USE OF HYSTEROSCOPY IN ADDITION FOR LAPAROSCOPY FOR EVALUATING CHRONIC PELVIC PAIN

This study assessed whether hysteroscopy can provide information conce rning the cause of chronic pelvic pain. We prospectively evaluated the findings in 547 consecutive patients who had laparoscopy to evaluate chronic pelvic pain at a large, referral-based clinic and outpatient s uite of a suburban hospital. Forty-eight had previous hysterectomies. The remaining 499 had hysteroscopy during the same surgery and met the following qualifications: chronic pelvic pain, dysmenorrhea, dyspareu nia, dysuria, back pain, pelvic pressure or dyschezia for a duration g reater than six months and previous failed medical therapy. When endom etriosis was the primary diagnosis at laparoscopy, hysteroscopy reveal ed abnormalities in 62 (32.5%) of 191 patients. At hysteroscopy, 46 of 105 patients (43.8%) with single or multiple leiomyomas of significan t sizes diagnosed laparoscopically were noted to have pathology within the uterine cavity. Ten of 11 patients (90.9%) found to have ovarian cysts underwent hysteroscopy. Four (40%) had uterine abnormalities; th e most common was cervical stenosis. Pelvic adhesions were found in 11 8 patients (21.6%). Eight-nine underwent hysteroscopy, and 24 (27%) ha d intrauterine abnormalities. Ninety-six patients (17.5%) who underwen t laparoscopic evaluation had endometriosis and pelvic adhesions. Nine ty-three of these underwent hysteroscopy, and abnormalities were noted in 26 (28.0%). In eight women (1.5%) no abnormality was found at lapa roscopy. Two underwent hysteroscopy, and no abnormality was noted in e ither woman. Hysteroscopy provides useful, adjunctive information and may improve the diagnosis and treatment of chronic pelvic pain.