Hysteroscopic and Laparoscopic finding in Infertile Women with proven
Endometrial Tuberculosis
Abstract
Background: Currently, none of the diagnostic procedures for
detecting female genital tuberculosis (FGTB) are 100 percent reliable,
and the same is true for endoscopic results. There are several studies
accessible on hysteroscopic and laparoscopic findings that are
suggestive of TB. However, no study to our knowledge summarises the
findings of laparoscopic and hysteroscopic examination in subfertile
female patients with biopsy, culture, or other laboratory test-proven
endometrial tuberculosis. Objective: Evaluation of
hysteroscopic and laparoscopic findings in subfertile women suffering
from proven endometrial tuberculosis. Materials and methods:
16,784 infertile women had a diagnostic hysterolaparoscopy between
February 2014 and June 2021, among which 1084 patients were prescribed
anti-tubercular medication based on the results of their findings;
however, only 309 individuals had endometrial tuberculosis verified via
positive on histopathology examination, AFB demonstration, Culture, and
GeneXpert MTB/RIF. We retrospectively observed the diagnostic
hysterolaparoscopy findings in those proven cases of subfertile women
suffering from FGTB. Results: The major findings on
hysteroscopy were periosteal fibrosis (209/309,67.63%), pale
endometrium(179/309,57.92%), and micro polyp(138/309,44.66%). Other
notable hysteroscopic findings were intrauterine adhesions
(88/309,28.47%), endometrial tubercle (78/309,25.24%), endometrial
polyp(54/309,14.88%), caseation(42/309,13.59%), focal
hyperemia(29/309,9.38%) and diffuse hyperemia(18/309,5.82%). The most
common finding on laparoscopy was abdominopelvic adhesions of various
grades (297/309,96.11%). The major findings of laparoscopy were
tubercle (155/309,50.16%), isthmo ampullary block (118/309,38.18%),
tubal diverticula (116/309,37.54%), hydrosalpinx (97/309,31.39%) and
TO mass (96/309,31.06%). 5.50% (17/300) had a normal appearance on
hysteroscopy, and 1.29% (4/309) had a normal-looking pelvis on
laparoscopy. Conclusions: In proven endometrial tuberculosis,
significant hysteroscopic findings are periosteal fibrosis, pale
endometrium, micro-polyp, and intrauterine adhesions, whereas major
laparoscopic findings are various grades of abdominal pelvic adhesions,
including perihepatic adhesions, miliary tubercle, isthmo ampullary
block, tubal diverticula, caseous material, and hydrosalpinx.
Tuberculosis should be considered if these signs are discovered during a
diagnostic work-up in infertile people.