Diagnosis Of Tubal Occlusion Research Articles

Comparison of Hysterosalpingography and Laparoscopy in Diagnosis of Tubal Occlusion

Background: Infertility is one of the most common conditions confronting Gynecologists and tubal factor is one of the most common causes of infertility. Hysterosalpingography and laparoscopy are used as methods for diagnosis of tubal patency in infertility. HSG is an OPD procedure and, for many years has been used as an invaluable procedure for diagnosis of tubal patency and intrauterine pathology in infertility. Laparoscopy is an invasive procedure and is used for evaluation of tuboperitoneal factors. Aims and objectives: To evaluate the diagnostic accuracy of hysterosalpingography in the diagnosis of tubal pathology in infertility in comparison to laparoscopy Methods: 60 patients of infertility were evaluated in the department of Gynecology and obstetrics, Government Lalla Ded Hospital ,Srinagar from April 2013 to August 2014. A prospective cross sectional study was performed. HSG was performed in the pre-ovulatory phase .Laparoscopy was performed under general anesthesia at least three months after HSG in the premenstrual phase. Diagnostic laparoscopy was considered as the reference standard in detecting tubal blockade and findings of hysterosalpingography were compared with laparoscopy. Results: All the patients in the study group were complaining of infertility. The total number of patients in this study was 60 in which 41 were in primary infertility group and 19 were in secondary infertility group. The age of patients was between 21 and 39 years. The average duration of primary infertility was 4.08 years and secondary infertility was 5.15 years. The sensitivity of HSG was 90.91% (95%CI: 76.43-96.86) and specificity was 77.78% (95%CI 59.24-89.39) with positive predictive value of 83.33% (95%CI 68.11-92.13) and negative predictive value of 87.50% (95%CI 69.0- 95.66),when tubal pathology was defined as any form of tubal occlusion detected at laparoscopy, either one sided or two sided. The further advantage of laparoscopy is the possibility of visualization of some other pelvic abnormalities which may be the cause of infertility. In our study, in patients with tubal block, adnexal adhesions were found in 15 (45%), endometriosis in 8(25%) and suspected intratubal block in 10(30%). Conclusion: HSG is the first step diagnostic test for assessment of fallopian tubes. Although laparoscopy is more invasive than HSG, laparoscopy with chromotubation is the gold standard for diagnosis of tubal block, and for identifying periadnexal adhesions and endometriosis and thus to guide appropriate therapy.

Comparison of Laparoscopy and Hysterosalpingography in Diagnosis of Tubal Occlusion

Comparison of Laparoscopy and Hysterosalpingography in Diagnosis of Tubal Occlusion

Uterine and tubal anatomical abnormalities in infertile women: diagnosis with routine hysterosalpingography prior to selective laparoscopy

Objective: To assess the findings and usefulness of hysterosalpingography as a routine investigation in the fertility workup prior to selective laparoscopy. 
 
 Design: Descriptive retrospective study.
 
 Setting: A university hospital in the north of Jordan.
 
 Subjects: All hysterosalpingographies performed in the period between 1st January and 31 December 2008. 
 
 Outcome measures: Detection of uterine and fallopian tube abnormalities and their correlation with laparoscopic findings.
 
 Results: During the study period, 281 infertile women underwent hysterosalpingography with no post procedural complications. The mean (SD) age was 31.5 (5.91) years. Mean (SD) duration of infertility was 4 (3.44) years. Infertility was reported as primary and secondary by 119 (42.3 %) and 162 (57.6 %), respectively. Altogether 281 patients and 562 tubes were examined. Of those, 402 were patent and 160 occluded. There was only one woman in whom peritubal adhesions were diagnosed. Because of hysterosalpingographically diagnosed tubal occlusion, 46 women (16.4 %) were referred for laparoscopy. Eight (17.3%) of them were treated with unilateral salpingectomy and 28 (60.8%) with bilateral salpingectomy. Salpingolysis was performed for 7 (15.2%) women, and 3 (6.7%) women had untreatable adhesions. The concordance was 71.7%. The sensitivity of HSG was 80%, the specificity 50%, the negative predictive value 61% and the positive predictive value 71%. Of the total of 281 women, 30 (10.7%) conceived within 1 - 11 months after the hysterosalpingography.
 
 Conclusions: The very high abnormal predictive value of hysterosalpingography in the diagnosis of tubal occlusion suggests that this procedure could be performed as a screening examination.

Comparisons of Hysterosalpingography and Laparoscopy Results in the Diagnosis of Tubal Occlusion

SUMMARY Objective: The compliance rate between the hysterosalpingography (HSG) and laparoscopy (L/S) results in patients who diagnosed tubal occlusion on the HSG was investigated. Also, the incidence of endometriosis was evaluated in the study population. Material and methods: Medical records of 139 women who were underwent L/S for the investigation of the tubal occlusion were reviewed retrospectively. The concordance rate between the HSG and L/S was investigated. The incidence of endometriosis in patients with no tubal pathology was compared with patients with unilaterally and bilaterally tubal occlusion. Results: Mean age of the women was 31.8±5.7years, mean BMI was measured as 24.6±4.6 kg/m2, and gravida 0 (05), mean infertility period was 30.7±3.7 months. Tubal occlusion was confirmed after the L/S in 38.8% of the patients (n=38) who has unilaterally tubal occlusion on the HSG. However, 58.8% (n=20) of the patients who were diagnosed as bilaterally tubal occlusion on the HSG was confirmed with the L/S. The misdiagnosis rate of the HSG was significantly high in women with unilaterally tubal occlusions compared with bilaterally tubal occlusions [(respectively, 61.2%, 51.2%) (p:0.001)]. Endometriosis was observed in 28.4% of the patients who had patent tubes and in 13.9% of the patients in the unilaterally tubal occlusion group and and in 22.7% of the patients in the bilaterally tubal occlusion group. But the difference was not statistically significant when groups were compared according to the rate of endometriosis (p=0.24). Conclusion: HSG is the first step diagnostic test for the assessment of the fallopian tubes. Although L/S is more invasive technique than HSG, L/S with chromopertubation is the gold standard test for identifying periadnexal adhesive disease and endometriosis.

The value of hysterosalpingography in the diagnosis of tubal pathology among infertile patients

To evaluate the diagnostic accuracy of hysterosalpingography in the diagnosis of tubal pathology among infertile patients. A prospective cross-sectional study in Kaunas University of Medicine Hospital within the period of 18 months was performed. Consecutive infertile women formed the study group according to defined criteria. Hysterosalpingography was performed in the preovulatory phase of the menstrual cycle. Laparoscopy and dye test was performed within one - three months after hysterosalpingography. General tubal pathology, tubal occlusion, and peritubal adhesions detected at hysterosalpingography were compared with general tubal pathology, tubal occlusion, and peritubal adhesions detected at laparoscopy. The study population comprised 149 infertile women. The sensitivity of 81.4% and specificity of 47.8% the likelihood ratio of a positive test result of 1.6 and a negative test result of 0.4 for hysterosalpingography while evaluating general tubal pathology was determined. Sensitivity of 84.1% and specificity of 59.1% and likelihood ratios of 2.1 and 0.3, respectively, were calculated, when tubal occlusion was defined as any abnormality of tubal patency. When definition of tubal occlusion was limited to two-sided occlusion, the sensitivity and specificity were 89.5% and 90% and likelihood ratios 9.0 and 0.1, respectively. As a test of peritubal adhesions, hysterosalpingography had sensitivity of 35.5% and specificity of 81.3% and likelihood ratios of 1.9 and 0.8, respectively. The diagnostic performance of hysterosalpingography in the diagnosis of general tubal pathology and peritubal adhesions is poor. Hysterosalpingography is more accurate in the diagnosis of tubal occlusion.

Hysterosalpingography versus Laparoscopy in the Evaluation of Female Infertility in Maiduguri, Nigeria.

Objective: To compare the results of hysterosalpingography and laparoscopic methylene blue test for assessment of tubal patency in patients with infertility. Subjects and Methods: The case records of 124 patients who underwent both hysterosalpingography and laparoscopy as part of comprehensive infertility work-ups at the University of Maiduguri Teaching Hospital between January 1996 and December 2000, inclusive, were reviewed. Results: There was a close correlation of both methods in 90.9% of the cases in the diagnosis of tubal patency. There was no statistical difference in the diagnosis of tubal occlusion using both hysterosalpingography and laparoscopy. However, there was a significant difference in the ability to make a diagnosis of peritubal adhesions for which laparoscopy was more useful (p < 0.001). Conclusion: The results suggest that laparoscopy is a superior method in the investigation of tubal patency with a better potential for full appraisal of peritubal adhesions prior to tuboplasty. It is therefore recommended as an essential investigation in patients with infertility. Key Words: Hysterosalpingography, Laparoscopy, Tubal Patency [Trop J Obstet Gynaecol, 2003, 20: 20-23]

The accuracy of serum chlamydial antibodies in the diagnosis of tubal pathology: a meta-analysis

Objective: To assess the discriminative capacity of Chlamydia antibody titers in the diagnosis of tubal pathology in subfertile patients. Design: Meta-analysis of studies comparing Chlamydia antibody titers and laparoscopy for tubal patency and peritubal adhesions. Patients: A total of 2,729 patients with subfertility in 23 studies. Intervention(s): Chlamydia antibody titer and laparoscopy as part of subfertility work-up. Main Outcome Measure: Sensitivity and specificity of Chlamydia antibody titers in the diagnosis of tubal pathology using laparoscopy with chromopertubation as the reference standard. Result(s): The discriminative capacity of Chlamydia antibody titers depended on the type of assay that was used. Summary receiver operating characteristic (ROC) curves of studies using ELISA or (micro)immunofluorescence revealed a better discrimination than the summary ROC-curve of studies using immunoperoxidase assay. Conclusion(s): The discriminative capacity of Chlamydia antibody titers by means of ELISA, microimmunofluorescence, or immunofluorescence in the diagnosis of any tubal pathology is comparable to that of hysterosalpingography (HSG) in the diagnosis of tubal occlusion. Chlamydia antibody testing involves little burden but provides no details on the anatomy of uterus and tubes. Whether or not Chlamydia antibody testing can replace HSG depends on the perspective taken in the diagnostic work-up of subfertility.

Tubal factors in infertility

Proximal, distal, and peritubal damage can be caused by a number of pathologic processes such as inflammation, endometriosis, and surgical trauma. The diagnosis of tubal occlusion relies primarily on hysterosalpingography, hysteroscopy, and laparoscopy. A number of innovative diagnostic procedures such as sonosalpingography, falloposcopy, and selective salpingography improved our ability to accurately diagnose tubal pathology. The long-standing surgical corrective approach to treat tubal occlusion has been replaced by noninvasive methods in selected patients with endoluminal damage. The development of noninvasive transcervical catheter methods to recanalize proximally obstructed fallopian tubes also allows access to the fallopian tubes for deposition of gametes and embryos and improves the diagnosis and treatment of tubal pregnancies. Transcervical tubal cannulation reduces the risks, costs, and morbidity of surgical procedures. The diverse applications of the transcervical tubal approach may also replace surgical invasive procedures in assisted reproductive procedures. Although radical changes have occurred in the treatment of proximal tubal occlusion, the repair of distal and peritubal damage frequently yields disappointing results, and will probably remain the challenge of the 1990s.