The role of hysteroresectoscopy in the diagnosis and treatment of reproductive age women with uterine leiomyoma

The objective: to investigate the features of hysteroscopic picture of the uterine cavity and endometrium condition in women with uterine leiomyoma (UL) and the possibility of using the results to choose a treatment method.Materials and methods. A total amount of reproductive age women with uterine leiomyoma that was examined is 216. Among them 118 women underwent surgical treatment for UL and 98 patients treated with conservative therapy. In addition to general clinical methods, ultrasound examination, hysterorectoscopy, and histological examination of the obtained material was performed, followed by a comparative analysis of the findings.Results. According to hysteroresectoscopy, the uterine cavity in women with UL was more frequently characterized by irregular wall relief (47.7%) and irregular shape (43.1%) due to submucosal (14.4%) and intramural nodes with centripetal growth (30.6% ), which was significantly more frequent compared to ultrasound findings (13.9%, p<0.05). Endometrial polyps predominated among endometrial pathology (55.6%), which was consistent with the histological finding (59.7%) and was twice as frequent as ultrasound findings (23.1%, p<0.05). And endometrial hyperplasia (14.8%), which was consistent with ultrasound findings (18.1%) but was twice as rare compared to histological examination (36.6%, p<0.05). Chronic endometritis was detected at hysteroscopy in less than 1% of subjects, whereas at histological examination, it was 26.4%, p<0.05. Ultrasound examination revealed no endometrial transformation during the cycle in 30.1% of women, which was consistent with a mismatch in endometrial development to the chronological day of the menstrual cycle according to histological examination (23.1%).Conclusion. Hysteroresectoscopy is an important stage in the examination of women with UL, which helps to assess the condition of the uterine cavity, in particular, the degree of deformation of leiomatous nodules, which determines the clinical course of the disease and is a contributing factor to infertility, and affects the choice of treatment tactics in this cohort of patients. Hysteroresectoscopy when combined with ultrasound and histological examination of the endometrium, a more comprehensive characterisation of the endometrial condition (chronic endometritis, mismatch of the day of the menstrual cycle) and the presence of associated pathological processes (polyps and endometrial hyperplasia) that require correction can be obtained.