Gel instillation sonohysterography: first experience with a new technique

Objective: A practical attempt to simplify and improve the technique of artificial uterine cavity distension by instilling gel instead of flushing saline. Design: Prospective observational study. Setting: Teaching hospital. Patient(s): One hundred twenty patients with an indication for sonohysterography (abnormal uterine bleeding, exclusion of congenital abnormalities, or preoperative or postoperative evaluation of submucous myomas, polyps, or synechiae). Intervention(s): A hydroxyethylcellulose gel containing anesthetic and antiseptic agents was instilled in the uterine cavity through a plastic intrauterine insemination cannula attached to a flexible plastic tube and a syringe. Transvaginal (3-dimensional) ultrasonography was performed concomitantly. Main Outcome Measure(s): Stable filling of the uterine cavity allowing a high-quality ultrasonographic visualization. Result(s): An optimal distension of the uterine cavity could be achieved with an average of only 4 mL (range, 2-10 mL) in 113 patients. As expected, a stable filling of the uterine cavity permitted a precise visualization of the uterine cavity and its linings and offered an optimal presentation for a 3-dimensional ultrasound recording and reconstruction. Conclusion(s): Gel instillation is a simple technique with minimal inconvenience for the patient and seems to be an attractive alternative to saline infusion during sonohysterography.