The association between preoperative vaginal dysbiosis and endometrial polyp recurrence after hysteroscopic polypectomy: A retrospective-prospective cohort study

Abstract

Aim

To explore whether preoperative vaginal dysbiosis influences the recurrence of endometrial polyps after hysteroscopic polypectomy.

Design

Retrospective-prospective observational cohort study.

Methods

A total of 679 patients from our university-affiliated hospital were included in this study. All patients underwent hysteroscopic polypectomy and were subsequently monitored for endometrial polyp recurrence through transvaginal ultrasonography at six-month intervals. Comprehensive clinical data were collected, encompassing preoperative vaginal dysbiosis, parity, polyp size, polyp number, the presence of uterine fibroids, polycystic ovary syndrome, endometriosis, and body mass index. The cohort was categorized into recurrence and non-recurrence groups, with comparative analyses conducted to assess the impact of these factors.

Results

Preoperative vaginal dysbiosis and endometriosis were significantly associated with endometrial polyp recurrence (P < 0.05). The odds ratio (OR) for preoperative vaginal dysbiosis was 3.286 (95 % confidence interval [CI]: 2.675–3.786), and for endometriosis, it was 3.328 (95 % CI: 2.567–3.643). Further analysis revealed that bacterial density, bacterial diversity, and the Lactobacillus detection rate were significantly higher in the non-recurrence group compared to the recurrence group (P < 0.05). In contrast, increased leukocyte esterase activity, Gardnerella vaginalis presence, and Candida detection were significantly more prevalent in the recurrence group than in the non-recurrence group (P < 0.05).

Conclusion

This study identifies preoperative vaginal dysbiosis as an independent risk factor for Endometrial Polyp recurrence after Hysteroscopic Polypectomy. Endometriosis is also associated with recurrence. Close monitoring of preoperative vaginal microecological parameters and targeted interventions could help manage dysbiosis and reduce recurrence.

IRB Approval

The First Affiliated Hospital of Guangxi Medical University Ethical Review Committee. Approval number: 2024-E817-01.