The Value of Hysterosalpingography in Gynecologic Diagnosis

Abstract

THE modern urologist or gastro-enterologist would have great difficulty in practising with any degree of success without the use of opaque materials and the roentgen ray. The same difficulty confronts the gynecologist in making a finished diagnosis, in predicting prognosis, and in accomplishing proper treatment if he deprives himself of the use of hysterosalpingography. Many of the pathologic conditions with which the gynecologist must contend involve the cavities and linings of the uterus and tubes, and hysterosalpingography offers the best and simplest means of locating and estimating extent and severity of these conditions. The day has passed when one needs guess as to the condition of the internal os, the condition of the endometrium, the size and contents of the uterine cavity, and the patency of the tubes. My first impression of the method was that it had limitless possibilities for the elucidation of gynecologic diagnosis, but that it might present serious dangers. Increased experience, however, has allayed my fears and convinced me that hysterosalpingography, when properly executed, is safe, easily performed, a minor procedure from the patient's standpoint, and of the utmost value in a certain number of difficult gynecologic studies. The contra-indications are active, serious infection of the genital tract and normal pregnancy. It is obvious that strict aseptic and antiseptic precautions should attend the injection, and that the greatest care should be exercised in carrying out the various steps of the procedure. The maneuver is harmful when it is improperly or carelessly done, and dangerous if certain contra-indications, are not observed; it is unsuccessful if improper instruments or poor oil are used, and useless if one cannot read the films correctly. In over 1,200 injections of iodized oil into the uterus and tubes, I have had no catastrophies and no untoward results to be regretted. The technic may be made very simple or very involved. There is no need for a manometer, with its long tubing, or other complicated instruments which are difficult to manipulate, and there is no need for hospitalization of the patient. By using the technic herein described, one can complete the maneuver in approximately two minutes, with a maximum of results and a minimum of discomfort to the patient. The patient is placed in lithotomy position over a Bucky diaphragm at the end of a table which has stirrups. A good light reflected into the vagina is necessary. A vaginal speculum is inserted, and the vagina and cervix are cleaned of discharge. Tincture of iodine is applied to the cervix and to the external os. The anterior lip of the cervix is then grasped with a single tooth volsellum to hold it in a fixed position. The oil-filled, short-tipped cannula, attached to the syringe, is inserted into the external os, pressing the acorn of the cannula gently against its opening, and the oil is injected slowly into the uterine cavity.