HIDROSALPINX BILATERAL PDF

Rechsteiner 1. Rodrigues 1. During a research visit for tissue collection at an abattoir located in Pelotas, Brazil, one female genital tract showed both enlarged oviducts. The reproductive tract was collected and analyzed. Occluded uterine tubes and an increase in the organ volume due to the large amount of fluid in the organ lumen were the macroscopic findings. Three samples, corresponding to isthmus, ampulla and infundibulum from each uterine tube and one sample from the endometrium were collected.

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The development of IVF techniques has diminished the importance of tubal infertility but recent discoveries shed a new light on reproductive tubal surgery prior to any IVF cycle. To adapt current state of the art recommendations concerning tubal factor infertility to actual possibilities in Romanian healthcare system and to grow the awareness of fellow fertility specialists and general practitioners to the improved outcomes of novel management and treatment modalities.

Methods and results. Four articles described general diagnosis using data from medical history, 21 works approached the diagnosis through hysterosalpingography, 14 papers introduced the use of different sonographic procedures, 8 files analyzed the importance of exploratory laparoscopy and 20 articles reviewed different treatment modalities.

The problem of fertility is growing nowadays not only in western countries but also in other areas as even in developing countries the couples postpone childbirth well over the age of 30 in order to focus on their careers and financial stability [ 1 ]. As seen in many guidelines the gold standard end point of care when speaking about infertility are the IVF techniques, but these are still expensive and present low accessibility in many countries and needless to mention that in some instances there is the barrier of culture and religion that needs to be broken [ 2 ].

Main causes of tubal factor infertility are: tubal obstruction or occlusion proximal, distal, unilateral or bilateral [ 3 ], endosalpingeal destruction [ 4 ], periadnexal adhesions [ 5 ], pelvic inflammatory disease [ 6 ], endometriosis [ 7 ], ectopic pregnancy [ 8 ], abdomino-pelvic surgery, use of intrauterine devices, induced surgical abortion [ 9 ], etc. International databases were queried for articles on the subject of management in tubal infertility.

Therefore, 67 free full text articles were found on this subject with the following distribution concerning the main subjects: 4 articles on general diagnosis using data from medical history, 21 works concerning hysterosalpingography, 14 papers on the use of different sonographic procedures, 8 files on the importance of exploratory laparoscopy and 20 articles analyzing different treatment modalities.

In case of suspected tubal infertility women who are not known to have comorbidities PID, history of ectopic pregnancy or endometriosis should be offered hysterosalpingography as initial screening test; alternatively hysterosalpingography should be replaced with hysterosalpingo-contrast-ultrasonography if available and in case of associated comorbidities the patient should be subjected to laparoscopic chromopertubation [ 10 ]. Tubal spasm is the culprit for lower accuracy of this diagnostic imaging technique but with the use of intravenous scopalamin and rotation of the patient it has been reduced to a minimum [ 12 ].

HSG has two contraindications: PID and pregnancy always perform the procedure during days of the cycle , and a history of allergic conditions requires premedication with methylprednisolone 32mg for 12h and 2h in advance [ 13 ]. Moreover HSG with an oil-based contrast media has been proven to have a somewhat therapeutic role through flushing of tubal debris [ 14 ]. Sonohysterography and hysterosalpingo-contrast sonography are credited with Hysterosalpingo-contrast sonography evolved from using a negative contrast which is saline water to a positive contrast agent that is microbubble agent and from 2D to 3D and even 4D imaging [ 16 ].

HyCoSy is advantageous as patients exhibit a better pain tolerance, avoidance of iodinated contrast medium and preventing the use of ionizing radiation [ 17 ]. Unfortunately laparoscopic chromopertubation remains the gold standard in evaluating the tubal sterility Fig. Through the injection of diluted indigo carmine into the uterine cavity with simultaneous laparoscopy in order to visualize the tubal fill and spill into the abdomen Fig.

The disadvantages of this procedure are: expensive, invasive and requires anesthesia Fig. For proximal tubal disease other macroscopic anastomosis surgeries have been abandoned in favor of selective salingography and transcervical tubal cannulation. In cases with distal tubal disease is offered the option of a neosalpingostomy which can be technically upgraded till the level of laparoscopy with CO2 or yttrium aluminum garnet laser used for performing a cruciate incision at the distal end of the tube [ 22 ].

There are still some unclear aspects concerning the association between hydrosalpinx and tubal sterility but the introduction of salpingectomy prior to IVF procedures has improved overall outcome of IVF procedures and thus proved 2.

A distinct group of patients with tubal infertility is that requiring sterilization reversal through tubal reanastomosis. Reproductive surgery has the objective of restoring the natural procreation in couples with tubal factor infertility. At worldwide level, there is still need for a randomized control trial comparing the benefits and costs for IVF versus reproductive tubal surgery.

Unfortunately, in Romania the expertise chain needed for a complete fertility clinic is broken at the level of diagnosis through sonography as in the evidence of the Romanian Society for Ultrasonography in Medicine and Biology there are registered only 3 healthcare specialists able to perform hysterosalpingo-contrast sonography. Given the fact that nowadays a single IVF cycle costs around U.

National Center for Biotechnology Information , U. Journal List J Med Life v. J Med Life. Author information Article notes Copyright and License information Disclaimer. Received Oct 24; Accepted Jan 6. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Rationale. Keywords: tubes, infertility, hysterosalpingography, ultrasonography, laparoscopy. Introduction The problem of fertility is growing nowadays not only in western countries but also in other areas as even in developing countries the couples postpone childbirth well over the age of 30 in order to focus on their careers and financial stability [ 1 ].

Methods International databases were queried for articles on the subject of management in tubal infertility. Results In case of suspected tubal infertility women who are not known to have comorbidities PID, history of ectopic pregnancy or endometriosis should be offered hysterosalpingography as initial screening test; alternatively hysterosalpingography should be replaced with hysterosalpingo-contrast-ultrasonography if available and in case of associated comorbidities the patient should be subjected to laparoscopic chromopertubation [ 10 ].

Open in a separate window. Discussions For proximal tubal disease other macroscopic anastomosis surgeries have been abandoned in favor of selective salingography and transcervical tubal cannulation. Conclusions Reproductive surgery has the objective of restoring the natural procreation in couples with tubal factor infertility. Disclosures None.

References 1. Fertility: assessment and treatment for people with fertility problems. London: Royal College of Obstetricians and Gynecologists; Inhorn MC, van Balen F. Infertility around the globe. Los Angeles: University of California Press; Farhi J, Ben-Haroush A. Distribution of causes of infertility in patients attending primary fertility clinics in Israel. How members of the Society for reproductive endocrinology and infertility and Society of reproductive surgeons evaluate, define and manage hydrosalpinges.

Fertil steril. A new classification system for pregnancy prognosis of tubal factor infertility. Int J Clin Exp Med. Genital Chlamydia trachomatis: an update. Indian J Med Res. Effect of endometriosis on inplantation rates when compared to tubal factor in fresh non donor in vitro fertilization cycle. J Hum Reprod Sci. Tubal patency following surgical and clinical treatment of ectopic pregnancy. Sao Paolo Med J. A case-control study on the relationship between induced abortion and secondary tubal infertility in Vietnam.

Fukushima J Med Sci. Seli E. Oxford: Wiley-Blackwell; Should a hysterosalpingogram be a first line investigation to diagnose female tubal subfertility in the modern subfertility workup?

Human Reproduction. Hysterosalpingography in the workup of female infertility: indications, techniques and diagnostic findings.

Insights Imaging. Imaging of female infertility. J Radiol. Prevalence of tubal obstruction in the hysterosalpingogram of women with primary and secondary infertility. J Reprod Infertile.

Panchal S, Nagori C. Imaging techniques for assessment of tubal status. First experience using 4-dimensional hysterosalpingo-contrast sonography with SonoVue for assessing Fallopian Tube Patency. J Ultrasound Med. Hysterosalpingocontrast sonography HyCoSy : evaluation of the pain perception, side effects and complications. BMC Medical Imaging. The significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by hysterosalpingography.

Tohoku J Exp Med. Infertility evaluation via laparoscopy and hysteroscopy after conservative treatment for tubal patency. Laparoscopy: as a first line diagnostic tool for infertility evaluation. Journal of Clinical Diagnostic Research. Female infertility. Clinical Evidence. Sotrel G. Is surgical repair of the fallopian tubes ever appropriate? Reviews in obstetrics and gynecology. Hydrosalpinx functional surgery of salpingectomy?.

The importance of hydrosalpinx fluid in assisted reproductive technologies. J Gynecol Endosc Surg. Reproductive outcomes after operative laparoscopy of patients with tubal infertility with or without hydrosalpinx. Chin Med J. Yashoda RA. A study on tubal recanalization. Journal of Obstetrics and Gynecology of India.

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Current management of tubal infertility: from hysterosalpingography to ultrasonography and surgery

The development of IVF techniques has diminished the importance of tubal infertility but recent discoveries shed a new light on reproductive tubal surgery prior to any IVF cycle. To adapt current state of the art recommendations concerning tubal factor infertility to actual possibilities in Romanian healthcare system and to grow the awareness of fellow fertility specialists and general practitioners to the improved outcomes of novel management and treatment modalities. Methods and results. Four articles described general diagnosis using data from medical history, 21 works approached the diagnosis through hysterosalpingography, 14 papers introduced the use of different sonographic procedures, 8 files analyzed the importance of exploratory laparoscopy and 20 articles reviewed different treatment modalities.

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Fallopian tube carcinoma: pearls and pitfalls

This condition is often bilateral, and even when hydrosalpinx affects just one tube, the other one tends to be abnormal at some point as well. Although a large number of patients with hydrosalpinx are asymptomatic in most cases this is an incidental finding , hydrosalpinx is characterized by producing:. Hydrosalpinx is often caused by chronic infections of the fallopian tubes. In most cases these are caused by sexually transmitted diseases such as gonorrhea or chlamydia, which may go undetected for years, slowly damaging the tubes. Transvaginal ultrasound. This easy-to-perform procedure allows the specialist to observe the presence of liquid inside the tubes.

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Hydrosalpinx

Brought to you by. Tentugal 1 , T. Cunha 2 , A. Learning objectives To illustrate the radiologic spectrum of fallopian tube carcinoma.

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Hidrosalpinx

A hydrosalpinx is a condition that occurs when the fallopian tube is blocked and fills with serous or clear fluid near the ovary distal to the uterus. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility. A fallopian tube filled with blood is a hematosalpinx , and with pus a pyosalpinx.

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