Generality
Sonohysterography, also known as hysterosonography, is a "transvaginal ultrasound that allows" a fairly accurate analysis of the internal cavity of the uterus.
Generally, doctors prescribe it when, based on a certain symptomatology or the patient's clinical history, they suspect uterine problems such as: polyps, fibroids, congenital anomalies, malignant tumors, endometrial adhesions, etc.
Minimally invasive, sonohysterography does not require any particular preparation and consists of two consecutive main moments: the first, in which the doctor performs a simple transvaginal ultrasound to evaluate the "orientation of the uterus, and a second, in which he analyzes in full the" entire uterine cavity thanks to the injection of a special saline solution.
The results are available immediately, however they require evaluation by a gynecologist.
Brief reminder of the uterus
Learn and hollow, the uterus is the female genital organ that serves to accommodate the fertilized egg cell (ie the future fetus) and to ensure its correct development during the 9 months of pregnancy.
Figure: representation of a normal uterus. According to the most accurate descriptions, the uterus has two other areas, in addition to the body of the uterus and the uterine cervix: they are the "isthmus of the uterus and the bottom (or base) of the uterus. The isthmus of the uterus is the constriction that divides the body and the neck of the uterus. The fundus (or base of the uterus) is the upper portion of the body, located above the imaginary line that joins the two fallopian tubes. It is rounded in shape and protrudes forward.
It resides in the small pelvis, precisely between the bladder (anteriorly), the rectum (posteriorly), the intestinal loops (above) and the vagina (below).
In the "span of life, the uterus changes its shape. If up to prepubertal age it has an elongated appearance similar to a glove finger, in adulthood it looks a lot like an inverted (or inverted) pear, while in the post-menopausal phase it gradually reduces its volume and becomes crushed.
From a macroscopic point of view, doctors divide the uterus into two distinct main regions: a more enlarged and voluminous portion, called the body of the uterus (or uterine body), and a smaller portion, called the neck of the uterus (or uterine cervix).
What is sonohysterography?
Sonohysterography, or hysterosonography, is an "ultrasound that allows accurate study of the uterine cavity transvaginally.
It is a minimally invasive diagnostic technique, as - beyond the insertion of the ultrasound probe into the vagina - it does not involve any exposure of the patient to radiation harmful to health.
ADDITIONAL PROCEDURES
Sonohysterography could also include the study of blood flow in the vessels supplying the uterus and other neighboring organs of the genital tract.
The ultrasound examinations that also allow an "analysis of the blood supply" are the so-called Doppler ultrasounds.
HOW DOES AN ULTRASOUND WORK?
The tool with which doctors perform an "ultrasound is the" ultrasound. An ultrasound system comprises three main elements: a computerized console, a monitor, and an ultrasound probe (or transducer).
The ultrasound probe is the element which, placed on the body, allows to view on the monitor (after processing by the computerized console) the organs and tissues located inside the examined area.
The transducer works like this: thanks to the passage of alternating electric current, the probe produces a certain amount of ultrasound; these penetrate through the skin and affect the underlying tissues (or organs). A portion of the penetrated ultrasounds is subject to refraction - that is, it is absorbed by the tissue - while another portion is subject to reflection - that is, it goes back towards the transducer.
In hitting the probe, the reflected altitude (also called echo) generates an electric current, which the computerized console can interpret and transform into images on the monitor.
The resolution of the images depends on the ultrasound emission frequency: the higher this frequency, the greater the penetration of the ultrasound into the tissues and the better the resolution.
The ultrasound gel
As readers who have undergone some kind of ultrasound in the past will have noticed, the doctor applies a special gel to the area of the body that he intends to examine with the probe.
Each type of ultrasound requires the use of this gel, as it is essential to eliminate the air that could come between the transducer and the anatomical area under examination.
All this allows for better quality images.
When you do
Doctors prescribe a sonohysterography when, based on some symptoms or signs present in a woman, they suspect some uterine problem, including:
- Polyps
- Fibroids
- Atrophy of the endometrium
- Endometrial adhesions
- Tumor masses or lesions of a malignant nature
- Congenital defects.
Particularly well-known congenital defects of the uterus are the so-called anomalies of the Müllerian ducts (bicornuate uterus, didelph uterus, septal uterus, uterine agenesis, etc.).
In addition, they also resort to it when they have to investigate cases of infertility or continuous spontaneous abortions.
I AM DOPPLER HYSTEROGRAPHY
A Doppler sonohysterography allows the doctor to evaluate:
- The presence of any obstructions along the blood vessels; obstructions, such as a clot, which prevents normal blood flow.
- The flow of blood in polyps, fibroids and congenital malformations.
- The presence of pelvic varicose veins (also known as pelvic varicocele) or aneurysms.
WHEN IS IT CONTRAINDICATED?
Sonohysterography is contraindicated in at least two situations:
- In case of pregnancy. In light of this, women who suspect even minimally of being pregnant must communicate it to their gynecologist, who can make the most correct decisions.
- In case of pelvic inflammatory disease. It is an acute or chronic inflammatory process that affects the female reproductive organs and adjacent structures. The most affected structures are the fallopian tubes; then, to follow, the uterus, the ovaries and the pelvic peritoneum. It is usually caused by some infectious agents, such as Chlamydia trachomatis, Neisseria gonorrhoeae And Mycoplasma hominis.
FOLLOW UP
Some pathologies and abnormalities of the uterus require periodic monitoring, especially during treatment or recovery from surgery (on the uterus).
This monitoring involves a series of diagnostic tests, often including sonohysterography.
Preparation
Sonohysterography does not require any special preparation. Therefore, it is not necessary to go on an empty stomach, interrupt any drug treatments, etc.
The only advice doctors give is to wear comfortable clothing.
WHAT IS THE BEST TIME TO TAKE THE EXAM?
According to the medical opinion, the best time to undergo sonohysterography is the first week after menstruation. There are at least two reasons for this:
- Immediately after menstruation, the endometrial mucosa is very thin, which makes it much easier to visualize the uterine cavity.
- It is almost certain that the patient is not already pregnant.
However, it should be noted that this timing indication applies in general. In fact, in some particular circumstances (N.B: it depends on the symptoms), doctors prefer to conduct the examination at other times of the menstrual cycle, because it is more useful for the purposes of obtaining information.
IN THE DAY OF THE PREVIOUS
Shortly before performing the sonohysterography, patients should empty their bladder.
Procedure
Once the patient has been seated on a classic gynecological couch, the radiologist (or a competent health technician) starts the sonohysterography with a simple transvaginal ultrasound, in order to first evaluate the orientation of the uterus and the appearance of the ovaries. For this first analysis, apply a sterile wrapping and the classic ultrasound gel on the probe (NB: in this situation, it also acts as a lubricant).
At the end of the transvaginal ultrasound, he takes out the probe and inserts one into the vagina speculum sterile.
Once the saline solution is injected, he extracts it speculum and insert the ultrasound probe again, this time to accurately visualize the internal cavity of the uterus.
During the Doppler sonohysterographies, the ultrasound probes used and the access route remain unchanged. What changes is the image observed on the monitor, which presents different colors depending on the blood flow.
HOW LONG DOES THE PROCEDURE TAKE?
The procedure just described lasts from 20 to 30 minutes.
WHAT DOES THE PATIENT FEEL DURING THE EXAMINATION?
Sonohysterography is a generally painless examination. In fact, the cases of women who find it annoying or not very tolerable are very rare and do not depend on how severe the symptoms are (this means that very pronounced symptoms do not affect the tolerability of the procedure).
Sometimes, the exam can cause small cramps and brief episodes of vaginal bleeding.
The former are due to the saline solution used; the latter last a few days and are a normal consequence of the insertion, in the vagina, of the speculum and the probe.
AFTER THE PROCEDURE
Since sonohysterography does not involve the administration of anesthetics or sedatives, at the end of the examination the patients can return home immediately and immediately dedicate themselves to normal daily activities.
Risks, benefits and limitations
Sonohysterography is a diagnostic procedure with almost no risk, as it does not involve injections, incisions or administration of drugs with possible serious side effects.
BENEFITS
We have already talked about some advantages, such as minimal invasiveness, high tolerability and non-use of ionizing radiation harmful to health. However, hysterosonography has other points in its favor:
- It is available to most, as it is not as expensive as other diagnostic imaging procedures.
- The soft tissue images provided are clear, much clearer than those obtainable with some X-ray examinations (which are harmful ionizing radiation).
- It is relatively short in duration.
- It allows to identify uterine anomalies that normal transvaginal ultrasound scans (therefore those in which the distension of the uterus walls is not expected) are not able to detect.
- It allows you to determine if a certain condition of the uterus (for example polyps or fibroids) is severe enough to require surgery. In other words, it clarifies when it is appropriate to operate and when it is not.
LIMITATIONS OF THE PROCEDURE
The limits of sonohysterography emerge on a few occasions.
One of these is when patients present with cervical stenosis (N.B: stenosis is the medical term for pathological narrowing). This condition does not allow the insertion of the catheter for the injection of the physiological saline solution, the purpose of which is to stretch the walls of the uterus. As will be remembered, the enlargement of the uterine cavity plays a fundamental role in obtaining clear and significant.
Results
Very often, the results of sonohysterography are available to the patient already at the end of the procedure. The result is always written by a radiologist, who observes and evaluates the images processed by the ultrasound scanner.
At this point, it is essential and necessary to consult your trusted gynecologist, who will express an opinion on what emerged from the sonohysterography and will plan a possible treatment.
