Transcervical Recanalization Research Articles

Combined use of laparoscopy and hysteroscopy in the treatment of female infertility

The experience of combined application of hysteroscopy and laparoscopy in treatment of infertile women is analyzed. An alternative technique of treating occlusion of the uterine tubes with the method of their transcervical recanalization using ureteral catheter is represented. The statement is made about the perspectives of applying combined hysteroscopy and laparoscopy in treatment of patients with infertility.

Evolution of reproductive surgery

Purpose: To show the main stages of formation, the current state and promising directions for the development of reproductive surgery in gynecology.
 Object and methods. This report is based on the data of clinical investigations of more than 350 women with tubal - peritoneal infertility. The results of масrо, microsurgical and laparoscopic methods of Fallopian tubes plastics were estimated by means of comparative analysis. The results of transcervical recanalization of Fallopian tubes in case of their proximal occlusion were also evaluated. An addition, we analysed the experimental data of animal investigations (rabbits) and studied available scientific articles.

Transcervical recanalization of fallopian tubes: problems and development prospects

In recent years many methods of transcervical cannulation of the proximall fallopian tube have been developed and reported in the literature. The purposes of this article is to review these techniques and their potential uses in modem practise.

The efficacy of transcervical recanalization of obstructed postoperative fallopian tubes.

The efficacy of transcervical recanalization of obstructed postoperative Fallopian tubes was evaluated in 29 patients who were referred for recanalization. Nineteen had strictures at the site of Fallopian tube reconstruction, and five had strictures, three had fistulae, and two had fistulae and strictures at the site of reversal surgery. A 0.014-inch highly flexible guidewire was passed through the obstruction into the ampullary segment, followed by a 1. 1-2.2 Fr bougie catheter to dilate the stricture. After recanalization, the distal tube was studied by selective salpingography. The method was technically successful in 17 of 19 patients with underlying inflammatory disease and resultant postoperative strictures. The tubes remained patent in 12 patients for a period of 12-48 months; three patients conceived, all delivering healthy babies. Significant disease of the distal tubes was present in seven patients. The technique succeeded in three of five patients with postoperative strictures following reversal surgery. One patient subsequently conceived and delivered a healthy baby. The technique failed in all five patients with fistulae complicating reversal surgery. Transcervical recanalization is thus recommended in the management of patients with postoperative strictures with underlying inflammatory obstruction and strictures complicating reversal surgery.

Salpingitis Isthmica Nodosa: Technical Success and Outcome of Fluoroscopic Transcervical Fallopian Tube Recanalization

To evaluate the technical success and outcome of fallopian tube recanalization (FTR) in salpingitis isthmica nodosa (SIN). SIN is a well-recognized pathological condition affecting the proximal fallopian tube and is associated with infertility and ectopic pregnancy. We reviewed the presentations, films, and case records of all patients attending for FTR for infertility from 1990 to 1994. Technical success and total, intrauterine, and ectopic pregnancy rates at follow-up were determined. SIN was observed in 22 of 349 (6%) patients. FTR was attempted in 34 tubes in these 22 patients. Technical success was achieved in 23 of 34 (68%) tubes affected by SIN. In 5 of the 11 failed recanalizations, failure was due to distal obstruction. At least one tube was patent on selective postprocedural salpingography in 17 of 22 (77%) patients. There were no recorded perforations or complications. At follow-up (mean 14 months), total, intrauterine, and ectopic pregnancy rates were 23%, 18%, and 4.5%, respectively. FTR in SIN is technically successful and, compared with previously reported results in unselected infertility patients, is associated with only a slightly less favorable intrauterine pregnancy rate and a comparable ectopic pregnancy rate. The findings of SIN at FTR should not discourage attempted fluoroscopic transcervical recanalization.

Recanalization of obstructed fallopian tube by selective salpingography and transvaginal bougie dilatation: outcome and cost analysis

To investigate effectiveness and cost of transcervical salpingography and recanalization in the management of infertility caused by tubal occlusion. Retrospective analysis of patients investigated with transcervical selective salpingography and, in some instances, treated by transcervical recanalization. Four hundred patients with hysterosalpingography diagnosis of obstructed fallopian tubes (clinical environment) are investigated. A repeat hysterosalpingogram after administration of a prostaglandin antagonist demonstrated patency of the tubes in 82 patients and selective transcervical salpingography demonstrated patency in an additional 131 patients. Transcervical tubal recanalization. Of the remaining 187 patients, recanalization by transcervical technique was successful in 145 patients. The underlying etiology for tubal obstruction was salpingitis isthmica nodosa in 62, salpingitis and perisalpingitis in 71, endometriosis in 8, failed surgical anastomosis in 43, and undeterminate cause in 3 patients. Pregnancy was attained in 24 patients, there were 10 minor and 1 major complication. Attained and maintained patency of tubes, pregnancy, attendant complications. A pregnancy rate of 12.8% was attained after transcervical recanalization of obstructed tubes. An attendant increased rate of pregnancy in patients proven patent after selective salpingography, valuable detailed information about proximal and distal tubes after recanalization of the obstructed proximal tube segment, the low rate of complications, and low cost are factors recommending the use of this technique. Moreover, tubal surgery or IVF treatment are not influenced adversely by prior transcervical tubal recanalization and remain an option for patients who failed to attain pregnancy.

Transvaginal recanalization of occluded fallopian tubes

SummaryTranscervical selective salpingography and transcervical recanalization of obstructed tubes by bougie dilatation are advocated for diagnostic assessment and therapeutic correction of obstructive lesions of the fallopian tubes. Premedication with aspirin (a prostaglandin antagonist) proved normal patent tubes in 82 of 400 patients, referred with the diagnosis of obstruction of both fallopian tubes on hysterosalpingograms. In another 131 patients, selective salpingograms proved one (n = 93) or both (n = 38) tubes to be patent. Premedication with a prostaglandin antagonist and selected salpingography proved the obstruction to be functional in nature in more than one-half (213/400) of the patients. In 133 of the remaining 187 patients, recanalization via the transcervical approach was possible. Forty-two of these patients became pregnant. Selected salpingography is recommended as a highly effective procedure to diagnose functional obstruction and allow assessment of the distal tubes not previously demo...

Transcervical recanalization of strictures in the postoperative fallopian tube.

To evaluate use of transcervical recanalization in patients with reocclusion of the proximal fallopian tube after failed surgery to reverse sterilization or failed tuboplasty to treat inflammatory disease. The standard technique for transcervical recanalization was attempted in seven patients after failed reversal surgery and in 12 after failed tuboplasty. Four of seven patients with failed reversal surgery had fistular tracts and one also had a stricture; the remaining three patients and all 12 patients treated after failed tuboplasty and tube reimplantation had strictures at the site of implantation or anastomosis. Transcervical recanalization failed in all patients with fistulas but succeeded in 13 of 15 with stenoses. Three patients became pregnant 1-16 months after recanalization and two after in vitro fertilization and embryo transfer. Reocclusion occurred in two of 10 patients reexamined 6-36 months after recanalization. Transcervical recanalization is recommended as an alternative to repeat microsurgical reimplantation or tuboplasty.