title: State-of-the-art flexible hysteroscopy for office gynecologic evaluation.
abstract: OBJECTIVE
  To evaluate office flexible hysteroscopy without anesthesia with regard to pain, inconvenience and cost.
  
  
  METHODS
  A survey of patients to evaluate the level of pain they experienced during office hysteroscopy, and a comparison of costs for these procedures with those of hospital dilatation and curettage.
  
  
  METHODS
  Office-based hysteroscopy suite in the outpatient building of a tertiary institution.
  
  
  METHODS
  Women referred to this institution for gynecologic evaluation between February 1992 and December 1993.
  
  
  METHODS
  Diagnostic flexible hysteroscopy without anesthesia, cervical dilatation, or paracervical block.
  
  
  RESULTS
  A total of 417 women (mean age 42 yrs, range 16-84 yrs; 78 postmenopausal) were referred for evaluation during the study period. The most common indication for referral was abnormal uterine bleeding (86%). Hysteroscopy could not be completed in 29 women (7%), primarily because of cervical stenosis. Pain ratings obtained from 387 patients were as follows: easily acceptable discomfort, minimal discomfort during procedure, 133 (34.5%); acceptable discomfort, uncomfortable but easily bearable, 86 (22.2%); tolerable discomfort, equivalent to menstrual cramps and spasms, 106 (27.4%); barely tolerable pain, tolerable for short time only, 48 (12.4%); and intolerable pain, severe enough to stop the procedure before completion, 14 (3.6%). A single adverse event, a postprocedure temperature elevation, was easily treated with oral antibiotics. No pathology was identified in 183 (43%) of the women; 95 (22%) had polyps and 90 (21.5%) had fibroid tumors. The average duration of a procedure was 5 minutes. The charge for office hysteroscopy was $475.
  
  
  CONCLUSIONS
  Flexible office hysteroscopy without anesthesia was well tolerated by the majority of the women. In addition, the procedure is far less expensive and time consuming than when it is performed in an operating room. We believe that it is a safe, well-tolerated, and cost-effective procedure of great diagnostic value.
authors.affiliation: Department of Gynecology, A 81, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Bradley
authors.forename: T
authors.initials: T
authors.lastname: Widrich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D003251:Constriction, Pathologic / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004107:Dilatation and Curettage / Q000191:economics; D004867:Equipment Design; D005260:Female; D005334:Fever / Q000209:etiology; D006176:Gynecology; D017721:Hospital Costs; D006801:Humans; D020702:Hysteroscopes; D015907:Hysteroscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D007889:Leiomyoma / Q000175:diagnosis; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D018583:Pliability; D011127:Polyps / Q000175:diagnosis; D012449:Safety; D013997:Time Factors; D002577:Uterine Cervical Diseases / Q000503:physiopathology; D014592:Uterine Hemorrhage / Q000503:physiopathology; D014594:Uterine Neoplasms / Q000175:diagnosis