A PROSPECTIVE-STUDY OF TRANSVAGINAL HYDROSONOGRAPHY IN THE EVALUATIONOF ABNORMAL UTERINE BLEEDING

OBJECTIVE: The purpose of this study was to determine whether the intr auterine instillation of saline solution during transvaginal ultrasono graphic imaging (hydrosonography) improves the diagnostic accuracy in detecting intrauterine abnormalities determined by direct visualizatio n of the intrauterine cavity with either hysteroscopy or after hystere ctomy. STUDY DESIGN: This study was a prospective, blinded study of 39 women referred with the diagnosis of abnormal uterine bleeding alter failing medical management. A routine vaginal probe ultrasonographic e xamination was followed by a blinded transvaginal hydrosonography in p atients proceeding to either hysteroscopy or hysterectomy. RESULTS: Tw elve of the 39 patients had masses that impinged on the intrauterine c avity al hysteroscopy or hysterectomy. In 4 of the 12 patients with co nfirmed masses, an intrauterine lesion was detected by hydrosonography that was not seen on routine vaginal probe ultrasonography. In no cas e was an intrauterine mass detected by the hysteroscopy or after hyste rectomy when hydrosonography indicated a normal intrauterine cavity. I n 4 cases hydrosonography suggested that masses were present that were not confirmed at direct visualization. Although hydrosonography alway s recognized when intracavitary pathologic conditions existed in a pat ient, hydrosonography sometimes underestimated the number of intracavi tary lesions present. CONCLUSIONS: Hydrosonography is a simple, minima lly invasive, and effective tool to use in the evaluation of patients with abnormal uterine bleeding who have not responded to medical treat ment. In no case did hydrosonography fail to indicate when pathologic conditions existed in a given patient, and a normal hydrosonography al ways indicated a normal intrauterine cavity at hysteroscopy or after h ysterectomy. For these reasons hydrosonography is a sensitive tool to triage women with abnormal uterine bleeding to operative or conservati ve management.