Prospective study of one-stop diagnostic and see-and-treat outpatient hysteroscopy service at Royal Derby Hospital

Abstract

Introduction Abnormal uterine bleeding is the most common problem that a woman is referred with to a gynaecology clinic. This study evaluates the important role of a one-stop diagnostic, see-and-treat outpatient hysteroscopy service set up in an ambulatory gynaecology unit at Royal Derby Hospital. Methods This is a prospective study of 762 consecutive patients attending ambulatory hysteroscopy clinics. Ambulatory clinic included outpatient hysteroscopy (OPH) clinic, one-stop postmenopausal bleeding clinic and polyp treatment clinic. Results 323/762 (42.3%) patients were referred with postmenopausal bleeding (to one-stop PMB clinic); 148 (19.4%) with ultrasound diagnosis of endometrial polyp (to polyp treatment clinic); 262 (34%) with other menstrual disorders and other indications to other OPH clinics. Outpatient hysteroscopywas performedsuccessfully in 694 cases (success rate of 91%). In further 39 cases, OPH was attempted but abandoned due to cervical stenosis (n = 17), poor views (n = 10), severe vasovagal attack (n = 2) or patient discomfort (n = 10). OPH was performed using vaginoscopic approach in 60% cases. Among those with recorded BMI, 60 women attending OPH clinics had BMI over 40. 223 endometrial polyps and 37 cervical polyps were removed successfully in one-stop setting. Endometrial polyps were treated using either bipolar electrosurgical versapoint electrode (58%), mechanical hysteroscopic devices such as polyp snare or grasping forceps under direct vision (15.5%) or more recently miniature hysteroscopictruclearmorcellator (26.5%) enabling diagnosis and treatment of this common lesion in the same setting. Hysteroscopic retrieval of IUCD with lost threads was done in 100% cases (n = 22). Local anaesthetic was only required in 12% cases. In a patient satisfaction survey conducted in a random sample of 100 women, 94% said they were very satisfied or fairly satisfied with their OPH procedure and 89% reported pain scores of <2.9 on a visual analog scale (VAS) of 1-5. 59.7% (n = 455) seen in this one-stop clinic were reassured and discharged from the clinic with subsequent written notification of histology result; 31% (n = 234) had follow-up arranged for histology review either in oncology clinic if anticipated abnormal result or in general gynaecology clinic for any other reason to follow-up; 9.3% (n = 71) were added to waiting list for general anaesthetic procedure. Conclusion OPH is a safe, minimally invasive surgical procedure not only for diagnosis in women with abnormal uterine bleeding, but is also a feasible, cost-effective and patient-friendly way of treating the causes of abnormal bleeding in majority of cases in the same sitting.