Endometrial polyposis
In case of polyposis, the uterine cavity is lined with numerous polyps of different sizes - the surgeon sequentially removes them with a loop; in case of widespread hyperplasia, he performs resection of the functional layer of the endometrium (if there are no plans for pregnancy, ablation is possible), controlling the balance of the dilating fluid and the operation time. All material is examined histologically with an assessment of atypia - if it is detected, the tactics are determined together with the gynecological oncologist. Without treating the cause, polyposis recurs, so after surgery, hormonal therapy (gestagens, IUD with levonorgestrel) and ultrasound monitoring are prescribed every 3-6 months.
Indications
- endometrial polyps of any size according to ultrasound/hysteroscopy - mandatory removal with histology, especially in menopause;
- abnormal uterine bleeding, intermenstrual discharge, postmenopausal bleeding;
- polyps in case of infertility, miscarriage, before IVF;
- recurrent and multiple polyps, polyps in combination with hyperplasia.
Why resectoscopy and not curettage?
Curettage “blindly” leaves a stalk of the polyp in 30–50% of cases, which leads to relapse and injures the healthy endometrium; hysteroresectoscopy removes the polyp under visual control exactly at the base along with the stalk and preserves the rest of the endometrium - relapses are reduced to 5-10%, and in case of infertility, the implantation rate increases. Each polyp is examined histologically: in 1–3% (in menopause - up to 5–10%), atypia or cancer is found in them, so removal is indicated for everyone, including asymptomatic people. The price depends on the number of polyps.
