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Background: Endometriosis is one of the most common gynecological disorders, which causes pain and reduces fertility. An accurate diagnostic technique would be helpful in the management of these patients preoperatively. The objective of this study was to do a comparative evaluation of uterosacral involvement in deep infiltrative endometriosis by transvaginal sonography (TVS) and laparoscopic biopsy. Methods: TVS and laparoscopy were done in all patients suspected to have endometriosis. TVS examination was carried out to identify endometriotic lesions, and in suspicious laparoscopic views, biopsy was done and laparoscopic findings were confirmed by pathologic report. Then, TVS and pathological findings in laparoscopy were compared and data analyzed by SPSS Version 23. Results: In our study on 80 patients, the mean age was 34.47 ± 5.94 (mean ± SD) years. Comparison of ultrasound with laparoscopic examinations showed that ultrasound as the gold standard method, has sensitivity, specificity, and positive and negative predictive values of 93%, 65%, and 87%, and 78.9%, respectively, while in the diagnosis of increased uterosacral ligament thickness showed 82%, 100%, and 100% and 6.66%, respectively. While in the diagnosis of nodules in the uterosacral ligament, 100% for all four parameters in the diagnosis of endometrioma in the ovaries, and 71%, 96.4%, and 97.3% and 64.2%, respectively, in the diagnosis of rectal, bladder, and ureteral involvement. Conclusion: TVS can be used in the diagnosis of endometriosis by examining the increase in the thickness of the uterosacral ligament and the presence of hypoechoic nodules in it; also, this method demonstrates acceptable sensitivity and specificity in ovarian endometrioma.

Background: Hysteroscopy is a pragmatic diagnostic and operative method for the assessment of uterine pathologies. Cervical preparation is an important step for hysteroscopy, and it is recommended in order to reduce complications. The efficacy of Dilapan-S and Misoprostol as two means of cervical preparation were evaluated and compared in this study. Methods: This randomized clinical trial was conducted on women referred to Rasoul-e-Akram Hospital outpatient department. A total of 120 menopausal and non-menopausal patients with no history of vaginal delivery were included in this study. 400 micrograms of misoprostol and Dilapan-S were used for cervical ripening three hours before hysteroscopy. Cervical dilation was measured by the diameter of the largest dilator inserted without resistance prior to hysteroscopy. The time needed to achieve 9 mm dilatation was recorded. Complications of the procedure were evaluated and compared in both groups. Results: The size of the largest Hegar dilator without resistance in Dilapan-S and misoprostol groups were 7.6 ± 0.86 mm and 6.05 ± 1.04 mm, respectively (p < 0.0001). Preoperative complications including headache and nausea were significantly higher in misoprostol group (p = 0.013). Applying Dilapan-S for cervical ripening significantly reduced the time of cervical dilation (p < 0.0001). Conclusions: Short-term application of Dilapan-S before surgery, due to proper preparation of the cervix, increases the chance of successful hysteroscopy, without causing intolerance or major complications in patients or necessitating a longer preoperative hospital. Clinical Trial Registration: the study was registered at https://en.irct.ir/ (registration number IRCT20191123045476N2).