Removal of uterine polyps: clinical management and surgical approach

Abstract

Endometrial polyps have a reported prevalence from 7.8% up to 30% and are one of the most cost-consuming gynecological conditions for our specialty. There are strong practitioner beliefs that surgical removal of endometrial polyps is highly beneficial, particularly for those with abnormal uterine bleeding and infertility. Additionally, polypectomy is indicated to reduce the risk of malignancy. Transvaginal ultrasound is the first-line diagnostic option for detection of endometrial polyps, while sonohysterography has similar accuracy as hysteroscopy in the diagnostic confirmation. Blind dilatation and curettage is not recommended for polyp removal; rather, hysteroscopy in the operating room and office setting using small-diameter hysteroscopic equipment is the standard approach. This can be performed without anesthesia in most women. While hysteroscopy is an effective method for polypectomy with a low complication rate, it is unknown whether this is truly beneficial for reproductive-age women with infertility and prior assisted reproduction therapy. The risk of malignancy in women with postmenopausal bleeding justifies the necessity of polypectomy with histologic tissue examination. In asymptomatic women, the risk of malignancy is low, and there are no known benefits of polyp removal in the prevention of malignant transformation. Cost-effective studies remain to be done to provide us with the optimal approach to endometrial polyps including the management of asymptomatic and/or infertile women, ideal location including office-based or the operating room setting, complication prevention including intrauterine adhesions, and recurrence issues.

摘要

据报道, 子宫内膜息肉的患病率为7.8%∼30%, 是我们专科费用最高的妇科疾病之一。有从业者强烈认为, 手术切除子宫内膜息肉是非常有益的, 特别是对那些有异常子宫出血和不孕症的人。此外, 息肉切除术可以降低癌变的风险。经阴道超声是检测子宫内膜息肉的一线诊断方法, 而宫腔超声造影在诊断确诊方面与宫腔镜检查具有相似的准确性。不推荐盲目扩张和刮除息肉, 相反, 在手术室和门诊环境下采用小直径宫腔镜设备进行宫腔镜检查是标准方法。对于大多数女性来说, 这可以在没有麻醉的情况下进行。虽然宫腔镜是一种有效的息肉切除术方法, 并发症发生率低, 但尚不清楚这是否真的对患有不孕症和先前进行辅助生殖治疗的育龄期女性有益。绝经后出血的女性的癌变风险证明有必要切除息肉并进行组织学检查。在无症状的女性中, 癌变风险很低, 而且目前还没有已知的息肉切除在预防恶变方面的好处。要为我们提供治疗子宫内膜息肉的最佳方法, 还需要进行成本效益研究, 包括对无症状和/或不孕症女性的管理, 门诊或手术室环境的理想位置, 预防包括宫腔粘连在内的并发症, 以及复发问题。

Keywords:

• Endometrial polyp
• hysteroscopy
• uterus
• ultrasound
• sonohysterography

Potential conflict of interest

The authors have no competing interests to declare.

Source of funding

Nil.