Background: Hysteroscopic metroplasty is considered the standard treatment of the uterine septum. Incomplete removal of the septum is usually evaluated by a second-look office hysteroscopy.
Aim: To compare the efficacy of Saline Sonohysterography (SS) against office hysteroscopy in diagnosing incomplete resected septum. Methods: We performed a retrospective cohort observational study on 56 patients in a private hospital in Saudi Arabia from January 2020 to December 2022. The patients were diagnosed with uterine septum by transvaginal ultrasound and were operated upon by Hysteroscopic resection of the uterine septum. Eight weeks later, Saline sonohysterography was done during the postmenstrual phase for all patients. The primary outcomes were the residual septum length. The secondary outcomes were the residual cavity length and the intrauterine adhesions.
Results: our study showed no significant differences between the results of Saline Sonohysterography and office hysteroscopy regarding the length of the fundal notch (P-value=0.317) and residual cavity length (P-value=0.560), and it showed very good agreement between their results (P-value <0.001). Regarding intrauterine adhesions detection, Saline Sonohysterography showed a sensitivity of 55.5%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 91%, 92% accuracy (P-value <0.001) with good agreement with the results of the office hysteroscopy by Kappa method (K=0.672).
Conclusion: Saline Sonohysterography is as effective as office hysteroscopy in diagnosing incomplete uterine septum excision.