How do gynecologistsproceed with diagnosing Ovarian Cysts?
Although we do not see an increase in the rate of ovarian cysts after tubal reversal surgery, polycystic or simply cystic ovaries are one of the concerns some patients have expressed after tubal reversal surgery. For most, a thorough exam after the tubal reversal surgery, or close monitoring after the tubal reversal surgery will alleviate these fears.
Predicting whether a cyst is benignor malignant is not always straightforward. Clinical examination, serumconcentrations of CA 125, and ultrasonography are the main diagnostic protocols available.
Clinical examination is often unsatisfactory, with 30-65% ofovarian tumours being unnoticed and mostly overlooked by most doctors. Ultrasound studies of ovarian cysts will however confirm the presence or absence of cysts in nearly all cases. Combined with a pelvic exam, this will lead to diagnosing close to 100% of all cysts.
Vaginal ultrasonography is the most widely performed and accurate procedure for prediction of the benign nature of a cyst.
How do Gynecologists conduct the evaluation?
1. Gynecologists first take a detailed medical history of the patient and perform a physical examination. During the physical examination the gynecologist will perform a pelvic exam.
2. In a pelvic exam the gynecologist will place an instrument called a speculum into the vagina and will examine the vaginal walls and the cervix. The gynecologist may take samples of vaginal discharge or perform a Pap smear (removing cells from the cervix with a small brush). Samples are sent to a laboratory for microscopical examination.
3. The gynecologist will then do a bimanual exam by inserting two fingers into the vagina and placing the other hand on the abdomen to examine the size and shape of the uterus and ovaries. The ovaries may feel larger than normal and this exam may make the patient have discomfort. If cysts are felt, the gynecologist will suggest additional laboratory and diagnostic tests.
4. Laboratory tests mostly include;
a) a complete blood count (CBC) and a WBC to perceive any infection and internal bleeding,
b)a pregnancy test to identify uterine pregnancy or ectopic pregnancy.
5. Diagnostic tests include an ultrasound, Doppler studies, Vaginal ultrasonography, and if needed, an x-ray and laparoscopy.
6. An ultrasound test mostly able to shows size, numbers and what the cysts are made of. If the patient having the cyst is consisted of solid materials or a combination of fluid and solid materials, the gynecologist may suggest an x-ray to find whether it is a benign cyst or a malignant tumor.
7. Gynecologists may recommend later an additional diagnostic test that is laparoscopy if he suspects endometriosis having the cyst enlarged much without fluid.
8. Laparoscopic procedure involves the placing of a laparoscope (a narrow tube with a fiberoptic light at one end) into the lower abdomen. This is done via a small incision just below the navel to detect the ovaries. Next if the gynecologist feels the necessity, he may drain the fluid from the cyst, or he can remove the cyst entirely.
Would cysts be discovered during a tubal reversal surgery?
Yes – if you have cysts on either ovary during your tubal reversal surgery, Dr. Morice can remove the cysts at no additional charge.