Impact of uterine cavity filling pressure levels on pain and procedure duration in diagnostic hysteroscopy: A retrospective cohort study.

Aim: This study investigates the impact of intracavitary pressure levels on pain, visualization quality, and procedure duration in office hysteroscopy, comparing standard pressures (60-100 mmHg) with high pressures (110-150 mmHg).

Methods: We conducted a retrospective cohort study involving non-menopausal women undergoing diagnostic hysteroscopy at a tertiary clinic. Patients were categorized into two groups based on intracavitary pressure: the standard pressure group (60-100 mmHg; n = 72) and the high-pressure group (110-150 mmHg; n = 37). Outcomes measured included pain scores, procedure duration, and fluid volume used. Logistic regression was employed to identify risk factors for severe pain.

Results: The high-pressure group demonstrated significantly shorter procedure durations compared to the standard pressure group (96.56 ± 34.36 vs. 163.00 ± 61.78 s, p < 0.001). Pain scores were lower in the high-pressure group (VAS 3.00 [0.00-7.00] vs. 3.50 [0.00-9.00], p = 0.041). Additionally, high-pressure procedures used less fluid compared to standard pressure procedures, which helps to reduce the risk of fluid-related complications. Logistic regression analysis identified higher fluid volumes (odds ratio [OR] = 1.005, 95% confidence interval [CI] = 1.001-1.010) and the need for pressure increases (OR = 3.914, 95% CI = 1.157-13.238) as significant risk factors for severe pain.

Conclusions: Higher intracavitary pressure levels (above 100 mmHg) in office hysteroscopy are associated with reduced pain, shorter procedure durations, and decreased fluid use, enhancing visualization and procedural efficiency while maintaining patient comfort.