Transcript GENITO URINARY TUBERCUOSIS

HYSTEROSCOPIC MARKERS FOR
ENDOMETRIAL TUBERCULOSIS
Dr. PAAYAL CHOBE
Dr. Paayal Chobe
• MBBS (gold medalist), MD OBGY
• Clinical fellowship in Gynae -Laparoscopy-
Mumbai BEAMS
• Diploma in Gynae Laparoscopy KIEL &
GIESSEN GERMANY
• Presented poster in AICOG 2003
BANGALORE
• Presented paper use of Misoprostol prior
to hysteroscopy AMOGS 2009-Aurangabad
• Faculty in state conference AMOGS 2009
GENITO URINARY TUBERCUOSIS
Always secondary to Tuberculosis elsewhere
in the body usually in the Lungs,
Peritoneum, Lymph Glands and Bone.
1st case was recorded by Morgagni on
autopsy.
INCIDENCE:
• Involvement of organs –Norries
Site
Fallopian tubes
Endometrium
Ovaries
Cervix
Vagina & vulva
%
85-90
35-50
5-6
3
2
• Involvement of Endometrium
• Extensive
• The Endometrium is replaced by hyalanized
connective tissue thereby --------obliterating the
cavity.
• Patients present as Oligomenorrhoea to
Amenorrhoea.
HYSTEROSCOPY• Purely visual method of investigation.
• Gives better overall view of all the
pathological conditions and changes of the
endometrium.
• Better tissue perception as compared to
hysterosalphingography(HSG)
• Should ideally be coupled with
laparoscopy
Pre-Requisites
• Proper counseling
• Detailed history taking and P/S P/V
examinations
• Pre-menstrual
• Role of Misoprostol prior to hysteroscopy
• Paper presented at AMOGS 2009 study
conducted at Gauravi Centre For
Laparoscopy by Dr. Paayal Chobe
Diagnostic Hysteroscopy
• Distension medium-normal saline
• Sites to look for markers-endocervix
• Uterine cavity
• Endometrium
• Tubal ostium
Hysteroscopic Pictures
Normal endometrial cavity on hysteroscopy
Normal ostium and endometrium
Normal findings on hyteroscopy
Hysteroscopy Markers
• Usually os stenosed –so difficulty in
passing hysteroscope---misoprostol can be
used prior
• Endocervical canal-narrow
• Endometrial cavity-obliterated,adhesions
and distorted.
• Endometrial lining-pale,patchy
• Advanced cases tubal ostia not visualised.
Scanty Endometrium
Obliterated Endometrial Cavity
Fibrosed Endocervical canal & Cavity
Obliterated cavity Due to adhesions
Narrow endocervical canal
Confirmatory test
• Endometrial biopsy• However negative endometrial biopsy is not an
indication for discontinuing AKT as HPE of
endometrium does not necessarily reflect the
state of fallopian tubes
Endometrial biopsy
Other confirmatory tests
• TB PCR-polmerase chain reaction
• Senitivity 80-90%
Newer horizons
• TB Interferon-gamma release assays
• Most recent available test
Summary• Endometrial tuberculosis-important cause
of infertility
• Hysteroscopy better than HSG to diagnose
• Hysteroscopy should ideally be coupled
with laparoscopy
• Endometrial biopsy-confirmatory test