Diagnostic hysteroscopy for the investigation of abnormal uterine bleedingin premenopausal patients

The aim of this observational clinical study was to evaluate the feasibilit y and diagnostic accurracy of outpatient diagnostic hysteroscopy in premeno pausal patients suffering from abnormal uterine bleeding. Between September 1996 and September 1999, 819 patients were referred to our outpatient hyst eroscopy clinic, 317 of which were premenopausal, and presenting with menst rual symptoms. All hysteroscopies. were performed using a standard 30 degre es 5-mm hysteroscope, and the uterine cavity was generally distended with n ormal saline. Hysteroscopy was completed successfully in 305 cases (96.2%), but since the routine use of lidocaine spray in 1998 this figure increased up to 98.9%. Intrauterine pathology was diagnosed in almost 34% of patient s, the most frequent being submucous myomas (14%) and endometrial polyps (1 4%); there was no case of endometrial cancer in this subset of patients. Mo reover, there was an age-related distribution of intrauterine pathology, wi th the highest incidence in patients aged 41-50 years. Diagnostic hysterosc opy is a simple and safe technique, well accepted by the vast majority of p atients; due to its excellent diagnostic accurracy, and its high success ra te as an outpatient procedure, we wonder why inpatient D&C under general an esthesia is still regarded a diagnostic or even therapeutic option for pati ents with abnormal uterine bleeding. Abnormal uterine bleeding (AUB) represents one of the single most common re asons for gynecological referrals [1]. Traditionally, dilatation and curett age (D&C) is performed for both diagnostic and therapeutic reasons. Despite the fact that already three decades ago first papers reported on the diagn ostic failure of blind D&C in up to 25% of cases, it is still the most wide spread procedure in our speciality [2, 3]. Due to its higher diagnostic accuracy and suitability for outpatient invest igation, hysteroscopy is now replacing blind D&C. For instance, between 199 4 and 1998, the annual number of D&Cs performed in England has decreased fr om 168,404 to 106,146 with a 6-fold increase in the number of diagnostic hy steroscopies [4]. Similarly, there has been a dramatic decline in D&C rates in the United States over the past decade]5]. From a forensic point of vie w, high rates of false-negative findings with D&C are becoming increasingly unacceptable. The new generation of hysteroscopes in combination with an atraumatic cervi cal passage allow for success rates of almost 98% in an outpatient setting [6]. Consequently, hysteroscopy is now generally acknowledged as the 'gold standard' investigation of the uterine cavity. This observational study reports on the feasibility and results of outpatie nt hysteroscopy in all premenopausal women referred to our outpatient hyste roscopy clinic for menstrual symptoms within the last 3 years.