Hysteroscopy of the uterine polyp

Endoscopic studies have recently become increasingly popular. And this is not surprising, because they have a great advantage over other diagnostic methods. The endoscope inserted into the cavity of the organs allows one to evaluate their state in a three-dimensional picture on the screen of the monitor, to reveal various neoplasms and, if necessary, even to remove them immediately in the course of diagnosis. Endoscopic diagnostics is used to study ENT organs, gastrointestinal tract, internal genital organs. In gynecology, hysteroscopy of the polyp uterus has become very popular , in the process of which it is possible to detect such a neoplasm in a woman's body, and to successfully remove it, or at least take material for histological examination to exclude or confirm a malignant process.

Etiology and clinical picture of uterine polyposis

Polyps, wherever they are formed, are pathological formations from the body's own tissues. In the uterus, the material for such neoplasms is actively dividing the cells of the mucosa and the muscular layer of the uterus. In normal growth and reproduction of cells of the uterus is under the control of the endocrine and immune systems, so glitches in the work of the glands responsible for the hormonal balance, as well as a decrease in immunity can be considered a risk factor for the onset of pathological changes in the cells of the uterine mucosa.

Speaking frankly, scientists can not really name the reasons that lead to the formation of polyps in the uterus. In addition to hormonal imbalance and decreased immunity, they suspect involvement in the formation of benign formations inflammatory processes in the gynecological area and mechanical damage, which are usually associated with sexual abuse or the use of additional funds for pleasure. But we can not exclude the situation with tissue breaks during childbirth, as well as the consequences of surgical intervention, for example, with abortion and diagnostic scraping.

The uterus of a woman is so called, because it is the main organ of the female reproductive system, in which a new life is ripening for nine months. This pear-shaped organ, located between the bladder and the large intestine, has a complex structure. It distinguishes the body with the bottom at the place of attachment of fallopian tubes, neck and isthmus (centimeter area between the body of the uterus and its neck). Inside the cervix lies a narrow (only 2-3 mm) cervical canal, covered with a glandular tissue that opens into the vaginal cavity.

The walls of the uterus are considered three-layered. The outer layer or perimetry, protecting the uterus from the outside, consists of a connective tissue and can not be seen with the aid of a hysteroscope. Its violation is associated with perforation of the organ. The inner wall of the uterine wall (myometrium) is an elastic muscle tissue, which also consists of 3 layers: superficial, vascular and internal.

And finally, the inner layer of the uterine wall is the endometrium. This is a two-layered mucous membrane of the organ, the basal layer of which (adjacent to the myometrium) remains unchanged, and the functional glandular is constantly renewed. As a result of such updates, the thickness of the endometrium varies depending on the phase of the menstrual cycle. Up to monthly there is a gradual growth of mucous tissues, after which they exfoliate and come out in the form of menstrual bleeding. Further, the process of regeneration of the inner layer of the endometrium is observed.

All this is physiologically conditioned processes that occur from month to month in the female body. But sometimes in some part of the uterine endometrium, in the cervical canal or at the exit from it, the process of cell proliferation goes out of control and unusual outgrowths of a round or oval shape (sometimes with small bulges) that connect with the mucus by the foot are formed.

Polyps in most cases are found in a single specimen. At the same time, their dimensions may be different, which is why the severity of the symptoms of pathology depends. Small polyps inside the uterus are most often detected accidentally during an ultrasound examination, because they do not manifest themselves in any way.

Larger or multiple small (in this case they speak of polyposis) of the formation in the body of the uterus can not but affect the contractility of the organ and the processes occurring inside it. They interfere with the natural renewal of the endometrium and can cause unpleasant and dangerous symptoms in the form of:

• uterine bleeding outside menstruation,
• the appearance of bloody, brownish or pink discharge, not associated with menstruation,
• intensification and soreness of menstrual bleeding,
• "Causeless" pain in the lumbar region,
• unpleasant pulling feelings and soreness in the lower abdomen,
• discomfort and pain during intercourse.

Depending on the tissues from which the polyp body is formed, neoplasms are divided into: glandular, glandular fibrous and fibrous, which are considered not dangerous in terms of degeneration, but can bring a lot of unpleasant symptoms, up to problems with conception of the child. Such polyps in most cases have a light tint (almost white, beige, light pink), and stand out against the background of bright pink mucosa. Their size, depending on the tissues of which the polyp consists, ranges from 1.5 to 6 cm. They can be located on a pedicle or have a base of smaller diameter than the body of the built-up edge.

The most dangerous are adenomatous polyps, which although small (up to 1.5 cm), are still associated with precancerous state due to the high risk of malignant cell growth and significant penetration into the deeper layers of tissues. These are neoplasms with an uneven surface, having a grayish shade.

Hysteroscopy is a method of simultaneous confirmation of the presence of polyp uterus and its removal. And the polyp (or several neoplasms) can be located, both in the body cavity of the uterus, and in the cervical canal.

One third of women who have had polyps in the cervix have them on the endometrium of the body. Despite the small size (up to 1 cm), cervical polyps carry more severe complications, such as infertility and a problematic pregnancy. Therefore, the treatment of polyps in the uterus, which consists in removing neoplasms by various methods, including hysteroscopy, is especially important for women who dream of their own child. And what is very important, you need to remove polyps before the onset of pregnancy. After conception at any time, such operations are no longer carried out.

[1], [2], [3],

Indications for the procedure

Hysteroscopy of the uterus  is a diagnostic test that a gynecologist assigns to a woman with suspected development of some female pathologies, for example, the formation of a polyp, which although not considered a malignant neoplasm, can significantly impair the patient's quality of life. In addition, some types of such growths are prone to muggling, which means they can lead to the development of uterine cancer.

If there is a suspicion of polyposis of the uterus, the gyroscopy is carried out both as a diagnostic and in the form of a medical procedure that allows you to safely and effectively get rid of pathological growths of the organ tissues.

However, hysteroscopy can be prescribed not only for polyps of the uterus. As a control diagnostic study, it is prescribed after surgical interventions in the gynecological area (for example, diagnostic scraping, operations on the uterus and ovaries, etc.).

As for the diagnostic scraping, which was very popular earlier, but is currently less and less used because of the lack of visual control over the procedure and the large number of possible complications, hysteroscopy helps to identify and correct the shortcomings of this method. Ideally, endometrial scraping should be performed under the control of an endoscope (in our case, a hysteroscope).

GYT is often prescribed to control the effectiveness of hormonal therapy, as well as to identify pathological causes of infertility (stenosis or plugging of the fallopian tubes, anomalies of the development of the uterus and ovaries, etc.).

As a treatment-diagnostic procedure, hysteroscopy of the uterus can be prescribed in the following cases:

• when there is bleeding between menstruation or during menopause, malfunctions of the menstrual cycle
• when suspected of various defects in the development and structure of the organ,
• in case of premature spontaneous abortion,
• in a situation where after birth there are various complications,
• if symptoms indicate the presence of foreign substances in the uterus; to foreign bodies it is possible to carry:
  • means of intrauterine contraception, which tend to fuse with the tissues of the uterus or cause perforation of the walls,
  • small fragments of bone tissue that can damage the integrity of the walls of the uterus,
  • the remaining after birth or abortion fragments of the placenta and amniotic egg,
  • Ligatures that have an irritant effect on the endometrium.
• if there are reasons to suspect a violation of the integrity of the walls of the uterus ( perforation or perforation)

Hysteroscopy of the uterus is a very useful diagnostic procedure for suspected damage to various internal layers of the organ wall (muscle and mucous layer). It is about inflammatory processes, mechanical damage or pathological proliferation of internal tissues of the uterus (dysplasia).

If you look closely, you can understand that polyps on the mucous uterus are one of the options for dysplasia, because they are also formed from their own tissues. Let's try to clarify the situation with what polyps are like, what they are, what are dangerous and what symptoms can cause a doctor suspicion of polyposis of the uterus.

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Preparation

Since hysteroscopy of the polyp uterus implies not only diagnostic but also therapeutic manipulations that are equated to surgical intervention, such treatment can not be carried out without special preparation, especially when it implies the use of anesthesia.

To begin with, the patient should be examined by a gynecologist who makes a preliminary diagnosis. An examination on an armchair with mirrors can not give a complete picture of what is happening inside the cervical canal and the uterus. At first the doctor relies on those changes that are noticeable in the usual gynecological examination on the armchair, anamnestic information and complaints of the patient, if any.

If a doctor suspects the presence of polyps in a poppy and offers a woman such a study as hysteroscopy, which in most cases ends with surgery, he should tell the patient about all the nuances of this procedure: how is hysteroscopy of the polyp uterus, how to prepare for the procedure, what methods of anesthesia, projected results and all sorts of risks. If a woman gives her consent to manipulate the hysteroscope, she is given a comprehensive examination.

Numerous analyzes before hysteroscopy of the uterus, aimed at confirming and removing the polyp (or polyps) include:

• taking a material and conducting a general blood test that will help clarify if the body has an acute inflammatory process, most often associated with the activation of an infectious factor,
• Conducting a test for coagulability ( coagulograms ),
• biochemistry of blood (detailed analysis),
• a blood test for sugar to exclude severe forms of diabetes mellitus, in which any wounds, including postoperative wounds, very badly heal,
• taking the material and conducting a general urine test showing the state of the genitourinary system.

All these tests are needed in order to prevent various complications during and after the operation, but they do not provide enough information to confirm the diagnosis. Instrumental research helps to clarify the diagnosis:

• Ultrasound of the abdominal  and pelvic organs,
• transvaginal ultrasound, reminiscent of an endoscopic examination, but without subsequent surgery (it helps not only to detect polyps, assess their size and structure, but also to identify a possible pregnancy in its early stages, because the operation in this case becomes impossible).

In principle, a clear picture of the polyps in the uterus is seen after the ultrasound diagnosis. But only to find the polyp is not enough. By medication, the problem of polyps in the uterus is not solved. And hormonal therapy, prescribed in severe cases of polyposis, is considered to be an auxiliary method. And the main thing is still the removal of polyps by all possible methods (hysteroscopy, surgical curettage, laser removal, cryodestruction, exposure to electric current or radio waves).

But the hysteroscopy procedure also has certain contraindications, which require a more thorough examination of the patient. Therefore, an additional examination of a woman on a gynecological chair is performed, during which the doctor probes the abdominal region from the outside and inside through the vagina, which makes it possible to identify abnormalities in which the operation is contraindicated. During manipulations on the chair, the gynecologist takes swabs from the vagina microflora, since intracavitary operations are not performed if there is a bacterial or fungal infection in the lesion.

The state of the lungs and respiratory system can be judged by the chest X-ray, and the electrocardiogram (ECG) tells about possible pathologies of the heart . This information is especially important for effective and safe anesthesia.

Some diagnostic measures require additional training. So that smears on the microflora produced real results, doctors do not advise douching within a week before the analysis, use any vaginal pills, including contraceptives, to have sexual intercourse. About any medications you need to tell the doctor, as well as about the intolerance of various types of anesthetics.

A very important point is the definition of the date of the operation. The fact is that the endometrium of the uterus is constantly in the process of changes. Removal of polyps is recommended to be carried out in those days when the thickness of the mucous uterus is minimal and neoplasms can be easily seen both in the area of the body and in the region of the foot. During menstruation, surgical interventions are not done, but the minimum thickness of the endometrium is observed even within 3-5 days after the end of the critical days. It is these days and it is recommended to conduct hysteroscopy. In extreme cases, you will have to keep within the first 10 days of the initial phase of the menstrual cycle.

Preparation for the study on the eve of the procedure consists in refusing food intake for 6-8 hours before the start of the study. This also applies to drinking water and other liquids. In addition, immediately before hysteroscopy, it is necessary to empty the bladder.

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Technique of the removal of polyp uterus

Hysteroscopy can be performed for diagnostic and therapeutic purposes. When polyps in the uterus were found by other types of research, diagnosis with a hysteroscope is no longer critical, it only allows you to more accurately determine the size and location of tumors in order to develop the most effective tactics for their removal.

Hysteroscopy of the uterine polyp as a treatment procedure usually follows immediately after a diagnostic assessment of the condition of the tissues and is an operation on the uterus, which in most cases does not require the removal of the reproductive organ itself. This need arises if adenomatous neoplasms were found in the uterus, and histological examination (biopsy) confirmed the fact of the degeneration of polyp cells into malignant ones. In this case, the removal of the uterus is intended to prevent the spread of tumor metastases throughout the body.

Diagnostic and medical measures are carried out with the aid of a hysteroscope, resembling a probe with a camera at the end and cranes, by means of which a composition is introduced into the cavity to remove the cavity and level its boundaries. It can be liquid or gas.

Hysteroscopes can have different sizes. The device for surgical intervention is larger than the diagnostic one, besides it is equipped with a channel through which additional instruments are delivered to the surgical site, which may be needed during the treatment (catheters, scissors, laser conductors, loop electrode, curette, etc. .). At the end of the probe, in addition to the microcamera, which displays the image on the computer screen, there is a light source.

Hysteroscopy of the endometrial and cervical polyps is performed in the operating gynecological hospital, in specially equipped premises of perinatal centers and gynecological clinics, less often in outpatient settings (office hysteroscopy). The operation to remove the polyp can be attributed to simple interventions, when it comes to polyps of small size. Single polyps of small sizes are completely permissible to be removed on an outpatient basis.

Removal of large growths is considered a complex operation, which requires not only special equipment, but also considerable experience and knowledge of the surgeon. In severe cases, hysteroscopic removal of polyps in the uterus is performed after a course of hormonal therapy.

But no matter what the operation to remove the polyps in the uterus, it is carried out with general or regional anesthesia. Anesthesia with hysteroscopy of the uterus and removal of polyps is selected individually taking into account the characteristics of the patient's organism and the complexity of the operation.

Local anesthesia, which is carried out by licking the uterus with lidocaine or other anesthetics, is shown mainly during diagnostic activities. Treatment of the entrance to the uterus with anesthetics is also carried out in the case of small single polyps or the impossibility of general anesthesia.

But nevertheless in the vast majority of cases preference is given to general anesthesia. In this case, anesthetics are administered intravenously or by means of a laryngeal mask (inhalation anesthesia). Inhalational anesthesia is considered a safer method of anesthesia, because after it there are fewer side effects in the form of dizziness, nausea, myalgia. And the general condition of the patient after such anesthesia is better than after the intravenous infusion of anesthetics.

A more modern method of anesthesia can be considered regional anesthesia. Anesthetic is injected into the spine as close as possible to the spinal cord. As a result, the patient for a time loses the sensitivity of the lower body, while remaining fully conscious.

This method completely eliminates the appearance of unpleasant symptoms, characteristic of general anesthesia, but it is more difficult to perform, and also requires additional time and professionalism of the anesthesiologist.

The use of general and regional anesthesia requires the presence of an anesthesiologist next to the patient, not only during surgery. Within 24 hours after the procedure, the doctor-specialist should monitor the patient's condition and leave his post only with satisfactory indices of vital functions.

The second step after anesthesia can be considered manipulation to expand the uterine cavity. First, using a special tool, the diameter of the cervical canal is increased so that the hysteroscope tube can be freely inserted into the uterine cavity. Then, by means of a tap, the cavity is filled with gas or liquid.

As the gaseous filler usually acts carbon dioxide, which is fed into the uterine cavity by a special device called a hysterophilator. It is necessary to control the speed of gas supply and its pressure inside the uterus, since high indices can cause disruption of cardiac activity, cause a rupture of blood vessels and air entry into the blood, which can even lead to death.

Liquid filler can serve as dextran (rarely used because of the increased risk of anaphylaxis and high cost of the drug), distilled water, solutions of sodium chloride, glucose, glycine, Ringer's solution. In this case, during the operation, the volume and pressure of the liquid to be delivered must be monitored

One of the drawbacks of liquid hysteroscopy is considered to be a large load on the vessels. Plus, there is the danger of infectious complications. Nevertheless, in most cases, as a filling of the uterine cavity, surgical operations select the fluids, while the diagnosis can also be made with the use of carbon dioxide.

It should be understood that the liquid in the uterine cavity is not in a standing state. It washes the organ and must flow out freely. Those. The inflow and outflow of fluid must be constant. The latter is carried out with the help of the Gegar expander, which increases the free space of the cervical canal (this is very convenient when removing large polyps that have to be removed through a narrow space inside the cervical canal). In the case of gas hysteroscopy, the outflow of gas is carried out using a special tap, after which the uterine cavity is washed with an antiseptic solution.

The device is injected into the uterus slowly, very carefully. First, the doctor examines the cavity of the organ and the mucosa of the cervical canal, noting the location of the polyps, their size and structure. If polyps are removed at another time, the doctor simply takes the biopsy material through additional tools that the doctor manages with the hysteroscope. With the planned operation and in the case when immediately after diagnosis there is an opportunity to carry out and excise pathological growths, the material for histological examination is a remote polyp.

Removal of the polyp with hysteroscopy of the uterus can be carried out in various ways. Mechanical removal of tumors involves the use of surgical instruments (forceps and scissors), which are fed to the site of surgery with a hysteroscope.

Hysteroscopy of cervical polyps is facilitated by the fact that such neoplasms are small and located on a thin pedicle. Removal of such polyps can be carried out even under local anesthesia. Usually, first the build-up is rotated several times relative to the leg (unscrewed), after which it falls off and is extracted outward with the help of the instruments of the hysteroscope. The place of attachment of the polyp to the mucosa is additionally scraped through a special loop (curette).

In the presence of special equipment, the excision of the leg of the polyp and the cleaning of its location can be carried out by means of an electric current or a laser.

Removal of the endometrial polyps of the uterus in the case of small sizes of tumors located on a thin stalk can be performed by the same methods as polyps in the cervical canal. If it is a question of large build-ups, then after loosening them, the leg is excised with a resectoscope or plastic scissors (polypectomy).

If the polyps have a non-standard shape (for example, they lack a leg, like those of the parietal polyps), or their location in the mouth of the fallopian tubes complicates the habitual method of performing the operation by unscrewing the build-up, excision of such outgrowths can be performed immediately by a resectoscope. But if there is such an opportunity it is better to resort to safer methods of electrosurgery or to laser removal of the tumor, followed by cauterization of the polyp's location, which is possible in both cases.

In electrosurgery, cauterization of tissues at the site of removal of polyps is called electrocoagulation. The laser simultaneously dissects tissues and seals the blood vessels, which prevents bleeding.

In general, surgery to remove polyps in the uterus with the help of a hysteroscope does not take much time. A single polyp in the cervix is usually removed no more than 15-20 minutes. In more severe cases, the removal of polyps takes a little over half an hour.

Repeated Hysteroscopy

Repeated hysteroscopy of the uterus is the usual procedure after removal of polyps localized in the endometrium of the organ. It is conducted to monitor the results of treatment. But in some cases, repeated hysteroscopy is prescribed after a time after mechanical removal of polyps, because these neoplasms tend to recur.

And although re-formation of polyps in the same place or nearby is not considered a very frequent complication (according to different data from 3 to 10% of cases of removal of polyps in the uterus), this fact can not be ignored. Most often, recurrent polyps resort to laser removal, because it gives more stable results, because the laser is able to penetrate into the deep layers of tissues. Nevertheless, in not all cases the process of polyps formation ceases. Relapses may not be single, which speaks of serious problems in the body that require special treatment, for example, hormone therapy.

In this case, hormonal treatment is first performed, followed by hysteroscopy of the uterine polyp with subsequent cauterization of endometrial tissue. Hormonal therapy is sometimes replaced by diagnostic scraping, which has fewer complications than hormone therapy, yet the uterine mucosa is characterized by rapid tissue repair, which can not be said about the body after hormones.

Contraindications to the procedure

Like any surgical intervention, removal of polyps in the uterus is not prescribed to all patients. Some contraindications can be considered absolute, and then you have to look for other methods to combat polyposis of the uterus. With other limitations, you can cope with an effective treatment of an identified pathology or waiting for the necessary time.

Absolute contraindications to hysteroscopy of the uterine polyp can be considered:

• Pathological changes in the endometrium of the uterus that are not amenable to treatment (the presence of rough inelastic scar tissue due to tissue damage during childbirth or stenosis of the cervix, when access to the organ and the possibility of its expansion are limited).
• Severe pathology of various organs and systems in the stage of decompensation (complicated arterial hypertension, too high glucose levels in the blood, providing severe diabetes mellitus, etc.).
• Oncological pathologies of the uterus. If magpation of polyp cells located in the cervix is detected, its removal by hysteroscopy poses a certain danger, since with the fluid flow, malignant cells can spread not only throughout the body, but also beyond it, for example, into the abdominal cavity.
• Violation of blood clotting, which is associated with a greater risk of bleeding and a large loss of blood during surgical manipulation.

Relative contraindications include:

• Pregnancy. Any manipulation of the cervix is fraught with an increase in her tone and the risk of premature births and miscarriages, not to mention the introduction into the uterus, where at this time the child grows and develops. The possibility of removing polyps in the uterus is discussed with the help of a hysteroscope after the delivery.
• Menses. Despite the fact that during menstrual bleeding the thickness of the endometrium is small, which makes it possible to easily detect and remove polyps, there are certain limitations of the visualization of the operation, so the procedure is prescribed when the intramuscular discharges become scarce or absent altogether (from the 5th to the 10th day of the menstrual cycle).
• Bleeding from the uterus, which was caused by tissue hyperplasia or any other pathology. Again, the reason is the limitation of the visibility of the manipulations carried out and the inability to qualitatively evaluate the result of the operation. In this case, the hysteroscopy of the polyps is carried out after the bleeding has been stopped. In addition, it may be necessary to wash the uterus with sterile solutions so that blood clots do not distort the real picture of events.
• Inflammatory pathologies of gynecological organs in the stage of exacerbation. Most often, these pathologies are associated with a violation of the microflora of the vagina (dysbiosis) and activation of a bacterial, viral or fungal infection. It is clear that surgical intervention will contribute to complicating the situation and the spread of pathogenic microflora throughout the body (generalization of the process). First, an effective treatment of pathology is carried out and only after the infection has been defeated can we start talking about the operation.
• Systemic infections, including ARVI, influenza, angina and other respiratory infections and inflammatory diseases. There's nothing to say. Intervention is possible only after an effective course of treatment of the underlying disease.
• Relapses of various pathologies of organs and systems of the body (exacerbation of peptic ulcer, gastritis, bronchial asthma, etc.) due to the high burden on the body. The operation can be performed after the stage of stable remission.

There is no surgery to remove polyps in the uterus in patients who are in serious condition due to somatic pathologies. First you need to stabilize the patient's condition, and then talk about a possible operation.

Consequences after the procedure

The consequences of any operation are directly related to the level of professionalism of the medical personnel involved in the procedure. For example, an anesthesiologist should not only decide on the safe introduction of anesthesia and effective drugs, but also correctly calculate the dose of medications, which will help to avoid many complications during and after surgery.

Accuracy of the surgeon will help to prevent the development of inflammation after accidental damage to the healthy mucous uterus or perforation of the organ. Preparation and disinfection of instruments by junior medical staff. Antimicrobial measures on the part of the surgeon and his assistants will help to avoid infection of the wounds after removal of the polyps, which significantly hampers the recovery and recovery of the endometrium.

The only consequences of hysteroscopy of the uterine polyp, which can not be ruled out, are small discomfort and unexpressed pain in the abdomen within a few days after the operation. Still, there was interference in the work of the organ and damage to its tissues, so there is nothing surprising or dangerous in such symptoms. If a woman suffers a lot of pain, you can remove it with rectal suppositories with analgesic effect, but usually this is not necessary.

Lean smearing or spotting from the genitals after hysteroscopy of the polyp uterus is also considered a normal phenomenon. This symptom can be observed within 2-3 weeks after the procedure. However, if the discharge increases and is accompanied by appreciable pain, there is every reason to contact the attending physician for advice.

Another suspicious symptom, indicating possible complications, is an increase in body temperature. In principle, with uterine polyposis after surgery, an inflammatory process in the endometrium, not associated with pathogenic microflora, is observed. The body temperature may rise slightly, but again in 2-3 days will recover. If there is a strong increase in body temperature or a low-grade fever lasts for 5 or more days, it indicates that the inflammatory process has been protracted, and most likely it is associated with infection.

In this case, doctors prescribe antibacterial drugs (in injections or pills). In addition, funds can be prescribed to combat intoxication of the body, hormonal therapy. Quite often, hysteroscopy is used in combination with curettage of the uterine cavity.

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Complications after the procedure

Despite the advanced method of hysteroscopy of the polyp uterus without complications, the operation does not always work. Too many factors influence the outcome of the operation and the safety of its conduct. So complications can appear not only in the postoperative period (for example, in the form of inflammations), but also at the time of medical manipulations.

Hysteroscopic removal of polyps in the cervix and her body in the vast majority of cases is performed under general or local anesthesia. Regardless of the type of anesthesia, there is always a risk of allergic reactions, including severe (Quincke's edema, anaphylactic reactions). To avoid such complications, anesthesia tolerance tests must be performed before surgery. An anesthesiologist should clarify the presence of pathologies of the respiratory and cardiovascular system in order to correctly calculate the dose of drugs and the time of their action.

Since the surgery for excising polyps is carried out using fluids for uterine expansion, it is very important to control their volume and pressure, which will help to avoid complications such as increased blood pressure, pulmonary edema, anaphylactic reactions. In patients with diabetes, the use of glucose solution is not recommended.

During the operation, other troubles can occur. For example, perforation of the uterine wall due to carelessness of the surgeon or weakness of the sheath itself. In addition to the uterus, other organs located nearby can also be affected. The consequence of perforation of the uterus wall and damage to the vessels of the myometrium may be uterine bleeding during the procedure.

Now a little about those troubles that can wait for a woman a few minutes, days or weeks after the operation. First, it is an inflammation of the endometrium ( endometritis ) caused by an infectious factor, in which antibiotic therapy is mandatory.

Secondly, bleeding, which may appear after surgery. In connection with this symptom, hemostatic agents are prescribed and the causes of bleeding are identified using the same hysteroscopy. In some cases, bleeding is not so great, but it is accompanied by stenosis of the cervix, which makes it difficult to remove blood outside, and stagnant phenomena inside the organ are fraught with inflammatory processes. A few relax the muscles of the cervix will help conventional antispasmodics.

Thirdly, with uterine polyposis and large polyps, severe damage to the endometrium is noted, which can inflame even in the absence of infections. And inflammation is fraught with the development of adhesive process in the organ. For women during the menopause, this complication will be brought only by a slight discomfort (it may take a little stomach), but patients of childbearing age may face infertility.

Danger is also the removal of a polyp that has malignant cells that were not detected by histological examination. Incomplete removal of the polyp threatens the spread of malignant process deep into or nearby tissue.

And, of course, with any method of removing polyps, there is always a certain probability of their recurrence, which does not mean refusal to fight the disease. Always remember the danger of degeneration of polyp cells.

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Care after the procedure

Depending on the method of surgery on the uterus, the severity of the pathology and the type of operation (urgent or planned), the  postoperative period after removal of the polyp with the help of hysteroscopy of the uterus will proceed in different ways. If the operation was pre-planned, i. E. All the necessary studies were performed, and without any complications the patient could leave the clinic the next day or after the anesthesia had ended. But this does not mean that she can return to the usual life, because non-compliance with certain requirements may entail various kinds of complications.

So, what are the recommendations you can hear after hysteroscopy of the uterine polyp:

• If the doctor deems it necessary, he can prescribe anti-inflammatory and antibacterial therapy, which in no case can not be waived.
• The patient can also be prescribed hormone therapy when it comes to large areas of damage or the presence of adhesions. Such treatment will help the uterine mucosa to recover faster without complicating the adhesion process and relapse of the polyposis.
• Hormonal therapy can be prescribed for hormone imbalance, which resulted in the appearance of a polyp. The treatment regimen can include both normal hormones and hormonal contraceptives. Take them, despite the danger of gaining weight.
• If the operation was performed without preliminary full examination of the patient and the material for histology was not taken in advance, the biopsy will be a remote polyp. The results of the biopsy come after a few days. It is necessary to take them and save them for the future. If the analysis confirms an oncology (a cancer of a uterus), the additional operation which purpose will become removal of a uterus as a matter of urgency will be appointed.
• Now with regard to sexuality. It should be limited for a while. How many it is necessary to abstain from traditional sex (one week or month) will be told by the attending physician. But we must remember that premature initiation of active sexual life is fraught with various complications, including bleeding and infection of the body.
• 2-3 weeks the doctor will advise you to refrain from hot procedures (solarium, bath, sauna, sauna, hot foot baths), so as not to provoke bleeding.
• As for douching, in this case they are not relevant and even dangerous. First, the uterus is capable of purifying itself without our help. Secondly, douching without the need only promotes the washing out of the vagina beneficial microflora and weakening of local immunity. Thirdly, the lack of sterility of used devices and dishes can lead to infection of the body from the outside. The doctor himself will say when this treatment and prophylactic procedure will be necessary.
• Use of vaginal tablets, suppositories and hygienic swabs is also not possible, at least 2 weeks before repeated hysteroscopic examination. By results of a biopsy and an estimation of a status of an endometrium the doctor can cancel some restrictions or appoint or nominate additional procedures.

As for the monthly, their appearance can be expected on the same days as before the operation. However, in some cases there was a slight shift in the menstrual cycle (the menstruation started earlier or later than the prescribed time, but not more than a week), which is not considered a pathology. The norm can be considered unusually abundant discharge, as well as an increase in the duration of menstruation in the recovery period. Later everything will be adjusted without outside interference.

Another thing is if the plentiful monthly starts to resemble bleeding. In this problem it is better to hurry to the doctor, because it is very difficult to independently consider the boundary between the norm and pathology.

Now the question that interests many young women: when can pregnancy occur after hysteroscopy of the uterus? Frankly speaking, everything is purely individual. It is clear that in the first month, when sex is limited, pregnancy can not go. But in the following months, such an outcome is not excluded, because the ability to conceive hysteroscopy of the uterine polyp does not affect in any way. Moreover, many women could become pregnant in the first six months, and all thanks to hysteroscopy.

But here there is one nuance. Early pregnancy can end very badly, because the mucous uterus takes time to complete recovery, and this is at least three months.

How to prevent unwanted pregnancy? With the help of hormonal contraception, which should appoint a doctor for a period of 3 or 4 months. To be afraid of it it is not necessary, after all the cancellation of such medicines only increases the chances of conceiving a child due to the rebound effect. So getting rid of polyps plus increasing the chances of pregnancy due to hormonal therapy becomes a real opportunity for a woman to become a mother in the near future, which she could only dream of before the operation.

[12], [13]

Reviews about the procedure

Despite possible complications and risks, most of the reviews on the procedure of hysteroscopy of polyps in the uterus are set to positive. Some women note that after reading negative reviews about the operation, they were more afraid than they should. The operation in the vast majority of cases was successful, painless and without dangerous consequences.

Many people initially scared the need for general anesthesia. Not even anesthesia itself and the associated risk of allergic reactions and overdose, but the process of departing from it, accompanied by dizziness, nausea, vomiting, headaches and muscle pains, an ache in the lower back. In fact, the operation did not last long, so there were practically no complications from anesthesia, except for particularly sensitive patients.

Even those to whom polyps were removed under local anesthesia did not complain of pain and discomfort during the operation. Postoperative symptoms in the form of scant excretions from the genitals, minor pulling pains and discomfort in the lower abdomen, a short-term temperature increase little worried women and went without consequences.

Control hysteroscopic examination showed few complications. Yes, and recurrence of polyps, according to reviews, can be considered single complications, not related to the procedure itself. After all, the subsequent course of treatment with hormonal drugs and drugs that increase the general and local immunity, led to the stabilization of the condition and the polyps after removal no longer appeared.

Many women are simply happy with the opportunity presented to them to become a mother. In most cases, the pregnancy was diagnosed after 5 or more months. But some lucky enough to get a positive pregnancy test result even before this time (after 3-4 months, as soon as the endometrium has fully recovered).

But before the operation, many women did not even expect such a miracle, considering themselves incapable of reproducing a new life. And the fact that the operation was uncomplicated, went without complications and was relatively inexpensive, only increases the joy of those who are still talking with their tummy, and those who already saw the heir with their own eyes and was able to attach it to their breasts.

It is clear that without a negative feedback, no procedure, and even more, a full-fledged surgical intervention can not do. But such reviews speak to a greater extent not about the weak effectiveness of treatment, but the lack of professionalism and inaccuracy of specific doctors and anaesthesiologists working in separate clinics. It is with them that women associate complications arising during or after surgery. No one writes about non-compliance with post-operative care requirements, and this could also have an impact on the outcome of treatment.

Hysteroscopy of the uterine polyp is a procedure that combines 2 types of manipulation: diagnostic and therapeutic, which is very convenient for urgent operations. When observing the protocol of the research and the procedure of the procedure, the removal of polyps is considered quite safe and does not bring any special discomfort, especially since the intervention on the organs is not blind. The doctor can monitor any movement of the instruments and the situations that arise during the procedure, which means that a poor-quality removal of polyps is virtually impossible, especially if the laser is turned on. It can be confidently said that this method has a future and development prospects, while getting rid of polyps by this method has become an ordinary medical procedure today.