Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized,clinical trial

This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95±13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube.     

超声引导下肾上盏径路经皮肾镜碎石术治疗鹿角形结石疗效及安全性分析

目的总结超声引导下肾上盏径路经皮肾镜取石术(PCNL)的疗效及安全性。方法回顾性分析193例应用超声引导肾上盏径路PCNL治疗鹿角形结石的患者资料。193例均为鹿角形复杂结石(完全鹿角形结石74例,不完全鹿角形结石119例,结石长径2.5~9.0 cm),均完成超声引导下对后组上盏穿刺,其中十二肋下径路70例(36.3%),十一肋间径路123例(63.7%)。统计并分析手术清石时间、清石率及术后并发症。结果一期手术时间平均70 min(45~150 min),采用单一肾上盏通道186例,需另外建立经皮肾通道7例。一期碎石清石率72.0%(139/193),二期清石率88.1%(170/193)。术后输血6例,需选择性肾动脉栓塞止血2例。胸腔积液4例,2例需闭式引流。术后发热20例,无感染性休克及不良预后发生。无肺脏及其他内脏损伤。结论后组肾上盏径路的PCNL视野范围广,输尿管镜活动度大,碎石速度快、清石率高,对于鹿角形结石是一种安全有效的方法,值得临床治疗鹿角形结石选择性使用。     

Preoperative immune status and lipid peroxidation as risk markers for pyelonephritis attack after percutaneous nephrolithotomy

Pyelonephritis attack after percutaneous nephrolithotomy can be predicted on the basis of immunity parameters and blood level of lipid peroxides. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 130, No. 8, pp. 220–222, August, 2000     

冲洗液加温对经皮肾镜碎石取石术患者体温的影响

目的探讨冲洗液加温对经皮肾镜碎石取石术（PCNL）患者术中及手术结束时体温的影响。方法将100例接受PCNL的患者随机分为A、B两组,每组50例。A组应用室温的生理盐水进行冲洗,B组应用加温至37％的生理盐水进行冲洗,比较两组的一般参数、体温变化以及组内的体温变化。结果两组的年龄、体重、手术时间、冲洗液量、输液量及手术开始时体温无显著性差异。两组手术结束时体温均显著下降（P〈0．01）,A组的术中平均体温明显低于手术开始时体温（P〈0．01）,B组术中平均体温低于术前体温,但无统计学意义。B组手术结束时体温及术中平均体温明显高于A组（P〈0．01）,体温下降幅度明显小于A组（P〈0．01）。结论在经皮肾镜碎石取石术中冲洗液加温可以有效防止患者术中及手术结束时低体温。     

激光辅助超声引导下经皮肾穿刺的初步研究

目的：在进行经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)中,临床上可以通过X线定位以及超声定位两种方法来建立碎石的通道。然而,通过X线定位的方法不可避免地产生射线暴露。而通过传统的超声定位的方法可以避免射线的暴露,可困难在于,徒手操作很难将整个针道完整的可视化。这就带来了一系列的问题：如内脏的损伤,目标盏的丢失以及出血的隐患。我们这次研究的目的就是,评估利用激光辅助下超声引导经皮肾穿刺解决上述问题的可能性。方法：回顾2015年5月至2016年3月,我科24例病人行激光辅助下超声引导经皮肾穿刺取石术(激光组)。在建立经皮通道阶段,利用激光光束与穿刺平面的重叠,进而激光光束的偏移间接反映针道的偏移,并做相应调整,从而将针道在超声图像上完全做到可视化,顺利建立通道。并与24例同期运用传统徒手穿刺行经皮肾镜的病人(徒手组)进行临床数据对比。结果：激光组24例病人中,22例患者在首次激光辅助下穿刺中,针道顺利在超声中显影,从而顺利进入目标盏。另外2例穿刺中,穿刺通过在经过激光光束的纠正后,B超下显示进入目标盏。较之徒手组(16/8)有所改善。激光组穿刺时间显著短于徒手组。结论：激光辅助下超声引导经皮肾穿刺是一种改良的建立通道技术。利用激光光束与穿刺针、超声平面的重叠,在早期就能够纠正针道的方向,减少穿刺针数,缩短穿刺时间。激光辅助下超声引导经皮肾穿刺是PCNL术中一项安全有效的穿刺辅助方法。     

经皮肾镜取石术后发热的危险因素和防治措施

目的:探讨经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)术后发热的危险因素及其防治措施.方法:回顾性分析2009年9月~2013年6月在我科行PCNL的369例患者的临床资料,根据术后有无发热(体温>38.5 ℃)分为术后发热组和未发热组,分别分析PCNL术后发热的各种危险因素,并探讨其有效防治措施.结果:PCNL术后发热45例,其发生率为12.2%;发热与术前尿培养阳性、脓肾、结石表面积>6 cm2、术中出血量>400 mL、手术时间>90 min、灌注液量>30 L、引流不畅等因素有关(P<0.05).结论:发热是PCNL术后常见的并发症,术前有效控制尿路感染、合理预防性使用抗生素、正确掌握手术时机、控制手术时间、无菌操作、保持引流通畅是防治PCNL术后发热的有效措施.     

新型可控性人工肾积水在经皮肾穿刺精确定位中的临床应用研究

目的探讨新型可控性人工肾积水在经皮肾穿刺精确定位的临床应用。方法本研究选择经皮肾碎石患者400例,随机分为2组,A组200例患者行新型可控性人工肾积水辅助装置经皮肾碎石术,B组200例患者行传统人工肾积水穿刺定位经皮肾碎石术。比较2组患者建立穿刺通道时间,术中出血量,穿刺次数。结果 A组195例患者1次建立经皮肾造瘘通道,5例患者2次穿刺定位经皮肾造瘘成功。B组157例患者1次建立经皮肾造瘘通道,40例患者行2次或者多次穿刺定位,3例患者穿刺定位失败。A组和B组患者的穿刺时间、术中出血量、穿刺次数分别为(1.8±0.7)min vs.(2.5±1.2)min,(112.7±51.0)mL vs.(270.2±89.3)mL,(1.1±0.2)次vs.(1.8±0.7)次。差异具有统计学意义,P0.05。结论制备新型人工肾积水可为经皮肾穿刺造瘘提供有效引导。     

超声引导经皮肾镜取石术治疗孤立肾肾结石的安全性分析

目的:探讨超声引导经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗孤立肾肾结石的安全性及临床疗效.方法:回顾性分析2005年7月~2012年12月在我科行PCNL治疗的孤立肾合并肾结石患者138例,其中解剖性孤立肾16例,功能性孤立肾122例(对侧肾GFR <10 mL/min).肾功能异常35例.鹿角状结石41例,多发结石85例,单发结石12例,其中有同侧开放手术史者11例.采用实时彩色多普勒超声引导经皮肾穿刺,建立F18微创通道或F24标准通道,使用气压弹道超声碎石清石系统或钬激光清除结石.结果:138例均一期建立通道.采用单通道125例(90.6%),双通道13例(9.4%).平均通道建立时间(4.7±0.9) min,平均手术时间(49.5±12.6) min.术后血常规Hb平均下降5.8 g/L.6例患者接受输血,其中3例行超选择性肾动脉介入栓塞控制出血.35例肾功能异常者中,术后第1天SCr增高者32例(91.4%),平均增高(19.8±7.4) μmol/L;术后第7天降至正常水平者26例(74.3%).一期PCNL结石清除117例(84.8%),术后1月复查结石总清除率91.3%(127例).12例有残石者行体外震波碎石(extracorporeal shock wave lithotripsy,ESWL)治疗或保守观察.15例(10.9%)患者术后出现发热(体温>38.5 ℃),本组无脏器损伤和感染性休克病例.结论:超声引导经皮肾镜取石术治疗功能性或解剖性孤立肾合并肾结石是安全和有效的.     

微创经皮肾镜碎石术中肾盂压力变化与术后早期并发症的关系研究

目的探讨微创经皮肾镜碎石术(minimally invasive percutaneous nephrolithotomy,MPCNL)中肾盂压力变化及高压累积时间与术后早期并发症发生率的关系。方法对133例肾结石患者采用MPCNL治疗,监测术中肾盂压力及高压累积时间,将患者分为高压及低压组,分析2组患者术后发热、肾周积液及肾功能损害发生情况。结果高压组术后1~4 d平均体温高于低压组,差异有统计学意义(P0.05)。所有患者术后第1天尿蛋自明显高于术前,此后尿蛋白逐渐下降,高压组与低压组同一天所测尿蛋相比,差异有统计学意义(P0.05)。肾周积液发生率高压手术组显著高于低压手术组,差异有统计学意义(P0.05)。结论微创经皮肾镜碎石术后早期并发症的发生率与术中高肾盂压相关。     

B超介导微创经皮肾取石术治疗严重脊柱畸形合并上尿路结石

目的 评价应用B超介导微创经皮肾取石术(MPCNL)处理脊柱畸形合并上尿路结石的疗效.方法 收集本院2001年8月至2010年2月严重脊柱畸形(Cobb角＞90°)合并上尿路结石患者10例,共11侧肾,采用MPCNL术在B超介导下穿刺,观察术中术后大出血、周围器官损伤情况;记录平均手术时间、术后48 h与术前相比的血红蛋白下降水平;应用腹部平片和B超复查术后上尿路结石取出情况;并进行术后随访,记录术后随访时间及结石复发情况.结果 11侧肾脏共行14次MPCNL术,其中单通道MPCNL 10次,双通道MPCNL4次.所有患者手术均成功,术中术后未见大出血周围器官损伤等并发症发生.平均手术时间为(96±38) min,术后48 h血红蛋白下降(16±7) g/L.术后复查腹部平片和B超显示11侧上尿路结石完全取净.术后随访(36±28)个月,1例患者复发下盏小结石,其余9例患者未见结石复发.结论 B超介导下应用MPCNL处理严重脊柱畸形合并上尿路结石安全有效.     

超声与X线引导穿刺行经皮肾镜取石术临床对比的Meta分析

目的：通过系统评价的方法比较在超声和X线引导穿刺行经皮肾镜治疗肾结石的临床效果。方法计算机检索PubMed、EMbase、Cochrane、CNKI等数据库,收集关于超声和X线分别引导下行经皮肾镜取石术治疗肾结石的临床对照试验。评价指标包括结石清除率、并发症率、穿刺时间、出血量和术后住院时间。所有的数据采用RevMan 5.0软件进行Meta分析。结果该研究共纳入9个研究,包括1693位患者。 Meta分析的结果显示超声与X线引导穿刺下患者的结石清除率无明显差别[OR=1.11,95%CI(0.83,1.49),P=0.47];而在并发症发生率[OR=0.43,95%CI(0.27,0.69),P=0.00]、穿刺时间[WMD=-4.54,95%CI (-0.45,-8.62),P=0.03]、出血量[WMD=-22.77,95%CI(-36.57,-8.97),P=0.00]和术后住院时间[WMD=-0.16,95%CI(-0.28,-0.03),P=0.02]方面比较,超声引导下建立通道的效果要优于X线。结论超声和X线引导下经皮肾镜治疗肾结石的结石清除率效果相当,但超声引导下所用穿刺时间少且术后并发症低。     

部分无管化与传统经皮肾镜取石术治疗上尿路结石的临床疗效对比

目的对比部分无管化经皮肾镜碎石取石术(不留置肾造瘘但留置双J管)与传统经皮肾镜碎石取石术(既留置肾造瘘管也留置双J管)治疗上尿路结石的临床疗效,评价部分无管化经皮肾镜碎石取石术的临床可行性及应用价值。方法选择2013年5月至2014年5月入住我院需行经皮肾镜碎石取石术治疗且符合入选标准的上尿路结石患者206例,按手术次序的奇偶分为观察组(部分无管化经皮肾镜碎石取石术组)与对照组(传统经皮肾镜碎石取石术组),观察比较2组患者手术时间、结石清除率、疼痛评分(VAS)、术后镇痛药需求量、术后血红蛋白下降值、术后输血、术后大出血、术后发热、漏尿时间、术后住院天数、住院费用、术后恢复正常生活工作时间等指标的区别。结果 206例患者均顺利完成手术,2组手术时间、结石清除率、术后血红蛋白下降值、术后输血、术后大出血、术后发热病例比较差异均无统计学意义(P0.05);观察组术后疼痛评分(VAS)、术后镇痛药用量、漏尿时间、术后住院时间、住院费用、术后恢复正常生活工作时间均显著低于对照组(P0.05)。结论部分无管化经皮肾镜碎石取石术与传统经皮肾镜碎石取石术相比,在减轻患者术后疼痛、减少漏尿时间、缩短患者术后住院时间、降低住院费用及加快患者术后恢复正常生活工作上具有明显的优势,具有很大的临床应用价值,值得推广应用。     

术前CT平扫观察结石成分与经皮肾镜碎石术清石效果的关系

目的:分析术前CT平扫观察结石成分与肾结石经皮肾镜碎石术（PCNL）清石效果的关系。 方法:纳入2016年1月至2018年1月于广东省中医院珠海医院收治的310例肾结石PCNL患者为研究对象,开展回顾性分析。按照术前CT平扫观察的结石成分,分为易碎石组（208例）、难碎石组（102例）,并与术后实际结石清除率比较,观察术前CT判断与术后实际结石清除率的一致性。 结果:310例肾结石患者术后结石清除288例（92.90%）,其中一水草酸钙结石28例（9.72%）,磷酸钙结石48例（16.67%）,二水草酸钙结石91例（31.60%）,磷酸镁铵结石70例（24.31%）,尿酸结石51例（17.70%）;310例肾结石患者术后未清除22例（7.10%）,其中一水草酸钙结石7例（31.82%）,磷酸钙结石9例（40.91%）,二水草酸钙结石3例（13.64%）,磷酸镁铵结石2例（9.09%）,尿酸结石1例（4.54%）。易碎石组手术时间显著短于难碎石组（P<0.05）,术中出血量、CT值显著低于难碎石组（P<0.05）,住院时间较难碎石组无统计学意义（P>0.05）;PCNL术后实际碎石效果显示清除组手术时间显著短于未清除组（P<0.05）,术中出血量、CT值显著低于未清除组（P<0.05）,住院时间较未清除组无统计学意义（P>0.05）,证实术前CT判断与术后实际结石清除率存在一致性。术前CT判断结石清除效果灵敏度为71.53%,特异度为90.91%,准确率为72.22%,阳性预测值为99.04%,阴性预测值为19.61%,Kappa值为0.73。 结论:术前CT平扫观察结石成分对PCNL的清石效果具有一定预测价值,临床上应引起足够重视。     

颅内动静脉畸形患儿血管内栓塞术后出血的危险因素分析

目的探究颅内动静脉畸形(cAVM)行血管栓塞治疗术后出血发生率及相关危险因素。方法选取2013年8月至2018年8月于我院脑外科行血管内栓塞治疗的cAVM患者180例为研究对象,观察其术后1周颅内出血发生情况,比较出血及未出血患者临床资料及畸形血管团特点,采用Logistic回归分析法探究cAVM栓塞术后出血的危险因素。结果cAVM栓塞术后出血发生率为17.78%,多于术后3 d内发生,以脑实质出血最常见。单因素分析显示,高血压史、出血史、畸形血管直径、深静脉引流、合并动脉瘤、栓塞体积、引流静脉栓塞及术后血压未达标与术后出血有关(P<0.05),而性别、年龄、癫痫史、畸形血管位置、S-M分级、栓塞时间及术后使用脱水剂与术后出血无关(P>0.05);多因素分析显示,出血史、深静脉引流及引流静脉栓塞是血管内栓塞术后颅内出血的独立性危险因素(P<0.05)。结论出血史、深静脉引流及引流静脉栓塞是cAVM栓塞术后出血的独立性危险因素,正确认识并在手术过程中采取相应的防范措施有利于降低栓塞出血并发症的发病率。     

Preoperative immune status and lipid peroxidation as risk markers for pyelonephritis attack after percutaneous nephrolithotomy

Pyelonephritis attack after percutaneous nephrolithotomy can be predicted on the basis of immunity parameters and blood level of lipid peroxides. Translated fromByulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 130, No. 8, pp. 220–222, August, 2000     

Angiotensin type 1 receptor A1166C gene polymorphism is associated with endothelial dysfunction and in-stent restenosis after percutaneous coronary intervention

Background and purpose: Percutaneous coronary intervention (PCI) has been commonly used in the treatment of ischemic cardiovascular diseases, but the postprocedural in-stent restenosis (ISR) associated with altered endothelial functions has limited the clinical application of it; preventive medication with aspirin and statins has underlying adverse effects despite lowered risk of ISR. The purpose of this study was to investigate the role of angiotensin type 1 receptor (AT1R) A1166C gene polymorphisms in the development of endothelial dysfunction and ISR after PCI. Methods: A total of 483 ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI were prospectively genotyped using polymerase chain reaction (PCR) and restriction fragment length polymorphism assay. The demographic, clinical, laboratory and angiographic parameters were recorded peri-procedurally and the patients were followed within 3 years. The flow-mediated dilation (FMD) was used to reflect the short-term changes in endothelial functions among different genotypes. The significance of AT1R gene polymorphisms in the development of ISR was analyzed using univariable and multivariable models. Results: Amongst 483 patients, the distribution of the AT1R genotypes (AA, AC and CC) was associated with the levels of blood biomarkers of oxidative stress and deteriorated FMD after PCI (P<0.05). In univariable and multivariable logistic regression analysis, it was shown that AT1R CC genotype is strongly associated with the development of restenosis within 3 years after PCI (OR=3.736; P<0.001; calibrated OR=4.104; P<0.001). Conclusion: The CC AT1R genotype was associated with deteriorated endothelial functions in the target vessels of PCI and intermediate to long-term ISR. Our findings contribute to the foundation of genome-based prevention for high risk groups of cardiovascular diseases and pretreatment for the patients undergoing PCI.     

复杂肾结石CT三维成像与PCNL通道选择的临床意义

目的：探讨复杂肾结石CT三维成像与经皮肾镜碎石术（PCNL）操作通道选择的临床意义。方法：收集41例复杂肾结石和29例单纯肾结石患者,PCNL术前行双肾CT扫描,采用多平面重建后处理方法。观察复杂结石的位置及其与肾脏周围结构的关系,规划PCNL最佳操作通道。三维成像复杂肾结石,观察结石的分布情况。术前、术后测量结石面积、残留碎石,计算肾结石清除率和残留碎石率,运用SPSS软件进行统计学分析。结果：（1）两组肾结石在肾盂肾盏中的分布、经PCNL钬激光碎石效果均有统计学差异。（2）经第11肋间与第12肋下建立操作通道,PCNL钬激光碎石效果：单纯肾结石组两位置间无统计学差异;复杂肾结石组两位置间有明显统计学差异。（3）经上盏或中盏穿刺建立操作通道,PCNL钬激光碎石效果：单纯肾结石组两盏间无统计学差异;复杂肾结石组两盏间有明显统计学差异。结论：（1）对于复杂肾结石,根据CT三维成像和体表标志选择在第11肋间或第12肋下,及影像学定位选择后组上盏或中盏穿刺,建立PCNL操作通道具有临床应用价值;（2）PCNL的结石清除率满意,残留碎石率明显减少,提高选择及建立PCNL操作通道的成功率,可明显降低PCNL并发症的发生。     

16F微通道输尿管镜经皮肾钬激光治疗肾结石与输尿管软镜治疗肾结石的比较

【摘要】目的:分析16F微通道输尿管镜经皮肾钬激光治疗肾结石与输尿管软镜治疗肾结石的临床效果。方法:选择90例肾结石（<2 cm）患者作为研究对象,根据随机数表法将所选患者分为观察组和对照组,每组45例。对照组患者采用16 F微通道输尿管镜经皮肾钬激光治疗,观察组患者采用输尿管软镜治疗。观察两组患者术中出血量、手术时间、血红蛋白下降、住院时间、住院费用、结石清除率、血尿素氮（BUN）、血清肌酐（Cr）水平以及并发症发生情况。结果:观察组患者术中出血量、血红蛋白下降、住院时间及住院费用［（6.19±1.37） mL、（2.37±1.92） g/L、（4.26±1.04） d、（3 325.48±413.51）元］均明显少于对照组［（24.38±6.52） mL、（7.76±5.83） g/L、（7.15±2.17） d、（4 226.15±546.82）元）］,差异有统计学意义（P<0.05）;两组患者在手术时间上的比较差异无统计学意义（P>0.05）;观察组患者术后即刻清石率（95.56%）比对照组（82.22%）更高,对比的差异有统计学意义（P<0.05）;两组患者术后1月清石率比较差异不明显,无统计学意义（P>0.05）;术后,观察组患者BUN和Cr水平［（19.86±0.19） mmol/L、（315.08±10.84） μmol/L］高于对照组［（15.44±0.32） mmol/L、（267.29±19.25） μmol/L］,对比的差异有统计学意义（P<0.05）;观察组患者术后并发症的发病率（8.89%）显著高于对照组（28.89%）,比较的差异有统计学意义（P<0.05）。结论:与16F微通道输尿管镜经皮肾钬激光治疗相比,输尿管软镜治疗结石直径<2 cm的肾结石患者具有术中出血量少、创伤小、恢复快、并发症少的优点,建议在临床进一步推广应用。     

Sarcopenia is associated with increased severe postoperative complications after colon cancer surgery

IntroductionStudies have shown that sarcopenia is associated with poor outcomes in patients with gastrointestinal cancer undergoing surgery. We aimed to investigate the relationship between postoperative complications of sarcopenic patients who had been operated on for colon cancer and the effects on short-term mortality.Material and methodsIn this study, patients who had undergone colon cancer surgery between January 2013 and December 2018 were collected retrospectively. Sarcopenia was diagnosed by the skeletal muscle index (SMI) derived from a preoperative computed tomography scan. Multiple logistic regression analysis was performed to determine whether sarcopenia is associated with postoperative major complications (POMC).ResultsThe study included 160 patients with a mean age of 62.4 ±12.6 years. Clavien-Dindo grade 1–2 (minor) complications were not significantly different between the groups (p = 0.896). However, grade ≥ 3 (major) complications were detected in 13 (17.8%) patients in the sarcopenic group (SG) and in 5 patients in the non-sarcopenic group (NSG) (5.7%) (p = 0.016). Length of intensive care unit (ICU) stay was longer in SG (p = 0.002) and there was no difference between 1-month and 6-month mortality rates (p = 0.273 and p = 0.402, respectively). According to univariate analyses, sarcopenia and age over 65 years were related to POMC. In multivariate analyses, sarcopenia (odds ratio = 3.039; 95% confidence interval 1.008–9.174; p = 0.048) and advanced age (odds ratio = 3.246; 95% confidence interval 1.078–9.803; p = 0.036) were found to be independent risk factors for POMC.ConclusionsThis study showed that while sarcopenia is a risk factor for POMC, sarcopenia also prolongs the duration of ICU stay. Also sarcopenia has no effect on short-term mortality.     

Investigation of the infertile couple: hysteroscopy with endometrial biopsy is the gold standard investigation for abnormal uterine bleeding

During the last decade hysteroscopy has become the tool of choice for the evaluation of the endometrial cavity, including for assessment of abnormal uterine bleeding (AUB). Many clinicians would consider that, in most patients, the combination of transvaginal sonography and out-patient endometrial biopsy with diagnostic hysteroscopy could replace the need for dilation and curettage. Hysteroscopy was reported to have sensitivity, specificity, negative predictive value and positive predictive value of 94.2, 88.8, 96.3 and 83.1% respectively, in predicting normal or abnormal endometrial histopathology. The highest accuracy of hysteroscopy was in diagnosing endometrial polyps, whereas the worst result was in estimating hyperplasia. Therefore, since the incidence of focal lesions in patients with AUB is high, it seems that the most beneficial approach is to proceed with hysteroscopy complemented by endometrial biopsy early in the assessment of AUB. Nevertheless, the usage of distension media to flush the uterine cavity raises the concern that when the endometrium harbours pathology, there is the potential risk of retrograde dissemination of malignant cells into the peritoneal cavity. The clinical significance of the dissemination of endometrial cells during hysteroscopy is still undetermined.