OBJECTIVE: The purpose of this study was to assess the usefulness of sonohysterography in the detection of abnormalities of the uterine cavity in infertile patients, compared with other diagnostic methods, such as transvaginal sonography, hysterosalpingography and hysteroscopy. METHODS: Three intrauterine pathologies including intrauterine synechiae, endometrial polyp and submucosal myoma, that could be possible causes of infertility were diagnosed. RESULTS: Transvaginal ultrasonography and hysterosalpingography were able to detect 41.7% and 83.3% of uterine pathologies respectively comparing with sonohysterography to detect all of the uterine pathologies. CONCLUSION: Our results show that sonohysterography is easy, inexpensive, well-tolerated and non-invasive technique with high sensitivity in the detection of uterine pathologies. Therefore the use of sonohysterography for the diagnosis of intrauterine pathologies in infertile patients is highly recommended.
Diagnosis ; Female ; Gynatresia ; Humans ; Hysterosalpingography ; Hysteroscopy ; Infertility ; Myoma ; Pathology ; Polyps ; Ultrasonography

PURPOSE: To assess the role of MR imaging in the detection of Asherman's syndrome, especially whenthis is associated with a congenital uterine anomaly. MATERIALS AND METHODS: MR images were obtained in thesemicoronal plane parallel to the long axis of the uterus in 11 patients. Dilatation and curettage involving thein-sertion of an intrauterine device was performed in all patients, and transabdominal metroplasty was performedin four with uterine anomaly. MR imaging findings we r e compared with those of hyste rosalpingograhy in all patients and compared with sur-gical findings in four. RESULTS: The MR findings of uterine synechiademonstrated in nine of 11 patients were focal thickening of the uterine junctional zone (n=2), hypointense fociin the en-dometrium (n=1), or both these findings (n=6). Seven of the 11 patients had associat-ed uterineanomalies, which were demonstrated in all seven by MR imaging. In four of the seven, HSG failed to demonstratethese anomalies. CONCLUSION: MR imaging satisfactorily demonstrated intrauterine lesions in nine of 11 patientswith Asherman's syndrome, and was especially helpful in demonstrating associated uterine anomalies.
Axis, Cervical Vertebra ; Dilatation and Curettage ; Female ; Gynatresia* ; Humans ; Intrauterine Devices ; Magnetic Resonance Imaging* ; Uterus

From May 1995 to February 1997, 46 patients underwent resectoscopic surgery for infertility. Of 46 patients, 32 patients had uterine synechiae, 5 patients had polyps, 3 patients had septums, 3 patients had bony foreign bodies, 2 patients had submucosal myomas, 1 patient had tuberculous endometritis. The resectoscopic procedure proved of special value for resection of intrauterine adhesion, submucosal myoma, septum and polyp. Except 5 patients, intrauterine conditions were improved and 10 patients were conceived. So it goes without saying that resectoscopic surgery is a effective and acceptable procedure for the management of infertility of endometrial factors. However, with the finding of slightly less satisfactory results with time and number, further follow-up is still needed to establish the usefulness of the procedure.
Endometritis ; Female ; Follow-Up Studies ; Foreign Bodies ; Gynatresia ; Humans ; Infertility* ; Myoma ; Polyps

OBJECTIVETo investigate the surgical methods of treating severely injured vagina.

METHODSA retrospective study was carried out on the clinical materials and results of 7 patients suffered from severe vaginal injury.

RESULTSDifferent surgical approaches such as trans-suprapubic, transperineal or both approaches were applied according to the position of the atresia, meanwhile, different surgical methods such as skin graft, free flap transplantation, vaginal mucous flap advancement, direct anastomosis of the two ends, "Z" plasty was used to repair the vagina according to the different defect of the vagina, except for 1 case complicated with vaginorectus fistula, all the other cases were achieved satisfactory results.

CONCLUSIONSThe accurate judgment of the severity of the vaginal injury and the understanding of the changed anatomy around the injured vagina was the key points to the success of the surgical treatment of traumatic vaginal atresia.

Female ; Gynatresia ; etiology ; surgery ; Humans ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Vagina ; injuries ; surgery

OBJECTIVETo investigate the types, clinical features and therapeutic approaches of congenital anomalies of the vagina.

METHODSThe clinical data of 81 patients with congenital anomalies of the vagina were analyzed retrospectively.

RESULTSThere were 5 types in these 81 patients, and 16 (19.7%) patients showed absence of the vagina, 15(18.5%) had vaginal obstruction, 10 (12.3%) had transverse vaginal septum,14(17.2%) had longitudinal vaginal septae,18(22.2%) had septum obliquus, and 8 (9.8%) had imperforate hymen. Forty-eight (59.2%) patients presented with primary amenorrhea, and 22(27.1%) complained of irregular pelvic pain. Fifteen of the patients with absent vagina underwent amnion artificial vaginoplasty, and the others were treated with incising and removing the septum, all having good clinical outcomes.

CONCLUSIONAmnion artificial vaginoplasty is a good option for treatment of absent vagina.

Colpotomy ; methods ; Female ; Gynatresia ; surgery ; Humans ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Vagina ; abnormalities ; surgery

OBJECTIVE: We compared the expression pattern of progesterone receptor, integrin 3, cyclooxygenase-2 (COX-2) in in-phased endomerium of patient with the disease related implantation and control group, and tried to confirm the clinical efficacy of the immunohistochemical markers for discrimination of occult uterine receptivity defect in in-phase endometrium. STUDY DESIGN: Endometrial tissues were obtained from 60 women with normal (group 1; n = 20), uterine synechiae (group 2; n = 15), and endometriosis (group 3; n = 25). On 7 ~ 8 days after ovulation (POD 7 ~ 8), sex hormone levels were measured and immunohistochemical staining of PR, integrin 3, and COX-2 expression were performed. RESULTS: PR was decreased in the group 2 and increased in the group 3 comparing with the group 1. integrin 3 expression was significantly decreased in the group 2 and 3. COX-2 expression was significantly decreased in the group 2. But, in the group 3, COX-2 expression was slightly increased in glandular epithelial cells, and significantly increased in stromal cells. CONCLUSIONS: In-phase biopsies from patients with endometriosis and uterine synechiae showed different expression pattern of integrin 3, COX-2, and PR compared to the control. The aberrant expression of immunohistochemical markers be associated with occult uterine receptivity defect and produce the useful diagnostic method.
Biopsy ; Cyclooxygenase 2* ; Discrimination (Psychology) ; Endometriosis ; Endometrium* ; Epithelial Cells ; Female ; Gynatresia ; Humans* ; Ovulation ; Progesterone* ; Receptors, Progesterone* ; Stromal Cells

OBJECTIVE: To evaluate the spectrum of hysteroscopic surgery to be extended. METHODS: Total 1101 women who had undergone hysteroscopic operations with Urione(R) solution and Normal saline as distension media between Feberary 2001 and December 2008 were selected. Clinical characteristics, laboratory data and postoperative result were retrospectively analyzed. RESULTS: Hysteroscopic myomectomy was 884 cases. hysteroscopic polypectomy was 447 cases. Hysteroscopic adhesiolysis was 89 cases. Hysteroscopic adenomyomectomy or adenomyolysis was 66 cases. Hysteroscopic IUD removal was 31 cases. Hysteroscopic ablation for DUB and endometrial hyperplasia was 32 cases. Hysteroscopic septolysis was 18 cases. Hysteroscopic conceptus removal was 6 cases. Mean size of myoma was 3.4 cm. Mean operation time was 47 minutes. Mean deficit of distension media was 193 cc. Average duration of hospitalization was 4.9 days. Average change of Hb. was 1.5 g/dL. Complications of hysteroscopic operation were 16 cases. That is uterine perforation (n=9), hyponatremia (n=2), pulmonary edema (n=2), delayed bleeding (n=2) and bladder perforation (n=1). CONCLUSION: The indication of hysteroscopic op. can be very extended. Pure intramural myoma, subserosal myoma, endometrial polyps, adenomyosis, uterine synechiae, uterine septum, endometrial hyperplasia, DUB and ectopic conceptus can be resected by hysteroscopic operation. Intraoperative ultrasonographic guidance is very important. It makes the complication and morbidity rate to be lower.
Adenomyosis ; Endometrial Hyperplasia ; Female ; Gynatresia ; Hemorrhage ; Hospitalization ; Humans ; Hyponatremia ; Hysteroscopy ; Myoma ; Polyps ; Pulmonary Edema ; Retrospective Studies ; Urinary Bladder ; Uterine Perforation

OBJECTIVES: To uncover gynecologic conditions with similar transvaginal sonographic findings of thick uterine endometrium with honeycomb appearance in pre-and postmenopausal women.METHODS: We retrospectively reviewed cases of patients with endometrial tissue biopsy from January 2010 to December 2016. We also collected office flexible hysteroscopic findings and surgical pathologic results. We analyzed data from 393 patients with confirmed endometrial pathology. Among these patients, 69 had transvaginal ultrasonographic images with thick uterine endometrium and honeycomb or “Swiss cheese” appearance.RESULTS: We found gynecologic conditions such as submucosal leiomyoma with degeneration, endometrial polyp, pseudocystic endometrial change associated with tamoxifen use, progesterone associated endometrial change, pyometra, retained placenta, and uterine synechiae manifested with similar thick endometrium with “Swiss cheese” appearance in transvaginal sonographic images. The most common diagnosis in postmenopausal women was atrophic endometritis, followed by endometrial cancer and endometrial polyps. The most common diagnosis in premenopausal women was abnormal uterine bleeding without pathologic conditions.CONCLUSIONS: Sonographic findings of thick uterine endometrium with “Swiss cheese” appearance need to be considered together with a thorough review of the patient's history and chief complaint before making a tentative diagnosis due to the various conditions sharing the feature.
Biopsy ; Diagnosis ; Endometrial Neoplasms ; Endometritis ; Endometrium ; Female ; Gynatresia ; Humans ; Hyperplasia ; Leiomyoma ; Menopause ; Pathology ; Placenta, Retained ; Polyps ; Progesterone ; Pyometra ; Retrospective Studies ; Tamoxifen ; Ultrasonography ; Uterine Hemorrhage