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Uterine fibroids are the most common pelvic tumours, occurring in 30% of women over the age of 30 years. Their incidence increases with age, and they are more common in certain ethnic populations. The frequency of fibroids reported in literature varies widely due to differences in diagnostic tests used, populations studied and study design. The largest study to date, prospectively followed up 95,061 female nurses in America aged between 25 and 44 years with questionnaires every two years, to determine the incidence of fibroids among premenopausal women by age and race . The diagnosis of fibroids was self reported and confirmed for a sample of cases. The crude incidence rate in this study was 12.8 per 1,000 woman years. The standardised rates were much higher in black women than in white women, 30.6 and 8.9 per 1,000 woman years respectively. Even after adjusting for variables such as body mass index, infertility and contraception, the rates among black women were significantly higher than those amongst white women (RR 3.25; 95% CI 2.71–3.88). Another large American survey included 1,364 women aged between 35 and 49 years who were randomly selected from an urban health plan. All recruited women underwent transvaginal ultrasonography. The cumulative incidence of fibroids at 50 years of age was 70 and >80% for whites and African Americans respectively. The prevalence of fibroids is lower in Europe, although still remarkable from the healthcare point of view. An Italian cohort study documented an incidence of ultrasonographically detectable fibroids of 21% in a series of 341 unselected women residing in an urban zone aged between 30 and 60 years . A Swedish study recruiting 335 unselected subjects from an urban district and who accepted to undergo transvaginal ultrasonography showed a prevalence of 3% in women aged between 25 and 32 years and 8% in those aged between 33 and 40 years .
A careful vaginal examination allows detection of pathology of the pouch of Douglas, such as nodules of the rectovaginal septum or fixed retroverted uterus. The five steps in the fertiloscopy procedure are: hydropelviscopy, dye test, salpingoscopy, microsalpingoscopy, and hysteroscopy. Hydropelviscopy is performed by first inserting a Verres needle into the pouch of Douglas. This needle is inserted 1 cm below the cervix, and then saline solution is instilled through a perfusion line using no other pressure than gravity. Introduction of a Verres needle and then of the fertiloscope in the pouch of Douglas sometimes raises fear of rectal injury. The fundamental question was to know at an early stage whether fertiloscopy was as accurate as laparoscopy, which was considered at that time the "gold standard" in infertility investigation. The only real complication is represented by rectal injury. However, such injury may be always treated conservatively with antibiotics without surgical intervention.
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