Uterine polyp is a very common disease prone to recurrence. Recurrent endometrial hyperplasia in 1.5% of cases is malignant. The greatest likelihood of developing cancer of the uterine mucosa is associated with adenomatous polyps (adenomas). The disease can develop at any age. The optimal method of treatment is hysteroscopy (removal of the endometrial polyp). The operation is minimally invasive and high-tech, which significantly reduces the likelihood of recurrence of the pathology and the development of negative consequences.
What is a uterine polyp?
Pathological formation, rising above the surface of the endometrium (mucosa) of the smooth muscle of the penis, in which the fetus is born, is called a uterine polyp in medicine. They have a different configuration, consistency, narrow or wide base, smooth, villous or lobed.surface. Neoplasia can range in size from a sesame seed to a golf ball. Polyps of the mucous membrane of the uterus are single and multiple. The term "polyposis" is used if the number of neoplasias is more than twenty.
According to its structure, the polyp consists of three components. The surface of the formation is covered with epithelial tissue, the stalk consists of a fibrous base and thick vessels. Neoplasia can ulcerate, become infected, metaplasia, necrotic.
Polyps are classified most often by morphological structure. The following types of pathological formations are distinguished:
- Glandular polyps are made up of endometrial tissue containing glands.
- Glandular-fibrous are represented by a mucosal layer lining the cavity of the internal reproductive organ and connective tissue (stroma).
- Fibrous are formed by dense connective tissue.
- Adenomatous polyps are represented by glandular epithelium and are prone to transition to endometrial cancer.
Endometrioid polyps rarely grow beyond the uterine cavity. They are detected both in young girls and in menopausal women. In gynecology, the condition is regarded as precancerous, and in most cases, surgery is prescribed to remove the endometrial polyp.
Treatment methods
As statistics show, pathological formations of the uterus are most often formed against the background of a disorder in the hormonal function of the ovaries and an increase in estrogen levels. But hormone therapy asthe primary treatment is rarely used.
The best treatment is hysteroscopy - resection of the uterine polyp using endoscopic equipment. The formations on the leg are “unscrewed”, and the bed is cauterized by the cryogenic method or electrocoagulation. The eliminated neoplasias are subsequently sent for histological examination, the results of which determine further treatment tactics.
Removal of a fibrous polyp of the endometrium is carried out by polyectomy with curettage (curettage) of the uterus. When resection of glandular pathological formations, additional hormonal therapy is required. For the treatment of adenomatous polyps of the uterus, radical methods of therapy (supravaginal amputation, panhysterectomy) are used.
Hysteroscopy Benefits
The use of modern equipment during the operation improves its quality and reduces the risk of complications. In surgery, such methods of treatment are quite widespread. The terminology of the operation is usually derived from the name of the equipment with which it is performed.
Hysteroscopy of the endometrial polyp is the removal of focal uterine hyperplasia using a special endoscopic apparatus in the form of a tube with a fiber optic system and illumination. The operation is endovision, that is, it does not provide for opening the cavity. But this is not the only plus of hysteroscopy.
- Surgical manipulation does not require special preparatory measures.
- Resection of focal uterine hyperplasia withendoscopic equipment, less traumatic than classic curettage.
- The negative consequences of hysteroscopy (removal of the endometrial polyp) are rarely detected.
- Short rehabilitation period.
- Due to visual control, the probability of incomplete removal of the polyp is minimal.
- After hysteroresectoscopy, the neoplasia bed is cauterized, which reduces the number of recurrences.
- If the manipulation is performed using a rigid hysteroscope, then it is allowed to use different channels for irrigation (long-term irrigation of the cavity) and aspiration. The operation using such equipment has a lower cost.
Removal of the endometrial polyp (hysteroresectoscopy): indications
The operation, although minimally invasive, is still a surgical intervention. The decision to carry it out is made after numerous examinations. Pathologies that are indications for hysteroresectoscopy can only be established by a doctor. These include:
- Multiple endometrial hyperplasia that are common (uterine polyposis).
- Any solitary polyps that are asymptomatic.
- Endometrial neoplasia of any size with regular uterine bleeding.
- The development of anemia caused by frequent bleeding from the genitals.
- Profuse vaginal discharge accompanied by severe pain.
- Irregular menstruation.
- Inefficiency or complications after curettage.
- Adenomatous (glandular) polyps. Suchneoplasms, a high probability of degeneration from a benign to a malignant tumor.
- Threatened miscarriage.
- Hormonal failure. Hormonal imbalances can provoke the growth of neoplasms.
Removal of the endometrial polyp in the uterus during pregnancy planning is carried out to create good conditions for implantation of the embryo.
Contraindications
Before prescribing a resection, the doctor, during a physical examination and during the examination, identifies all the pathologies that prevent the use of this method of treatment. The general list of he alth conditions in which surgery is temporarily or permanently not indicated corresponds to contraindications to classical ectosomatic surgery.
- Acute infectious diseases of the respiratory tract (flu, tonsillitis, pneumonia).
- Infectious kidney disease of bacterial etiology.
- Respiratory failure.
- Decompensated heart failure.
- Chronic renal failure.
- Violation of liver function, accompanied by metabolic disorders, intoxication, development of hepatic coma.
- Shock.
- Disorders of the hemostasis system.
Contraindications for removal of uterine endometrial polyps from the reproductive system are:
- Acute inflammatory diseases of the genital organs (vulvitis, cervicitis, salpingo-oophoritis and others).
- Bacterial vaginosis.
- IV degree of vaginal cleanliness.
- Malignant neoplasms of the uterine mucosa.
- Uterine fibroids of large sizes.
- Submucosal fibroids over 5 cm in diameter.
For treatable diseases, surgery is delayed until full recovery. In severe lingering pathologies, the treatment tactics are set personally.
Preparation for surgery
Surgery is a very important stage in the treatment of the patient. All manipulations are carried out only with the consent of the patient. Resection of neoplasia of the uterine mucosa is a planned surgical intervention. Special preparation for the operation to remove the endometrial polyp (hysteroscopy) is not required. Laboratory tests and instrumental examination are standard for most invasive procedures.
- Examination by a gynecologist on a chair.
- Bimanual (two-handed) examination.
- Diagnosis of the vaginal cervix using a colposcope.
- Smears for vaginal cleanliness and cytology.
- Transabdominal pelvic scan.
- Clinical blood test.
- Blood biochemistry (glucose).
- A blood test for antibodies to the surface antigen of the hepatitis B virus.
- Antibodies to hepatitis C virus.
- Screening for HIV antibodies.
- Wassermann test (RW) - rapid test for syphilis.
- Fluorography.
- Electrocardiogram with transcript.
Hysteroresectoscopy is performed on the 5-15th day of the menstrual cycle. For patientstaking synthetic analogues of estrogen and progesterone, the operation can be performed on any day of the cycle.
In the morning before polypectomy, standard hygiene and depilation of the intimate area is carried out. It is necessary to refuse food intake. The operation is performed after cleansing the intestines by enema and with an empty bladder.
Hysteroscopy technique
Surgical manipulation is performed using a mono- or bipolar hysteroresectoscope. This is a complex instrument, consisting of optics, allowing visual control over the process and surgical device.
Removal of the endometrial polyp (hysteroscopy) is performed under intravenous anesthesia. The external genitalia, vagina and cervix are treated with an antiseptic solution. The lower segment of the uterus is fixed with bullet forceps. With the help of a uterine umbrella, the depth, position and condition of the uterine cavity are examined. The cervical canal is expanded for free insertion of the endoscopic instrument. The uterine cavity is filled with gas or liquid. This provides sufficient space for the operation of instruments and visual control over the progress of the operation.
A resectoscope and a video camera are inserted into the uterine cavity, which transmits the image to the monitor screen. The doctor examines the uterus, assesses the condition of the mucous membrane (endometrium), determines the location of pathological neoplasms. Resection of polyps is performed by an endoscopist.
Single polyps with a well-marked stalk are removed,using endosurgical scissors or a special loop. The loop electrode is often used to eliminate large neoplasia located near the uterine wall or having a fibrous structure. To prevent bleeding and reduce the likelihood of recurrence of the disease, the bed of formations is cauterized.
After removal of the endometrial polyp, the specialist removes the entire instrument from the uterine cavity and removes gas or liquid. The average duration of the operation is 20-40 minutes. With multiple polyps, technical difficulties, the operation takes longer. The duration of anesthesia can also be extended.
After surgery
After surgery, the patient is transferred to the ward. If the removal of the endometrial polyp went without complications, the patient is allowed to go home within a few hours after she recovers from anesthesia.
In the postoperative period, a course of antibiotics is prescribed to prevent infectious diseases. In the early days, a woman may experience aching pain. To eliminate them, the doctor prescribes drugs that relieve pain.
After the operation, a woman normally has scanty spotting. They usually go away on their own within 3-5 days.
Removed polyps are sent for histological examination. The results are usually ready in a week, at the same time the patient needs to visit a gynecologist to determine the subsequent therapeutic tactics. After removal of the glandular polyp of the endometrium, treatment with hormonal drugs is prescribed without fail.
Recovery period
Rehabilitation period for every woman is different. It all depends on the severity of the pathology, the presence of concomitant diseases, the age of the patient, the quality of the operation performed.
In the first few days, a slight increase in temperature is possible. The healing process may be accompanied by rare spasmodic pain. Their duration depends on the characteristics of the organism. In order for the recovery period after the removal of the endometrial polyp (hysteroscopy) to go smoothly, certain recommendations should be followed.
- No bathing for 2 weeks after surgery.
- Intensive heating should be abandoned.
- Temporarily cancel or reschedule some physiotherapy procedures (electrophoresis, laser therapy).
- It is forbidden to swim in pools and ponds.
- Exclude exercise and sports.
- You can not douche and use vaginal suppositories without a prescription from a gynecologist.
- Vaginal tampons should be avoided.
- You must abstain from sexual activity for 3-4 weeks.
Possible Complications
Intraoperative complications are extremely rare. The probability of their occurrence is low, but not completely excluded. The list of undesirable situations includes:
- Bleeding. Electrocoagulation of damaged endometrial vessels is used to stop diffuse bleeding.
- Perforation of the uterus due to mechanical damage (injuryprobe, curette).
- Traumatic injuries as a result of heat and energy exposure.
- Weights associated with the use of means of stretching the uterine cavity.
Complications can arise not only during the operation, but also after it. The negative consequences of hysteroscopy (removal of the endometrial polyp) can manifest itself in the form of the following pathological conditions:
- Accumulation of blood in the uterine cavity.
- Inflammation of the inner lining of the uterus.
- Infection. The incidence of such complications does not exceed 0.17-3%. The most common are sepsis, bacterial shock.
- Profuse prolonged discharge after removal of an endometrial polyp by hysteroscopy, as a rule, occurs due to non-compliance with medical prescriptions.
- Infertility. Total ablation of the uterine mucosa can cause the development of inability to conceive or miscarriage.
- Stenosis of the cervical canal. Anatomical narrowing most often occurs after electro- or laser coagulation of the mucous membrane of the cervical canal.
Treatment after removal of the endometrial polyp
In some cases, the doctor may prescribe additional medication. Medicines are not always prescribed, it all depends on the type of neoplasm. Basically, treatment is prescribed after the removal of the glandular polyp of the endometrium. This type of neoplasia is most often observed at a young age. Hormone therapy is aimed at the complete restoration of a woman's reproductive function.
The selection of hormonal contraception is carried out by a doctor. The combination of "Ethinylestradiol" (an estrogen hormone) with "Dienogest" (suppresses the trophic effect of estrogens) or "Desogestrel" is considered the most effective. The course of treatment can be from 3 to 6 months.
Also, to normalize hormonal processes, Mirena or Jaydes intrauterine devices are installed. The active ingredient of the contraceptive is levonorgestrel, which causes a decrease in the implantation function of the endometrium. The spiral is set for 5 years.
If a histological examination revealed additional pathologies, then treatment will be prescribed depending on the type of disease. If malignant cells are found in polyps, an additional comprehensive examination will be prescribed and, most likely, more radical treatment will be carried out.
Reviews
Most women are satisfied with how the operation went. They note the convenience of being able to go home a few hours after surgery.
Most often, patients in reviews of the consequences of hysteroscopy (removal of the endometrial polyp) write about prolonged bleeding that opened a few days after resection. But after taking medication, everything is quickly restored. But in general, women respond positively, especially those who were prescribed conservative treatment, which turned out to be ineffective.
Many patients note the high cost of the operation, but they themselves say that the end result is worth it. After a hysteroscopy, doctors often prescribe a course of oral contraceptives. Women who have not previously used such drugs report side effects and a too long course.
Pregnancy after hysteroscopy
Infertility after removal of a pathological neoplasm of the endometrium of the uterus develops only if the operation was performed with a severe degree of the disease or if the woman had problems conceiving or carrying a pregnancy before.
In reviews of hysteroscopy (removal of an endometrial polyp), young women say that they became pregnant very quickly, and the whole period was normal. Based on observations, doctors recommend planning conception after 3-4 menstrual cycles. It is believed that by this time the mucous membrane is completely restored, which reduces the risk of miscarriage.
Hysteroscopy is a modern and effective method of treating endometrial polyps. But a successful outcome depends not only on the professionalism of the surgeon, but also on the timely request for help and the implementation of all postoperative recommendations.
