A randomized prospective trial of rigid and flexible hysteroscopy in an outpatient setting

Objective To compare flexible and rigid hysteroscopy in an outpatient hysteroscopy clinic. Design A randomized, single-blinded prospective study. Setting A one-stop, outpatient hysteroscopy clinic in a district general hospital. Subjects 96 women referred to the clinic with abnormal uterine bleeding. Main outcome measures Patient pain scores, local anaesthetic usage, need for cervical dilation, quality of view, correlation of clinical and histological findings, duration of procedure, operator's assessment of the ease of the procedure. Results Data from 83 women were analysed; three declined to enter the study, one failed to complete the pain scores and nine also had an operative hysteroscopy. Immediate median pain scores were statistically lower in the flexible hysteroscopy group, 1.2 vs. 3.6 (P = 0.001). The difference persisted 30 min after the procedure (0.4 vs. 1.1, P = 0.031). Pain experienced with endometrial biopsy was similar in the two groups (2.5 vs. 3.0, P = 0.16). There were no statistical differences between the two study arms with regard to procedure duration, quality of view, need for cervical dilation, anaesthetic usage or operator assessment of the ease of the procedure. There was agreement in clinical and histological diagnoses in all cases. The operators' assessment of patients' pain level correlated highly with patient pain scores. There were no statistically significant differences in any end-point between the two operators. Conclusion Flexible hysteroscopy is associated with lower levels of patient discomfort than rigid hysteroscopy. Other study variables were comparable for the two types of hysteroscopy.