, observational study of 240 premenopausal and 55 postmenopausal consecutive patients with abnormal uterine bleeding. All patients 35 years or more with AUB not related to pregnancy were included. Exclusion criteria included active pelvic infection, severe cardiopulmonary co morbidity, cervical cancer, and initiation of contraception within the last 3 months. All the patients had vaginal sonographic examination, office hysteroscopy, and endometrial biopsy on one stop bases. Diagnostic indices of the different methods. Endometrial biopsy was the gold standard for diagnosing hyperplasia or cancer and combined hysteroscopy and biopsy 'was the gold standard for focal lesion and global endometrial disease. For focal lesion vaginal ultrasound had 42% sensitivity, 87% specificity, 3.2 positive predictive value, and 0.67% negative predictive value. Office hysteroscopy had corresponding figures of 91%, 100%, 91, and 0.09 respectively. Endometrial biopsy had corresponding figures of 17%, 100%, 17, and 0.83 respectively. Office hysteroscopy is the gold standard for diagnosing endometrial focal lesions and combined VUS and EB failed to detect more than 50% of them. This makes that 14% of patients wrongly diagnosed of being free of endometrial focal lesion. So, OH should be included in the initial evaluation of patients with AUB