2500 OUTPATIENT DIAGNOSTIC HYSTEROSCOPIES

Objective: To evaluate the feasibility and acceptability of outpatient diagnostic hysteroscopy. Methods: The outcome of 2500 consecutive out patient hysteroscopies was analyzed. Cervical dilation was performed w hen necessary and local anesthesia was not administered routinely. End ometrial biopsy and minor hysteroscopic procedures were carried out wh en indicated. Findings and outcome were compared according to patient characteristics. Results: The most common indication for hysteroscopy was abnormal uterine bleeding (87%). Hysteroscopy was performed succes sfully in 96.4%, and a complete view of the uterine cavity was obtaine d in 88.9%. Local anesthesia was used in 29.8% and was associated with the need for cervical dilation; both local anesthetic use and cervica l dilation were significantly more often required in nulligravid, null iparous, and postmenopausal women. Intrauterine pathology was diagnose d in 48%, the highest incidence being found in those 50-60 years old ( 53.7%). The presence of fibroids was the most common abnormality (24.3 %) but was seen in only 6.8% of women older than 60 years. Conversely, the incidence of endometrial polyps increased with age, up to 20.5% i n women over 60 years. Endometrial biopsy was performed in 68% and pro duced adequate tissue for histologic examination in 83.7%. Endometrial hyperplasia or carcinoma was detected in 1%. One hundred sixteen wome n (4.6%) underwent a minor hysteroscopic procedure.Conclusion: Outpati ent diagnostic hysteroscopy is both feasible and acceptable in the ove rwhelming majority of cases, with a high detection rate for intrauteri ne pathology. This procedure may become as routine in the 21st century as D&C has been in the 20th.