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Hysteroscopy is now the established “gold standard” for the assessment and treatment of intrauterine pathology such as fibroids, polyps, synechiae, septa and endometrial resection and/or destruction, and is regarded as a safe, acceptable and well-tolerated procedure [1–5]. In fertile women, hysteroscopic procedures are best performed when the endometrium is thin because the operating time is lessened and fluid absorption decreases, making surgery easier [6–9]. For these reasons, the days immediately after menstruation are the best period for hysteroscopy. Scheduling surgery during the early follicular phase is not always possible, so several drugs have been proposed to reduce endometrial thickness, intra-operative bleeding, surgical difficulties and duration of surgery [6, 10, 11]. Even if preoperative treatment with gonadotropinreleasing hormone analogues (GnRH-a) or danazol for 2 or 3 months has been recommended to remove large intramural sub-mucous myomas or perform endometrial resection [9], they are not as often used for procedure preparation especially in case of minor hysteroscopy. GnRH-a result in a state of temporary menopause and are expensive, while danazol induces unfavourable side effects including weight gain, growth of hair, acne and general malaise [12]. Several studies have reported that gestrinone also is capable of reducing uterine volume, menorrhagia and endometrial thickness [13–15]. A limiting factor existing among the previous treatments is the long time required to reduce the endometrium. Recently, to speed up endometrial preparation, other original treatments have been proposed as oral progestins and vaginal raloxifen [16], nomegestrol acetate [17] and oral contraceptives [18], and they obtained good results in terms of preparation of the endometrium, cost and acceptability. Shortening the preparation time before surgery may improve patient compliance and work organization [19]. The aim of this prospective, randomised study was to compare the effectiveness of nomegestrol acetate versus combined oral contraceptive treatments as short preoperative endometrial preparation before hysteroscopic surgery. L. Mereu (*) :G. Giunta :G. Carri : C. Prasciolu : E. D. Albis Florez : L. Mencaglia Division of Gynaecology, Centro Oncologico Fiorentino, Sesto Fiorentino, Italy e-mail: liliana.mereu@lacittadellasalute.it

We did a double-blind, randomized, placebo-controlled study to assess the incidence of infectious complications and the protective effect of antibiotic administration during operative hysteroscopic procedures in an office setting. A total of 1046 consecutively enrolled women with intrauterine lesions were randomly allocated to the reference group (523 patients administered with 1 g of cefazolin intramuscularly) and the study group (523 patients administered with 10 mL of isotonic sodium chloride solution), and treated in office setting by operative hysteroscopy for endometrial polypectomy, uterine septa, submucosal myomas, and intrauterine adhesions. The primary outcome measure was the computation of difference between groups in postsurgical infectious complications occurring in the 5 days after the procedures. The time spent in performing the various procedures did not differ significantly (P > .05) between the groups. With respect to the overall rate of postsurgical infection, we found that 12 (1.15%) of 1046 patients referred with symptoms related to infective complications, 7 (1.3% of 523 women) in the study--untreated--group and 5 (1.0% of 523 women) in the reference group. Such incidences did not differ significantly between the groups (P > .05). Antibiotics were prescribed in all cases of postsurgical infection and the infective process resolved in few days. None of these patients developed serious infections with adnexal involvement, as confirmed by clinical and ultrasounds evaluation. The results of the current study would support the American College of Obstetricians and Gynecologists recommendation not to prescribe routine antibiotic administration in the case of hysteroscopic surgery.

To evaluate 10 years' experience with hysteroscopic treatment of septate uterus in Italy.Multicenter retrospective study conducted from January 1988 to March 1997 (Canadian Task Force classification II-2).Twelve Italian centers for minimally invasive therapy.Women (total 973) with hysteroscopically diagnosed septate uterus.Hysteroscopic metroplasty performed with scissors, resectoscope, or neodymium:yttrium-aluminum-garnet laser.Data on indications for hysteroscopic metroplasty, details of patient management from pretreatment to follow-up, and pregnancy course and delivery were collected by questionnaire. Main indications were two or more abortions and primary infertility. Most procedures were performed with the resectoscope, followed by scissors and laser. Few minor complications occurred. Pregnancy rates were good.Hysteroscopy is safe and effective treatment of septate uterus in terms of both pregnancy rate and outcome.

Study Objective To describe the hysteroscopic findings in patients complaining of menorrhagia to establish any significant association between menorrhagia and benign/malignant intrauterine disorders. Design Prospective cohort study (Canadian Task Force classification II). Setting University La Sapienza, Rome, Italy. Patients One hundred eighteen premenopausal women undergoing office hysteroscopy for menorrhagia (group A) and 344 premenopausal patients undergoing office hysteroscopy for other indications (noncyclic abnormal uterine bleeding, infertility, ultrasonographic abnormalities, etc) (group B). Interventions Office hysteroscopy. Measurement and Main Results Data on the prevalence of hysteroscopic findings (cervical polyps, endometrial polyps, submucous myomas, low-grade hyperplasia and high-grade hyperplasia/endometrial carcinoma) were compared between group A and group B. The total prevalence, as well as the prevalence of type 0 and type I myomas (totally or >50% intracavitary, respectively), and the mean number per patients with submucous myomas was significantly higher in group A compared with group B (p = .0001, p = .024, and p = .017, respectively). Multivariable logistic regression analysis showed a statistically significant association between age (odds ratio 4.15, 95% confidence interval 1.55–11.1 in the 40- to 49-year age group), presence of submucous myomas (odds ratio 2.76, 95% confidence interval 1.52–5.00), and menorrhagia. Conclusions Menorrhagia seems to be associated with aging, the presence and number of submucous myomas, and with the degree of their intracavitary development.

Our aim was to evaluate the efficacy of laparoscopic pelvic denervation (uterosacral resection or presacral neurectomy) for the treatment of chronic pelvic pain with a predominant central-type localization in women with endometriosis or with no visible pathology. In a retrospective analysis performed in six centers, we evaluated the data relative to 58 patients with midline pelvic pain laparoscopically treated, with a follow-up of at least 6 months including a quantitative pain assessment. The distribution of types of pain (dysmenorrhea, deep dyspareunia, and pelvic pain not related to menses or coitus) was not different among stage I–II endometriosis, stage III–IV endometriosis, and no visible pathology, except that deep dyspareunia was significantly (p < 0.05) less frequent in the absence of visible pathology than in moderate to severe endometriosis. Both types of laparoscopic denervations significantly (p < 0.001) reduced after 6 months the intensity of midline dysmenorrhea, pelvic pain, and d...