COMPARATIVE STUDY OF THE ROLE OF ULTRASONOGRAPHY, LAPAROSCOPY AND HYSTEROSCOPY IN THE DIAGNOSIS OF CHRONIC PELVIC PAIN

Abstract

This study was conducted on 100 women'attending the department ·4 of obstetrics and gynecology, Benha University Hospital, complaining of CPP more than 6 month duration. For each woman included in the study, the following procedures were done: complete history, clinical examination, pelvic ultasonography, combined diagnostic hysteroscopy and laparoscopy under general anaesthesia with endotracheal intubation. We applied transabdominal pelvic ultrasonography as prelminary test for evaluation of intrauterine and extrauterine pelvic masses such as: uterine leiomyomas, uterine polyps or ovarian cysts. Then we used endoscopy (hysteroscopy or laparoscopy) as confirmatory test for evaluation of intrauterine lesion by hysteroscopy or extrauterine pelvic lesion by laparoscopy. Hysteroscopy offers simple method to investigate endocervical or endometrial pathology. We found that a variety of intrauterine abnormalities can be missed in diagnostic regimens that do not include hysteroscopy to evaluate CPP, and pelvic (U/S) alone can not evaluate intrauterine causes of CPP with positive predictive value (81.4%) and negative predictive value (36.8%). A diagnostic laparoscopy was arranged at which a search was made for any pelvic pathology to account for the pain, The finding of j even a single focus of endometriosis or an adhesion was given as a likely $ cause for CPP. Pelvic (U/S) evaluation of CPP usually needs confirmation by laparoscopy for extrauterine causes of CPP and we can