Ambulatory Hysteroscopy: diagnosis and treatment

Evidence Based Comparison Between...

...the different diagnostic techniques for the diagnosis of the cervix and the uterine cavity.

Bruno J. van Herendael
 
The knowledge of the anatomical condition and the functional condition of the cervix and the uterine cavity is of utmost importance before starting a treatment. I.e. in infertility even minor anatomical deformation have important consequences (tab 1).
 
Tab 1 Literature survey on the consequences of minor and major anatomical abnormalities at the level of the uterine cavity.
  
If we look at the infertile population there is a prevalence of uterine cavity formations of 32-64%.
 
Fig 1 Represents the classical pictograms of possible congenital anomalies at the level of the uterine cavity. Hysteroscopically it is important to diagnose the sub septated cavity as this condition is the responsible cause for a fair number of reproductive and gynaecological problems. The septated uterus can be treated in the out patient environment.

The Uterine Cervix

There are very few data on the level of the uterine cervix. There is however evidence that an anatomical normal cervix is essential to the proper functioning of the genital tract. There are a number of traditional diagnostic methods that have been used to inspect the cervix (tab 2 ).
  
Colposcopy: gives a visual impression of the outer cervix. The blood vessels can be appreciated and interpreted. The presence of the columnar epithelium on the outside, the so called erosions, often the cause of abnormal glandular secretions and Abnormal Uterine Bleeding (AUB) can be evaluated. Only the first few cm of the cervical canal can be visualised with a special cervical dilator but this manoeuvre is painful in most patients more especially in nullipara.
  
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