Cornual Obstruction Research Articles

Case Report: The effect of Kumari Taila Uttar Basti treatment on a patient diagnosed with bilateral cornual blockage in the Fallopian tube

Fallopian tube irritation is referred to as cornual block. It is brought on by a bacterial infection in the Fallopian tube, which spreads via sexuallty transmitted infection (STI), urinary tract infection (UTI), among others. Salpingitis is another name for fallopian tube inflammation. The patient, a 40-year-old registered at an infertility clinic, Sarangi Wardha, was examined for a cornual block using hysteroscopy and laparoscopy, which revealed the uterus and fallopian tube’s structural detail. The couple had been married for two years. It was noted that the patient had a history of failed IUI (intrauterine insemination) at her hometown fertility clinic. The patient anti-Mullerian hormone (AMH) was 0.16ng/dL, and her anti-follicular count (AFC) was poor. The intrauterine insemination failed as a result of cornual obstruction. The semen parameters of the male partner were normal. Bilateral ostia with sparse endometrium were seen during hysteroscopy. We had used Uttar Basti therapy for six days with a three-day gap. After treating the cornual block, patient’s ovum collection was done in January 2020. Fourteen oocytes were retrieved from the patient which were of 2GV, 5MI, and 7MII grade. Semen parameters were reportedly normal, but due to cornual block, ICSI (intracytoplasmic sperm injection) was performed. In March 2020, her first frozen embryo was thawed and transferred. A 2mg tablet of estrogen was given three times daily before the embryo transfer, from the second day of menstruation until the 14th. The patient had daily progesterone injections for six days beginning after the fourteenth day. Following embryo transfer, progesterone 2mg twice a day was given support and a dose of estrogen 2mg every day. A beta-human chorionic gonadotrophin hormone (hCG) test was performed fourteen days after embryo transfer. The report indicated positive beta-HCG value. The patient’s Fallopian tubes bilateral cornual obstruction is the main subject of this case report.

Fertility Outcomes following Laparoscopy-Assisted Hysteroscopic Fallopian Tube Cannulation: A Preliminary Study.

Objectives To determine fertility outcomes following laparoscopy-guided hysteroscopic tubal cannulation for cornual obstruction. Study Design A prospective cohort study in Life Institute for Endoscopy at Life Specialist Hospital Nnewi, Southeast Nigeria. Patients with unilateral or bilateral cornual tubal obstruction as the only cause of infertility were included. Outcome measures included successful tubal recanalization, procedural complications, conception rates (first spontaneous conception after the procedure), and live birth rates. Results Forty-nine infertile women were assessed for eligibility, but 27 met the inclusion criteria. Of 27 women, 24 (88.9%) had bilateral cornual obstruction and 3 (11.1%) had unilateral obstruction. Only three (11.1%) patients had failed cannulation. Successful recanalization rate was 90.2% (46/51) per tube and 88.9% (24/27) per patient. In the 24 patients with successfully recanalization, six spontaneous pregnancies (25.0%) and two intrauterine insemination-assisted pregnancies (8.3%) occurred within first six months of follow-up. All the eight (100.0%) pregnancies were intrauterine. The overall conception rate and live birth rate was 33.3%. There were no pre- or postprocedural complications. Conclusion Successful recanalization rate was 90.2% per tube and 88.9% per patient with a conception rate of 33.3%. Women with only cornual obstruction should be considered first for laparoscopy-assisted hysteroscopic cannulation before assisted reproduction.

Hysteroscopic and hysterosalpingographic study after intrauterine insertion of quinacrine pellets for non-surgical sterilization: results in 180 women

Objectives: Document the effects on the tube and uterus of one, two and three doses of 252 mg of quinacrine. Method: The study included 180 fertile women seeking permanent contraception at the Shatby Family Planning Clinic in Alexandria, Egypt, in 1988. All cases received three applications of seven 36 mg quinacrine hydrochloride pellets during the proliferative phase of three consecutive menstrual cycles. The patients were randomly divided into groups A, B and C. Hysterosalpingography (HSG) was performed on the 6th day of menstruation and hysteroscopy on the 10th day of the same cycle after the first application in group A, the second, in group B and the third, in group C. The study was concluded in 1999. Results: HSG showed 52 cases of bilateral obstruction, four of bilateral patency, and four of unilateral patency in group A. All in groups B and C elicited bilateral tubal obstruction. Cornual obstruction was seen in 33%, 65% and 85% in group A, B and C, respectively. Intramural obstruction was found in 50%, 33% and 10% in the three groups. Isthmic tubal obstruction was detected in 8%, 2.5% and 5% in groups A, B and C, respectively. Four types of ostial appearances could be recognized hysteroscopically. Type 0 (patent tubes), Type I (distal tubal blockage), Type II (intramural obstruction) and Type III (cornual obstruction). In group A, Type 0 was evident in 10%, Type I in 8%, Type II in 50% and Type III in 33% of cases. The respective figures in group B were 0%, 2.5%, 33% and 65%, while in group C, they were 0%, 5%, 10% and 85%. Hysteroscopy showed no abnormal endometrial findings in group A, but 35% and 85% of cases in group B and C showed some changes. Conclusions: Two applications of quinacrine were 100% effective. The side effects of quinacrine pellet applications were minimal and well tolerated by all the users. The possibility of reversal of the procedure is outlined.

Patient Rotation and Resolution of Unilateral Cornual Obstruction During Hysterosalpingography

© 2003 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Patient Rotation and Resolution of Unilateral Cornual Obstruction During Hysterosalpingography

Hurd, William W. MD; Wyckoff, Erich T. MD; Reynolds, David B. PhD; Amesse, Lawrence S. MD, PhD; Gruber, Jack S. MD; Horowitz, Gary M. MD Author Information

Patient Rotation and Resolution of Unilateral Cornual Obstruction During Hysterosalpingography

In Brief OBJECTIVE Unilateral obstruction of the proximal fallopian tube is identified in 10–24% of patients undergoing hysterosalpingography for evaluation of infertility. Upon further testing, this obstruction spontaneously resolves 16–80% of the time. We hypothesized that patient rotation during hysterosalpingography might resolve proximal tubal obstruction in some cases by altering either the location of intrauterine air bubbles or the spatial relationship of the tube to the uterine fundus. METHODS In patients in whom unilateral proximal tubal obstruction was detected during hysterosalpingography performed for standard clinical indications, the patient was rotated on her hip approximately 45° such that the obstructed tube was first superior (ventral) to the patent tube, and dye was reinjected. If obstruction did not resolve, the patient was rotated in the opposite direction so that the obstructed tube was inferior (dorsal) to the patent tube and dye reinjected. RESULTS Unilateral tubal obstruction was found in 15% of cases (24 of 156). Rotating the patient with obstructed tube superior to the patent tube never resulted in tubal patency, whereas rotating the patient with the obstructed tube inferior resulted in resolution of tubal patency in 63% of cases (15 of 24). CONCLUSION Unilateral cornual obstruction during hysterosalpingography is often resolved by rotating the patient such that the obstructed tube is more inferior. Although this observation may be the result of dislodging smaller air bubbles, from a fluid dynamics perspective a more likely explanation is unkinking of the more inferior tube. Unilateral cornual obstruction during hysterosalpingography is often resolved by rotating the patient such that the obstructed tube is more inferior.

Hysteroscopic tubal cannulation: long‐term results

ObjectiveTo examine the success rate and long‐term results of hysteroscopic cannulation under laparoscopic control for proximal fallopian tube obstruction.DesignRetrospective outcome analysis.SettingReferral endoscopic private practice for infertility.Subjects29 patients referred with proximal tubal cornual obstruction, confirmed by hysterosalpingography or laparoscopy, with other tubal factors confounding infertility. All patients underwent hysteroscopic proximal guide wire tubal cannulation under laparoscopic guidance.Main outcome measuresPregnancy outcomes from 2 to 5 years following the procedure.ResultsOf a total of 29 attempts at tubal cannulation, 16 were unsuccessful at the time of surgery (55%), while 13 patients had successful proximal tubal cannulation, and patency confirmed via intraoperative chromotubation. Of these 13, three were lost to long‐term follow up. Among the 10 remaining patients, there were three pregnancies: two term deliveries and one ectopic pregnancy. The remaining seven of the 10 patients with successful cannulations did not achieve pregnancy (70%) and elected for in vitro fertilization or adoption.ConclusionAfter over a decade of reports of hysteroscopic tubal cannulation, this procedure has been used as the first‐line, and often only, therapy for proximal tubal obstruction. The results of this series indicate that pregnancy rates are not as favourable as reported by others. These long‐term poor results should be considered when counselling patients with cornual occlusion about this surgery or other assisted reproductive options.

Laparoscopic myomectomy: The Italian experience

For many years hysterectomy has been considered the operation of choice for management of myomas instead of myomectomy, perhaps because of higher intraoperative morbidity and postoperative recurrence associated with the latter. 1 According to one group, the notion that myomectomy carries with it higher morbidity was not confirmed. 2 This may be due to improved surgical techniques. Recurrence of myomas is estimated to be approximately 15% to 30%, with a retreatment rate of 1 0 % . 3. 4 In recent years, corresponding with a rising trend to delay childbearing, myomectomy has become an increasingly common method of management. ~ Growing numbers of women are delaying their first pregnancy until their thirties and forties, thus adding infertility to the myoma problem. Several mechanisms by which myomas cause infertility have been postulated: elongation of the uterine cavity; cornual obstruction or distortion of fallopian tubes; vascularization; alteration of uterine fluid composition; and hypercontractility of myometrium. One report found that infertility and myomas were often associated, and 27% of women undergoing myomectomy experienced infertility. 3 A 50% pregnancy rate was reported after myomectomy in women with unexplained infertility. 1 The American College of Obstetricians and Gynecologists published the following guidelines for myomectomy in infertile women and in the those who request preservation of the uterus. ~ I. Leiomyomata in infertile women as a probable factor for failure to conceive or in recurrent pregnancy loss (all of the following must be present): A. In the presence of failure to conceive or recurrent pregnancy loss 1. Presence of leiomyomata of sufficient size or specific location is a probable factor. 2. No more likely explanation exists for failure to conceive or recurrent pregnancy loss. B. Before the procedure 1. Evaluate other causes of infertility. 2. Evaluate endometrial cavity and fallopian tubes. 3. Document discussion that disease process may require hysterectomy. II. Criteria for myomectomy in patients desiring to retain the uterus: A. Presence of either 1. Asymptomatic leiomyomata of such size that they are palpable abdominally and are a concern to the woman. 2. Ovulatory patients with leiomyomata as a probable cause of excessive uterine bleeding evidenced by either a. Profuse bleeding with flooding or clots, or repetitive periods lasting for more than 8 days. b. Anemia owing to acute or chronic blood loss.

Evaluation of the radiologic findings on hysterosalpingography by selective hydrotubation with flexible hysterofiberscope

The objective of this study was to assess further the significance and accuracy of hysterosalpingography (HSG) by comparing the radiologic findings on HSG to selective hydrotubation (SHT) using a hysterofiberscope in 106 women with tubal occlusion. Patency was successfully observed by SHT in 72 of 134 tubes and 62 of 106 patients. Proximal obstruction was divided into three groups according to the shape of cornual obstruction (sharp, dull, defect) on HSG. The success rate for SHT in unilateral obstruction (64%) were significantly higher than those in bilateral obstruction (39%). In the three groups of proximal obstruction, the success rates for SHT were 24, 75, and 30% in sharp, dull, and defect, respectively. The group of dull had significantly higher success rate than the groups of sharp and defect. Thirteen of 62 patients who successfully recanalized became pregnant at 9-month follow-up interval. Careful evaluation of the cornual obstruction in radiologic findings on HSG may be important for the decision on further treatment. Furthermore, SHT using a hysterofiberscope is an effective method for evaluating tubal obstruction and for managing it in a selected group of patients with tubal obstruction.

Surgery: Selective salpingography with an insemination catheter in the treatment of women with cornual Fallopian tube obstruction

The effectiveness of selective tubal cannulation using a simple and inexpensive tubal insemination catheter was evaluated in 23 infertile patients with cornual obstruction demonstrated by hysterosalpingography. Selective fluoroscopic tubal catheterization was accomplished in 95% of the patients with resulting tubal patency in 70% of the procedures (28 recanalizations out of 40 Fallopian tubes). Eight patients (34.8%, eight out of 23) became pregnant, six went on to full-term deliveries and two experienced spontaneous first-trimester abortions. One women conceived twice, and delivered a singleton pregnancy after the first recanalization and a twin gestation after the second salpingography. No complications were reported. The results of this study emphasize the ease, cost effectiveness and safety of this method, encouraging its use in patients with cornual Fallopian tube obstruction either as the sole therapeutic approach or in association with other assisted conception treatment alternatives.

Transcervical tubal catheterization utilizing flexible hysteroscopy is an effective method of treating cornual obstruction: A review of 120 cases

The author reviewed a 3 year experience in the treatment of bilateral cornual obstruction using an Olympus 4.7 mm flexible, operating hysteroscope (Olympus HYF-P) with a modified Katayama transcervical tubal catheter (Cook, Inc.) and concomitant laparoscopy. Of 120 patients undergoing treatment of bilateral cornual obstruction, the following results were obtained: post-operative patencies, 96; pregnancies, 48, of which 2 were ectopic; and reocclusions, 12. Of the reocclusions, 8 were treated with fluoroscopic catheterization of which two achieved normal pregnancies. The sole complication was a single cornual perforation with the tubal catheter. The results are statistically significant and indicate that the endoscopic treatment of bilateral tubal obstruction is effective.

Treatment of cornual obstruction by transvaginal cannulation without hysteroscopy or fluoroscopy

A new method for relief of cornual obstruction performed totally in the office is presented. We used the Jansen-Anderson catheter with 0.007-cm guide-wire for relief of the obstruction. Ultrasonography is used for demonstrating the position of the catheter and for tubal patency. Subsequent HSG is used for confirmation of tubal patency.

Diagnosis treatment of cornual obstruction using a flexible tip guidewire

Proximal tubal obstruction, either unilateral or bilateral, is a frequent finding on hysterosalpingogram (HSG). Approximately two-thirds of the fallopian tubes resected for proximal tubal obstruction reveal an absence of luminal occlusion. The distinction between true pathologic occlusion and either spasm or plugging is crucial in determining therapy. We combined hysteroscopic cannulation of the proximal fallopian tube with laparoscopy in 11 patients with proximal tubal obstruction diagnosed by HSG and confirmed at laparoscopy. Hysteroscopic cannulation was able to be performed in 72% of the fallopian tubes attempted, and there was a postcannulation patency rate by HSG of 73%. Six of the 11 patients became pregnant after tubal cannulation and adjunctive distal tubal surgery. Hysteroscopic cannulation of the fallopian tube is a safe diagnostic procedure that can be used to identify those patients with true proximal occlusion, and may also serve as a therapeutic procedure in some of these patients.

Diagnosis of cornual obstruction by transcervical fallopian tube cannulation

Interstitial fallopian tube obstruction (IFTO) occurs in 15% of hysterosalpingograms (HSG) performed for infertility. Conventional HSG or laparoscopy may not differentiate cornual spasm or other temporary cause from true obstruction. We used transcervical cannulation of the proximal oviduct with a 3-F Teflon catheter and flexible guidewire 0.018 inch (0.043 cm) in diameter under hysteroscopic or fluoroscopic guidance to evaluate IFTO in 28 patients. Fluoroscopic catheterization techniques with selective salpingography demonstrated patency in 84% of obstructed tubes. Hysteroscopic cannulation with direct visualization by laparoscopy or laparotomy was successful in 92%. In one patient, perforation of the isthmus occurred without sequelae. Transcervical coaxial cannulation of the proximal oviduct is an effective method for evaluating cornual obstruction.

Successful pregnancy outcome following removal of bilateral cornual polyps by microsurgical linear salpingotomy with the aid of the CO2 laser

Various surgical approaches have been advanced to treat cornual obstruction secondary to intraluminal polyps. This case illustrates microsurgical principles incorporating the CO2 laser to maximize the preservation of normal uterotubal anatomy and function after excising large bilateral cornual polyps and multiple uterine myomata and vaporizing endometriosis and pelvic adhesions. The subsequent conception and delivery of a viable full-term infant demonstrates the efficacy of this new approach. Additional studies are warranted to further evaluate the role of microsurgical linear salpingotomy with the CO2 laser in the treatment of cornual polyps to enhance fertility.