Abrasio is a scraping of the uterine cavity (synonym: abrasio uteri) for therapy and diagnosis. Parts of the mucosa or other tissue, such as polyps or fibroids (benign uterine muscle nodes), are completely or partially removed for histological examination (examination of fine tissue under a microscope). Abrasion is often used for diagnosis and therapy at the same time. Thus, tissue is simultaneously obtained for histological examination and pathological changes in the uterus such as polyps (a benign change in the mucosa) are removed.
Indications (areas of application)
- Metrorrhagia (bleeding outside the actual menstruation; it is usually prolonged and intensified, a regular cycle is not recognizable) in premenopause (= life span approximately starting from the 30th to 48th year of life).
- Failure to stop bleeding after hormone treatment.
- Postmenopausal bleeding (bleeding after which the last bleeding was absent for at least a year).
- Unclear ultrasound findings in the uterine cavity (polyps; hyperplasia, etc.).
The surgical procedure
After the gynecological palpation, the vagina is unfolded with the specula (gynecological examination instrument that allows the vagina (vagina) to be unfolded by spreading the two blades) and the portio (vaginal part of the uterus) is hooked. First, the scraping of the cervical canal (cervical canal) is performed. Then, the inner cervix is widened using so-called Hegar pins so that a curette (a kind of spoon with sharp edges) can be inserted into the uterine cavity and the tissue to be removed can be scraped out. Since the tissue is removed in two portions (fractions) and also examined histologically, this is called a fractional abrasion. This is useful in that it allows a distinction to be made between diseases of the cervix and the uterus. This is of great importance, because depending on the localization of the findings – especially in the case of malignant disease – different treatment must be carried out. Generally, in fractional abrasion today, before the uterine cavity is scraped, it is optically mirrored using a hysteroscope (HSK; instrument for mirroring the uterine cavity). This gives a better picture of the inside of the uterine cavity and facilitates the scraping, which would otherwise be performed without vision. Furthermore, hysteroscopy makes it possible to determine with certainty whether the tissue to be removed – for example, a polyp – could really be removed completely. If necessary, if there is evidence of incomplete removal, another curettage is performed or tissue is removed for examination using the hysteroscope. The procedure is generally performed under anesthesia. Only rarely is it performed under regional anesthesia (local anesthesia). It takes about 10 minutes and is usually performed on an outpatient basis. Usually, the bladder is emptied using a catheter before the procedure.
Possible complications
- Injury or perforation (piercing) of the uterine wall with the instruments, possibly with damage to adjacent organs (bowel, urinary bladder) is rare.
- Pain in the lower abdomen due to contractions of the uterus.
- Urinary retention or problems urinating for a few hours after the procedure (very rare).
- Light bleeding after hours or days is normal
- Infection or wound healing problems (very rare).
- Adhesions of the cervix, cervical canal, uterine cavity as a result of infection is possible. This can lead to menstrual disorders (cycle disorders) and / or conception difficulties (difficulties conceiving), possibly to sterility (infertility) (very rare).
- Hypersensitivity or allergies (e.g., anesthetics/anesthetics, medications, etc.) may temporarily cause the following symptoms: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
