Hysteroscopic versus histopathological agreement in the diagnosis of chronic endometritis: results from a retrospective observational study.

PURPOSE: To evaluate the agreement rate between hysteroscopy and pathological examination in case of chronic endometritis. METHODS: A retrospective observational study carried out at Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, Spain, from January 2021 to June 2022 was performed by obtaining data from 115 medical records of women who underwent office hysteroscopies that was compared with the findings of final histological examination of endometrial biopsy. Cohen's kappa index was used to evaluate this agreement rate. In addition, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were obtained. RESULTS: The agreement between hysteroscopic findings and histological examination showed a modest result with a Cohen's kappa index of 34%. In addition, we obtained a specificity of 70% and a sensitivity of 64%. The positive and negative predictive value were 60.8% and 73.4%, respectively. An excellent agreement rate (100%) between histological and hysteroscopic results was observed in presence of hyperemia and micropolyps. CONCLUSION: Although the sample size is not as large as that of other studies published so far, the first glance of our experience is that hysteroscopic signs are not yet sufficient to make an accurate diagnosis of chronic endometritis, thus requiring a histopathological confirmation to make it.

Complications of Pessaries Amenable to Surgical Correction: Two Case Reports and a Systematic Review of the Literature.

BACKGROUND: Forty percent of women will experience prolapse in their lifetime. Vaginal pessaries are considered the first line of treatment in selected patients. Major complications of vaginal pessaries rarely occur. METHODS: PubMed and Embase were searched from 1961 to 2022 for major complications of vaginal pessaries using Medical Subject Headings (MeSH) and free-text terms. The keywords were pessary or pessaries and: vaginal discharge, incontinence, entrapment, urinary infections, fistula, complications, and vaginal infection. The exclusion criteria were other languages than English, pregnancy, complications without a prior history of pessary placement, pessaries unregistered for clinical practice (herbal pessaries), or male patients. The extracted data included symptoms, findings upon examination, infection, type of complication, extragenital symptoms, and treatment. RESULTS: We identified 1874 abstracts and full text articles; 54 were assessed for eligibility and 49 met the inclusion criteria. These 49 studies included data from 66 patients with pessary complications amenable to surgical correction. Clavien-Dindo classification was used to grade the complications. Most patients presented with vaginal symptoms such as bleeding, discharge, or ulceration. The most frequent complications were pessary incarceration and fistulas. Surgical treatment included removal of the pessary under local or general anesthesia, fistula repair, hysterectomy and vaginal repair, and the management of bleeding. CONCLUSIONS: Pessaries are a reasonable and durable treatment for pelvic organ prolapse. Complications are rare. Routine follow-ups are necessary. The ideal patient candidate must be able to remove and reintroduce their pessary on a regular basis; if not, this must be performed by a healthcare worker at regular intervals.

Risk factors for cervical stenosis after conization / Factores de riesgo para estenosis cervical tras conización

Objective: To assess the incidence of cervical stenosis in women treated with conization and to identify risk factors for its occurrence. To determine the rate of medical and surgical complications due to conization. Methods: We performed a retrospective study of 113 women who underwent conization over a 1-year period at Hospital Universitario Puerta de Hierro Majadahonda in order to evaluate the frequency of and factors involved in cervical stenosis. Cervical stenosis was defined as a narrowing that prevented the insertion of a 3-mm endocervical curette through the endocervical canal. Univariate analysis was used to identify predictors of cervical stenosis. Statistical significance was set at 0.05. Results: A total of 14 patients were diagnosed with cervical stenosis (12.4%). The risk of cervical stenosis was greater when conization was performed in menopausal women (p = 0.047), when it was performed with laser excision (p = 0.046), when the height of the cone was ≥ 20 mm (p = 0.013), and when the ectocervical margins of the cone were affected by dysplasia after conization (p = 0.038). The variables age, previous treatment of cervical intraepithelial neoplasia (CIN), smoking, parity, human papillomavirus, histologic classification of CIN, postoperative bleeding, and second conization were not associated with an increased risk of cervical stenosis. Conclusions: The main risk factors for cervical stenosis were menopausal status, laser excision, cone height ≥ 20 mm, and involvement of exocervical surgical margins

Objetivo: Evaluar la incidencia de estenosis cervical en mujeres tratadas mediante conización e identificar factores de riesgo en su desarrollo. Determinar la tasa de complicaciones médico-quirúrgicas derivadas de la conización. Material y métodos: Estudio retrospectivo en el que se revisó una cohorte de 113 pacientes a las que se había realizado una conización a lo largo del año anterior en el Hospital Universitario Puerta de Hierro Majadahonda para evaluar la frecuencia y factores implicados en la estenosis cervical. La estenosis cervical se definió como el estrechamiento cervical que impide el paso de una microlegra endocervical de 3 mm de diámetro a través del canal endocervical. Se utilizó un análisis univariante para identificar factores predictores de estenosis. El nivel de significación se fijó en 0,05. Resultados: Se diagnosticaron 14 casos de estenosis cervical (12.4%). El riesgo de estenosis cervical fue mayor cuando la conización se realizó en mujeres menopaúsicas (P = 0,047), cuando se realizó conización con láser (P = 0,046), cuando la altura del cono fue ≥ 20 mm (P = 0,013) y cuando los márgenes exocervicales quedaron afectos tras las conización (P=0.038). Las variables edad, tratamiento previo de neoplasia intraepitelial cervical (CIN), tabaquismo, paridad, virus del papiloma humano (VPH), clasificación histológica de CIN, sangrado postoperatorio y reconización no demostraron aumentar el riesgo de estenosis cervical. Conclusiones: Las variables estado menopáusico, láser, altura del cono ≥ 20 mm y la afectación del margen exocervical fueron los principales factores de riesgo para la estenosis cervical

Prospective Study of Concordance Between Hysterosalpingo-Contrast Sonography and Hysteroscopy for Evaluation of the Uterine Cavity in Patients Undergoing Infertility Studies.

OBJECTIVES: The purpose of the study was to assess the accuracy of hysterosalpingo-contrast sonography (HyCoSy) for evaluation of the uterine cavity. METHODS: Hysterosalpingo-contrast sonography was compared with hysteroscopy for assessment of the uterine cavity. This work was a descriptive prospective study to assess the concordance between pathologic intrauterine findings using the Cohen κ coefficient. Ninety infertile patients from Puerta de Hierro University Hospital were included in the study. They underwent HyCoSy between June 2016 and April 2017. Fifteen of them had pathologic findings in the uterine cavity during HyCoSy and therefore underwent hysteroscopy. Clinical and sonographic findings were compared in those 15 patients by to evaluate the agreement between both techniques. RESULTS: In this study, intrauterine sonographic findings on HyCoSy and hysteroscopic features of the uterine cavity reached 100% concordance, with a κ coefficient of 1.000 and a 100% agreement rate. CONCLUSIONS: Hysterosalpingo-contrast sonography permits a very accurate evaluation of the uterine cavity, which could be of interest for infertile patients who might be examined for tubal patency.