Uterine polyps are local benign neoplasms growing from the endometrial mucosa. They look like tubercles located on a wide base, or round or oval formations on a thin stalk. There may be one or several of them in the uterine cavity; in the latter case they speak of polyposis. The size of polyps varies from a few millimeters to 8 or more centimeters.
- Signs of a polyp in the uterine cavity and their diagnosis
- When is polyp removal necessary?
- Methods for removing endometrial polyps
- What is hysteroscopy of the uterus for polyps
- Types of hysteroscopy
- Indications for hysteroscopy
- Features of the event
- Preparation
- Basic recovery recommendations
- Complications after polyp removal
- Contraindications
Signs of a polyp in the uterine cavity and their diagnosis
Often uterine polyps do not manifest themselves, but some patients have the following symptoms:
- Menorrhagia - heavy menstruation.
- Bleeding outside of menstruation.
- Spotting after sexual intercourse.
- Bleeding during menopause.
- Infertility and miscarriages.
- With large polyps, women may notice copious whitish discharge, discomfort and pain during intercourse, as well as periodic cramping pain in the lower abdomen.
To make a diagnosis, it is necessary to undergo a comprehensive examination, which includes the following procedures:
- Gynecological examination - particularly large polyps can be palpated during manual examination; cervical polyps can be detected during examination in the speculum.
- Ultrasound of the pelvis - in the uterus, growth of the endometrium with a local increase in its mucous layer is detected. The structure of this neoplasm is homogeneous.
- Separate diagnostic curettage followed by histological examination of the obtained material.
- Hysteroscopy - allows you to examine the endometrium from the inside, visualize single or multiple polyps and determine their location. The procedure is also therapeutic in nature, since it allows for the simultaneous removal of all identified tumors and their subsequent histological examination. This is the most effective method for diagnosing a polyp in the uterus.
Hysteroresectoscopy at the ABIA clinic, St. Petersburg:
Our clinic performs all examinations necessary for an accurate diagnosis: video colposcopy, ultrasound and ultrasonic hysterosalpingoscopy, laboratory tests. When solving various gynecological problems, the clinic’s gynecologists use modern diagnostic and treatment equipment and equipment from leading manufacturers of medical equipment.
When polyps and myomatous nodes are identified, our gynecologists will select the optimal and effective therapy, which may include hormonal therapy or surgical treatment. If necessary and if indicated, sick leaves are issued for the period of treatment.
When is polyp removal necessary?
The choice of patient management tactics and determination of the need to remove the polyp is determined individually. If a woman is of reproductive age and has no symptoms of a polyp, conservative management tactics can be chosen. In this case, the patient should undergo regular monitoring.
In all other cases, removal of polyps is indicated:
- Presence of symptoms of the disease.
- Pre- and postmenopausal periods, even if there are no symptoms.
Postoperative period
The postoperative period is individual. It must be borne in mind that the operation may vary in scope and goals.
However, the main general points are relevant for everyone.
For some time after the manipulation, the woman may experience discomfort and slight pain. To relieve it, they take painkillers.
If the endometrium is damaged, estrogen preparations are taken. They contribute to its restoration.
In any case, it is necessary to follow the doctor’s recommendations regarding the duration of the course of taking medications and their dosage.
Methods for removing endometrial polyps
Surgical removal of endometrial polyps is called polypectomy. It involves curettage of the endometrium followed by histological examination of the resulting material. Curettage can be performed blindly, under visual control using ultrasound or hysteroscopy. The latter method is the most preferable because it allows you to control the completeness of polyp removal and avoid the development of surgical complications (uterine perforation, excessive curettage with damage to the basal layer of the endometrium, etc.).
If treatment does not help, and the patient is in menopause, she may be offered surgery to remove the uterus in the following cases:
- Persistent relapses of multiple polyposis.
- High risk of malignancy of polyps.
- The presence of severe symptoms that significantly worsen a woman’s quality of life.
Advantages and disadvantages of GDS
Hysteroresectoscopy has a number of advantages over other endoscopic and open surgical interventions. This is due, in part, to the use of high-tech equipment that is used to perform it. Thus, video monitoring with high resolution quality, which accompanies the entire operation process, allows the surgeon to clearly see the size, shape and localization of pathological changes. Electrosurgical or laser instruments used during the procedure cause less tissue trauma compared to a conventional scalpel. The positive aspects also include the short duration of hysteroresectoscopy. Usually the operation lasts no more than an hour.
The disadvantages of the procedure include its limited capabilities. Some diseases cannot be eliminated using this method, so the surgeon will be forced to use alternative techniques. In addition, since hysteroresectoscopy is performed using high-tech equipment, it requires an experienced surgeon who is familiar with the operation of laser or electrosurgical instruments and endoscopic techniques to successfully perform it.
Types of hysteroscopy
There are diagnostic or surgical hysteroscopy. Diagnostic involves only examining the endometrium and endocervix for the presence of pathologies. The study is performed on an outpatient basis and does not require serious anesthesia (local anesthesia and sedation are sufficient) and a long recovery period. Therefore, it was called office hysteroscopy. Based on its results, the doctor draws up a plan for further management of the patient.
Surgical hysteroscopy allows for diagnosis and immediate treatment of identified pathologies. It is performed in an operating room and requires full anesthesia. The procedure is prescribed either when the diagnosis has already been established, or when the likelihood of detecting a pathology is extremely high.
We specialize in surgical hysteroscopy because we believe that invasive diagnostic techniques can be successfully replaced by safer tests. This will help make the correct diagnosis without the risk of surgical complications.
Features of the event
Therapeutic hysteroscopy is carried out on a hospital basis, including a one-day hospital in an operating room. An hour before the start of the intervention, premedication is performed - a sedative injection is given. After being delivered to the operating room, the patient is placed in a gynecological chair and given intravenous anesthesia. Next, proceed to the operation:
- Dilation of the cervical canal.
- A certain amount of sterile liquid is injected into the uterine cavity to “straighten” its walls.
- A hysteroscope is inserted through the cervical canal. As it is introduced, a step-by-step examination of all parts of the uterus is performed. First, the cervical canal is examined, then the uterine cavity and its angles.
- If necessary, surgical procedures are performed - taking a biopsy, removing polyps, dissecting synechiae, etc.
- At the end of the operation, fluid is removed from the uterine cavity.
Restrictions
Despite the effectiveness of the technique, there are also cases of limitations to its implementation:
- Pregnancy;
- Narrowing of the organ cervical canal;
- Diseases of the genital organs of an acute and chronic nature;
- Infections;
- Oncology in the last stages, some others.
In cases where a patient is diagnosed with kidney disease, heart disease, problems with blood clotting, or a number of other problems, the technique is prescribed with extreme caution, and the patient must prepare for it especially carefully according to an individual program.
Preparation
Preparation for hysteroscopy is similar to other surgical interventions in gynecology. First, an examination and, if necessary, certain treatment are carried out. The following tests are performed:
- General blood and urine analysis.
- Coagulogram.
- Blood type and Rh factor.
- Vaginal smear for flora.
- ECG.
- Test for STIs.
- Tests for HIV and parenteral hepatitis.
Hysteroscopy is planned at the beginning of the menstrual cycle (before day 10), since endometrial tumors are clearly visible during this period.
Immediately before surgery, it is recommended to follow these rules:
- Two days before hysteroscopy, avoid sexual contact.
- On the day of the operation, take a shower and then put on underwear made from natural fabrics.
- Remove jewelry and contact lenses.
- Immediately before entering the operating room, empty your bladder.
- Do not eat for at least 6 hours before anesthesia.
Basic recovery recommendations
- If an antibiotic is prescribed, take it for as long as your doctor recommends.
- To relieve pain after hysteroscopy, you can take antispasmodics or analgesics.
- Avoid sexual intercourse and heavy physical activity until the bleeding stops, but not less than 10 days.
- Perform hygiene measures in the shower. Taking a bath is not recommended.
- Toilet your genitals as needed, but at least 2 times a day.
- During the recovery period, it is not recommended to use tampons and menstrual cups; discharge should come out of the vagina freely.
Most women generally feel satisfactory after therapeutic hysteroscopy. The main complaints are nagging pain in the lower abdomen and weakness. The full recovery period takes about two weeks. However, if complications develop - fever, heavy bleeding, foul-smelling discharge, you should immediately consult a doctor.
Karl Storz is a leading manufacturer of medical equipment:
Equipment for minimally invasive surgery by Karl Storz (Germany) is used today all over the world. It has proven itself to be extremely reliable; the most modern technologies are used in its development. Operating endoscopes from the German company Karl Storz have been associated with tradition, high technology and quality for more than 70 years.
Hysteroresectoscopy with the help of reliable equipment from the German company Karl Storz allows you to save a woman from many unpleasant diseases in the most careful way.
Complications after polyp removal
As after any gynecological operation, the following complications may develop after hysteroscopy:
- Damage to the wall or cervix - treatment may require additional surgery to close the perforation.
- Damage to the cervix - may require stitches.
- Bleeding.
- Infectious complications.
It should be noted that complications after hysteroscopy are much less common than after other gynecological interventions performed “blindly”. But the possibility of their development cannot be completely excluded.
Contraindications
- The presence of decompensated chronic diseases that may interfere with anesthesia, for example, cardiovascular pathology.
- Presence of STIs and vulvovaginitis.
- The presence of diseases accompanied by a tendency to bleeding.
Euroonco specialists closely monitor the condition of patients not only in the postoperative period, but also at the initial stage. In this regard, we perform the procedure only after we are convinced that the patient has no contraindications. You can make an appointment for a consultation about uterine polyps by calling:
Book a consultation 24 hours a day
+7+7+78
Doctor's comment
Have you been scheduled for hysteroresectoscopy and are you experiencing fear that is quite natural for a person? First of all, you should know that this procedure is performed under anesthesia; there can be no talk of any unpleasant sensations. In addition, after treatment there are no marks left on the skin, since the intervention is performed without a single incision. Hospitalization lasts only a couple of days, after which you go home. Full recovery takes about a month, after which you can return to your normal lifestyle. By the way, many of our patients of reproductive age who sought help for infertility in a timely manner were able to give birth safely after treatment. For older women, hysteroresectoscopy allows treatment with preservation of the organ. Do you still have doubts? Make an appointment and together we will draw up a plan for further action.
Endoscopist Natiya Vitalievna Chekhoeva
