Outpatient microhysteroscopy: why does it fail?

Objective

To assess the failure rate of diagnostic outpatient hysteroscopy using a 2.5-mm semirigid hysteroscope.

Design

Retrospective cohort analysis.

Setting

Outpatient hysteroscopy unit in a large district general hospital.

Sample

All patients who had a diagnostic outpatient hysteroscopy during the study period.

Main outcome measures

Hysteroscopy was considered a failure when the uterine cavity was not accessible or when the view obtained was unsatisfactory.

Results

A total of 1976 patients were seen in the direct-access hysteroscopy unit between November 1994 and May 1999. The procedure was performed successfully in 1898 patients (96.1%) but failed in 78 patients (3.9%). Causes for failure included: cervical stenosis (n = 54; 67.9%), severe discomfort (n = 7; 8.9%), unsatisfactory view (n = 6; 2.6%), obesity (n = 5; 6.4%), large cervical polyp (n = 4; 5.1%) and vagal reaction (n = 2; 2.6%). Overall failure was more likely in postmenopausal (46/894; 5.1%) than in premenopausal patients (32/1082; 2.9%).

Conclusions

Diagnostic outpatient hysteroscopy using a 2.5-mm semirigid hysteroscope is a simple, safe, effective and acceptable investigation. The most common reason for a failed outpatient microhysteroscopy was cervical stenosis particularly in postmenopausal women.