Hysteroscopic observations in 348 consecutive cases of female genital tuberculosis: A prospective study

Abstract

Study objective: To evaluate the hysteroscopic findings in female genital tuberculosis.

Design: It was a prospective study of hysteroscopic findings performed on 348 cases of female genital tuberculosis (FGTB).

Setting: It was a prospective cross-sectional study in a tertiary referral centre.

Patients: A total of 348 patients with infertility with FGTB on various tests.

Intervention: A total of 348 patients of infertility found to have FGTB on various investigations were enrolled in the study. A detailed history was taken. Clinical examination, endometrial sampling and diagnostic laparoscopy were performed was also performed in selected cases. All patients underwent hysteroscopy as part of evaluation for infertility and tuberculosis (TB) findings.

Measurements and main results: The mean age, parity, body mass index and duration of infertility was 28.2 years, 0.31,23.1kg/m² and 3.44 years respectively. Infertility was primary in 81.03% and secondary in 18.96% cases. Diagnosis of FGTB was made by endometrial aspirate findings of positive AFB on microscopy (4.02%), positive culture (4.88%), positive PCR (83.90%), epithelioid granuloma (14.65%), positive AFB on microscopy or culture of peritoneal cytology (1.14%) or epithelioid granuloma on peritoneal biopsy (1.72%), definitive findings of TB on laparoscopy (41.95%) or probable findings of TB on laparoscopy (58.05%). Various hysteroscopic findings observed were normal findings (28.16%), pale endometrial cavity (54.31%), features of active TB (7.47%), features of chronic TB (19.54%), features of TB sequelae like obstructed ostia (both ostia in 13.79%, one ostia 14.94%, periostial fibrosis; (bilateral 4.59%, unilateral 5.17%), endometrial glands atrophy (12.35%), small shrunken cavity (6.32%), distorted cavity (5.17%), various grades of intrauterine adhesions (29.88%). Hysteroscopy in FGTB was associated with increased difficulties and complications like failed procedures, difficult visualisation, false passage and uterine perforation.

Conclusion: Hysteroscopy is useful modality to detect endometrial TB but is associated with increased difficulty and complications.

Keywords: Female genital tuberculosis; Hysteroscopy complications; Infertility; Intrauterine adhesions.