Tubal Catheterization Research Articles

Place of Selective Tubal Catheterization in the Management of Female Infertility in Togo

Objective: To determine the effectiveness of selective tubal catheterization in the management of female infertility due to proximal tubal obstruction. Method: This was a longitudinal descriptive study, conducted over a period of 24 months, which included 73 patients presenting with objectified bilateral proximal tubal obstruction after standard HSG. The intervention was performed on an outpatient basis, during the follicular phase with negative β-hCG assay the day before, in the interventional radiology room and under antibiotic coverage. Confirmatory hysterosalpingography was performed as the first step followed by selective tubal catheterization after the failure of spontaneous tubal opacification. The parameters studied related to socio-epidemiological, clinical and radiological data. Results: The age of our patients was between 24 and 42 years with an average of 33.97 years. The average duration of infertility was 3.95 years, with a predominance of primary infertility in 83.56% of cases. Voluntary termination of pregnancy (38.89%) and fibromyomas (33.33%) were the most represented gynecological-obstetrical antecedents. Selective tubal catheterization was successful in 92.14% of cases (129/140 tubes). It was possible bilaterally in 93.02% of cases and unilaterally in 6.98% of cases. The confirmatory HSG allowed a spontaneous opacification of 4.10% of the fallopian tubes. At the end of the procedure, all the recanalized tubes were opacified; 62.01% of them were normal, against 37.99% pathological with a preponderance of inflammatory tubes 26.61% followed by hydrosalpinx in 5.03% of cases. No major complications were encountered. The fertility rate was 23.29%. Conclusion: Selective tubal catheterization is a simple technique, without major complications with an efficiency close to natural fertility. It should be proposed as the first intention before any other procedure in the treatment of infertility by proximal tubal obstruction.

Extraperitoneal laparoscopic simple prostatectomy with urethra preservation using urethral initiation as the entry point: a practical approach for the treatment of benign prostatic obstruction.

The present study introduces a modified surgical procedure, extraperitoneal laparoscopic simple prostatectomy (LSP) with urethra preservation using urethral initiation as the entry point, and evaluates its feasibility, safety, and efficacy in the treatment of benign prostatic obstruction (BPO). A total of 50 patients with BPO underwent modified LSP from January 2018 to December 2020. The main surgical procedures performed were as follows: transversely incision of prostate surgical capsule at the urethral initiation; creating of the subcapsular plane and the space between urethra and adenoma; removal of lobes with preservation of urethra followed by suturing of capsule. Preoperative, perioperative, follow-up parameters, and complications were recorded and analyzed. Operative time was (106.34 ± 28.00) min and intraoperative blood loss was (98.80 ± 130.58) ml. Continuous bladder irrigation (CBI) was not performed routinely, catheterization duration was (5.26 ± 2.99) days, and postoperative hospital stay was (5.42 ± 1.62) days. Significant improvements were observed in functional outcomes, whereas no retrograde ejaculation, urinary incontinence, and urethral stricture occurred. Urethral rupture was not significantly influenced by operative time, intraoperative blood loss, and prostate volume. However, it prolonged CBI duration, drainage tube retention time, catheterization duration, and postoperative hospital stay. Operative time decreased with an increase in the number of cases, and the surgeon achieved proficiency level after handling 21-25 cases. Extraperitoneal LSP with urethra preservation using urethral initiation as the entry point is a feasible, repeatable, safe, and effective surgical procedure, which is suitable for treating BPO.

Accurate identification and surgical correction of type IIb uterine malformation using synchronized hysteroscopy and laparoscopy

To introduce an effective approach for accurate identification and treatment of type IIb uterine malformation using synchronized hysteroscopy and laparoscopy. Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique. The patient provided written informed consent for video and data collection for research purposes. The study was approved by the local ethics committee of Shengjing Hospital of China Medical University. Academic medical center. A 32-year-old young woman diagnosed with a right unicornuate uterus with a left rudimentary horn, with a 2-year history of dysmenorrhea. First, the patient was diagnosed with a unicornuate uterus with a rudimentary horn using ultrasonography and magnetic resonance imaging before the surgery. During surgery, synchronized hysteroscopy and laparoscopy coupled with a light test was performed to make a definite identification of the type IIb uterine malformation. During treatment of the type IIb uterine malformation, there were two key steps: resected the rudimentary horn and reserved more myometrial tissue to reduce the risk of uterine rupture in a subsequent pregnancy; and corrected the uterus to prevent future uterine prolapse. For the suture technique, suturing during resection was performed instead of suturing after complete resection to reduce the intraoperative bleeding as much as possible. Furthermore, tubal catheterization and hydrotubation under hysteroscopy monitoring were performed. Value and feasibility of synchronized hysteroscopic and laparoscopic identification and treatment of the type IIb uterine malformation. The total operation time was 89 minutes. The postoperative pathological findings revealed that the endometrium was found in the rudimentary horn. No dysmenorrhea was found during follow-up. At 26 months after the operation, the patient became pregnant naturally. Cesarean section was performed at 36 weeks + 2 days owing to premature rupture of the membranes. For the accurate identification and management of a type IIb uterine malformation, synchronized hysteroscopy and laparoscopy is an effective and feasible method.

The pregnancy rate of infertile patients with proximal tubal obstruction 12 months following selective salpingography and tubal catheterization

ObjectiveTo assess the efficacy of selective salpingography (SSG) with additional tubal catheterization (TC) among infertile patients diagnosed with PTO and analysis of reproductive outcome. Study DesignRetrospective cohort study. ResultsOf a total of 399 tubes with confirmed proximal tubal occlusion, 383 successfully restored their patency resulting in 96 % technical success rate. Thirty-five percent of oviducts that had their patency restored was treated with SSG and 65% required additional TC.Reproductive outcomes at minimum 12 months following the treatment were collected by a telephone survey. 21/221 women were lost to follow up. Out of remaining 200 patients with at least one patent tube, 80 patients conceived which resulted in 40 % overall pregnancy rate. ConclusionSelective salpingography and tubal canalization offer patient-friendly, minimally invasive and cost-effective alternatives to tubal microsurgery and IVF-ET in women with tubal occlusion with very high technical success rate and promising clinical results which depend also on the complexity of couple infertility. Specific indications and limitations make a careful assessment of fallopian tubes and comprehensive evaluation of partners' reproductive situation prior to therapy an absolute requirement.

Ultrasonography-guided hysteroscopic tubal catheterization of proximally occluded tubes - reproductive outcomes

Objective: To evaluate the reproductive outcomes of infertile patients suffering from proximal tubal occlusion (PTO) following ultrasonography-guided hysteroscopic tubal catheterization (HTC). Materials and Methods: A retrospective cohort study of infertile patients who underwent ultrasonography-guided HTC in a tertiary hospital, between 2010 and 2016. All patients included were diagnosed with unilateral/bilateral PTO on hysterosalpingograpy (HSG). HTC was performed using a modified Novy cornual cannulation set which was inserted through a 5F working cannel during an office operative hysteroscopy, followed by fallopian tube irrigation with saline-air mixture under ultrasonographic imaging. Patients who did not conceive in the following 6-12 months were referred to IVF treatment. Results: Sixty-one patients were included. Tubal recanalization rate was achieved in 25/25 of unilaterally occluded tubes (100%), and in 63/72 of bilaterally occluded tubes (87.5%). Median duration of follow up after catheterization was 40.57 months. In a median of 3.5 months following the procedure, 16 (26.2%) patients conceived spontaneously (n=14) or following intrauterine insemination (n=2), 12 (19.6%) of them delivered . Twenty-two additional patients underwent IVF after a median of 11 months following HTC. Sixteen of them conceived following a median of two cycles, of whom 75% failed IVF treatment prior to HTC. Conclusion: Ultrasonography-guided HTC may form an acceptable treatment modality in cases of PTO. Further research is needed to investigate the role of HTC in cases of PTO and repeated implantation failure.

Proximal Tubal Obstruction: Pathogenesis and Management

Abstract Objective: Proximal tubal obstruction is diagnosed with 15% of hysterosalpingograms performed for patients who have infertility. The accepted management is tubal catheterization. The aim o...

Ultrasonography Guided Hysteroscopic Tubal Catheterization of Proximally Occluded Tubes- Reproductive Outcomes

Ultrasonography Guided Hysteroscopic Tubal Catheterization of Proximally Occluded Tubes- Reproductive Outcomes

Retroperitoneal fibrosis secondary to non-urology carcinomas: a clinical and outcome analysis of 97 cases

Accumulated evidences have reminded us that since the prognosis of retroperitoneal fibrosis (RPF) secondary to non-urology carcinoma is poor it is essential to distinguish this condition from others. The objective of this study is to investigate the clinical features and outcomes of this infrequent but life-threatening disease. A total of 97 patients diagnosed with RPF secondary to non-urology carcinoma were enrolled in this retrospective study. The baseline information, history of carcinoma, clinical presentation, laboratory results, diagnosis, treatment and prognosis of the patients were collected and analyzed. The mean age was 62.32 ± 11.22years (range 31-85years). It took 16.72 ± 7.11days (range 3-34days) for the patients with originally unexplained hydronephrosis to get a definite diagnosis of RPF secondary to non-urology carcinoma. Imaging-confirmed RPF [confirmed by computed tomography (CT) or magnetic resonance imaging (MRI)] was found in 91 patients. Fifty-seven patients were diagnosed with histological-confirmed malignant RPF. Sixty-six patients received surgical interventions. Cystoscopy and double J tube were performed in 68 cases (102 sides, 172 times) and was failed in 93 times (54.07%). Pyelostomy was performed in 72 patients (92 sides) without a single failure. Furthermore, eighty patients received chemotherapy and/or radiotherapy. The 6-month survival since RPF secondary to non-urology carcinoma was confirmed was 30%. All patients with newly diagnosed unexplained hydronephrosis should undergo an age-appropriate carcinoma screening. The prognosis of RPF secondary to non-urology carcinoma was dismal. When dealing with hydronephrosis affecting renal function, pyelostomy instead of double J tube catheterization should be performed ahead of time.

Collection of fallopian tube cytology using a novel hysteroscopic tubal catheter

Collection of fallopian tube cytology using a novel hysteroscopic tubal catheter

Fallopian tube catheterization in the treatment of proximal tubal obstruction: a systematic review and meta-analysis.

What is the chance of clinical pregnancy when fallopian tube catheterization is used for proximal tubal obstruction? The pooled clinical pregnancy rate of tubal catheterization after proximal tubal obstruction is 27% (95% CI 25-30%). Restoring fallopian tube patency by performing tubal catheterization has fallen out of favour since the increased availability of IVF. Our study is the first systematic review and meta-analysis to investigate reproductive outcomes following tubal catheterization for proximal tubal obstruction. We undertook a systematic review and meta-analysis of 27 observational studies consisting of 1720 patients undergoing tubal catheterization for proximal tubal obstruction, who attempted to conceive naturally after the procedure. Systematic literature searches were performed in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. A total of 2195 titles and abstracts were reviewed. Only studies that reported outcomes when tubal catheterization was performed with no other tubal surgery were included. Twenty-seven cohort studies matched the inclusion criteria for the meta-analysis. The meta-analysis showed a pooled clinical pregnancy rate of 27% (95% CI 25-30%) after the use of tubal catheterization for unilateral or bilateral proximal tubal obstruction (27 studies, 1556 patients). In women with bilateral obstruction (14 studies, 617 patients), the clinical pregnancy rate was 27% (95% CI 23-32%). Our meta-analysis demonstrated that the pooled cumulative clinical pregnancy rates were 22.3% (95% CI 17.8-27.8%) at 6 months, 25.8% (95% CI 21.1-31.5%) at 9 months, 26.4% (95% CI 23.0-30.2%) at 12 months, 26.0% (95% CI 22.8-29.7%) at 18 months, 27.0% (95% CI 24.0-30.5%) at 24 months, 27.9% (95% CI 24.9-31.3%) at 36 months and 28.5% (95% CI 25.5-31.8%) at 48 months. The pooled live birth rate (14 studies, 551 patients) was 22% (95% CI 18-26%). The pooled ectopic pregnancy rate (27 studies, 1556 patients) was 4% (95% CI 3-5%). The included studies scored satisfactorily on the Newcastle-Ottawa quality assessment scale. The pooled clinical pregnancy rate after tubal catheterization was found to be almost comparable to that after IVF. However, included studies were small, non-comparative series with significant clinical heterogeneity in population characteristics, follow-up and surgical equipment, technique and experience. These findings suggest fallopian tube catheterization as an alternative strategy to IVF in patients presenting with proximal tubal obstruction. Further research should focus on comparing different surgical techniques of fallopian tube catheterization with IVF and provide cumulative reproductive outcomes over long-term follow-up. No funding was required and the authors have no competing interests to declare. N/A.

Hysteroscopically guided transvaginal ultrasound tubal catheterization—a novel office procedure

ObjectiveInvestigate a novel office hysteroscopic tubal catheterization therapeutic method for proximal tubal occlusion. Study designProspective cohort study in a tertiary referral center. We evaluated the procedure on a group of 27 patients that were referred to our unit for proximal tubal occlusion demonstrated by hysterosalpingography, 9 (33.3%) of them with primary infertility and 18 of them (66.6%) with secondary infertility.The intervention included the usage of the modified Novy cornual cannulation set which was inserted through a 5F working cannel during an office operative hysteroscopy, followed by fallopian tube irrigation with saline-air mixture under ultrasonographic imaging. ResultsOur series revealed no complication during or after the procedure; anesthesia was not required. One patient lost from follow-up. Of the remaining 26, 10 patients (38.4%) conceived either spontaneously or with treatment by clomiphene or gonadotropine associated with intrauterine insemination. The median time to conception was 5 months (range 4–17). ConclusionWe therefore concluded that office hysteroscopic tubal catheterization is a simple (without anesthesia required) option for the treatment of patients suffering from proximal tubal occlusion. Fertility outcomes in our series are comparable to other treatments options for tubal catheterization. Therefore, tubal catheterization should not delay the assisted reproducted techniques if indicated but we propose to include it in a global integrated approach.

Comparison of Pregnancy Outcome between Ultrasound- Guided Tubal Recanalization and Office-Based Microhysteroscopic Ostial Dilatation in Patients with Proximal Blocked Tubes.

The current research to the best of my knowledge is the first to compare the pregnancy outcome between ultrasound-guided tubal recanalization (UGTR) using a special fallopian tubal catheter, and office-based micrhysteroscopic ostial dilatation (MHOD) using the same tubal catherter in infertile women with previously diagnosed bilateral proximal tubal obstruction (PTO). This prospective study reported the pregnancy outcomes for 200 women in private infertility care center in Arafa hospital in Fayoum and in El Minya University Hospital in the period between January 2010 and October 2013 treated as outpatients for their bilateral PTO after the routine hysterosalpingography (HSG). A Cook's catheter, special fallopian tubal catheter, were used to recanalize the blocked tubes in 100 women (group A) under UGTR, and the same Cook's tubal catheter was used through 2mm microhysteroscope to cannulate both ostia using MHOD in another 100 women (group B). Pregnancy outcome was determined after the procedures for a 12-month period follow-up. The number of the recanalization of PTO was not significantly different between two groups. As of the 200 blocked fallopian tubes in group A, 140 tubes (70%) were successfully recanalized by passing the ultrasound-guided special cannula, while 150 tubes (75%) were successfully recanalized in group B, using the same tubal catheter through a 2mm microhysteroscope. The cumulative pregnancy rate after the two procedures was not statistically different between two groups. It was 25.9% in group A, while it was 26.3% in group B, after a 12-month period follow-up. UGTR is highly recommended as the first step to manage infertile women due to PTO, as it is easier procedure; however, there is possible to obtain nearly similar results after MHOD.

The role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques

Key content The pathogenesis of infertility is multi‐factorial; investigative and treatment approaches should therefore be individualised. There are many tests for tubal patency with their relative usefulness, but none address all aspects of tubal function. There is often a clear need for in vitro fertilisation (IVF) in the management of infertility. This article reviews the current best available evidence and provides an expert insight on the role of tubal patency tests in the era of assisted reproductive techniques (ART). Learning objectives To understand the relative advantages and limitations of laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, selective salpingography and tubal catheterisation, trans‐vaginal hydrolaparoscopy, salpingoscopy and fertiloscopy as tests for tubal patency. To understand the role of Chlamydia trachomatis serology in tubal patency testing. To evaluate the role of tubal patency test in the hierarchy of investigations for infertility. To understand the role of tubal surgery in modern management of infertility. To understand the importance of medical history taking in infertility. Ethical issues Counselling patients about benefits and risks of tests, surgery and need for assisted conception. Should primary care trusts fund tubal surgery in patients who are not otherwise eligible for IVF? There may be psychosocial issues or anxiety so a multidisciplinary approach is important.

Decreasing Suprapubic Tube-Related Injuries: Results of Case Series and Comprehensive Literature Review

Bowel-related injuries are known complications of suprapubic tube (SPT) catheterization placement. A literature review was conducted to determine identifiable risk factors for bowel injury. Results on the analysis of 25 cases are presented along with a proposed algorithm to aid in choosing between open, percutaneous, and image-guided methods of placement.

Hysteroscopically Guided Transvaginal Ultrasound Tubal Catheterization – A Novel Office Procedure

Hysteroscopically Guided Transvaginal Ultrasound Tubal Catheterization – A Novel Office Procedure

Outcome of Laparoscopy-Guided Hysteroscopic Tubal Catheterization for Infertility Due to Proximal Tubal Obstruction

Study ObjectiveTo determine pregnancy outcomes after laparoscopy-guided hysteroscopic tubal catheterization and to report its role in the era of in vitro fertilization. DesignClinical cases series (Canadian Task Force classification II-3). SettingReproductive surgery center. PatientsPatients with unilateral or bilateral proximal tubal obstruction as the only cause of infertility were included. InterventionsLaparoscopy-guided hysteroscopic tubal catheterization. Measurements and Main ResultsOnly the first spontaneous conception was considered. Cumulative conception rate (CCR) was calculated using Kaplan-Meier survival analysis. Of 168 women included, 107 (63.7%) had bilateral proximal obstruction and 61 (36.3%) had unilateral obstruction. The successful recanalization rate was 54.2% per tube and 61.9% per patient. In the 93 patients in whom at least 1 fallopian tube was successfully recanalized, 40 spontaneous pregnancies (43.0%) occurred within 24 months, of which 35 (37.6%) were intrauterine pregnancies and 28 (30.1%) resulted in live births. The CCR was 37.6% at 1 year and 43.7% at 2 years. Patients with unilateral obstruction in whom cannulation was successful had the highest CCR (60.7% at 2 years). ConclusionSuccessful tubal cannulation led to significant improvement in the pregnancy rate, which suggests that women with a proximal tubal block could be considered for laparoscopy-guided hysteroscopic cannulation, which is still a viable alternative to in vitro fertilization.

Retrograde Tubal Catheterization: About a Retrospective Study of 103 Cases

Retrograde Tubal Catheterization: About a Retrospective Study of 103 Cases

Single-Access Laparoscopic “Lavage” for Purulent Diverticulitis in a 96-Year-Old Patient

Recently, laparoscopic lavage emerged as an effective alternative for patients with perforated diverticulitis with purulent peritonitis. A 96-year-old woman, diagnosed with Hinchey 3 diverticulitis after a computed tomography scan, was operated on with a single-access "lavage" to reduce surgical trauma and to avoid stoma. The procedure was performed under general anesthesia. Tracheal intubation, nasogastric tube, and urethral catheterization were mandatory. The patient was in a modified Lloyd-Davis position, with the table tilted in Trendelenburg position, left side up. Surgeons were on the right side. The procedure was performed using a surgical technique similar to standard laparoscopy with traditional laparoscopic instruments. SURGICAL STEPS: The surgical procedure involved single-incision laparoscopic surgery (Covidien, Mansfield, MA) insertion, small bowel dissection, abscess opening, and peritoneal washing. The procedure was completed in 75 minutes with an estimated blood loss of 120 mL. The patient was kept in the intensive care unit for 1 day. She was on postoperative analgesia for 2 days and was discharged from the hospital on postoperative day 5. The patient was able to drink on day 1 and eat on day 3 after flatus.

Hysteroscopic tubal catheterization under laparoscopy for proximal tubal obstruction

The purpose of this study was to investigate the fertility outcomes of infertile patients having proximal tubal obstruction treated with hysteroscopic tubal catheterization (HCT) for recanalization under diagnostic laparoscopy. From January 2000 to December 2008, diagnostic laparoscopy was used to assess the tubal status of 61 patients with unilateral or bilateral proximal tubal obstruction, as confirmed by hysterosalpingography. Among them, 35 patients with tubal obstruction confirmed by chromopertubation under laparoscopy subsequently underwent HCT. The pregnancy outcomes and success rates of recanalization were investigated. In the 35 patients with confirmed tubal obstruction, HCT was performed in 54 fallopian tubes. The success rate of recanalization was 25.9% (14/54) per tube and 37.1% (13/35) per patient. Of the patients in whom tubal patency was restored, 4 achieved pregnancy, including 1 tubal pregnancy and 1 miscarriage. Among the 61 patients, excluding 14 who underwent in vitro fertilization-embryo transfer (IVF-ET) after laparoscopy, 13 were pregnant (27.7%), 9 gave live births, 1 had tubal pregnancy, and 3 had miscarriages. HCT under laparoscopy is an option for couples with tubal infertility who do not prefer IVF-ET.

Fallopian Tube Recanalization: Lessons Learnt and Future Challenges

Technological advances in fiberoptics and endoscopy have resulted in the development of minimally invasive transcervical tubal catheterization procedures with the potential of improved diagnostic accuracy of tubal disease and transcervical treatment of proximal tubal obstruction (PTO) with reduced risks, costs and morbidity compared with surgical procedures. Fallopian tube recanalization can be performed with catheters, flexible atraumatic guidewires or balloon systems under endoscopic (falloposcopy/hysteroscopy/laparoscopy), sonographic, fluoroscopic or tactile guidance. Falloposcopy provides a unique possibility to accurately visualize and grade endotubal disease, characterize and document endotubal lesions, identify the segmental location of tubal pathology without complications, objectively classify the cause of PTO and guide future patient management. This is in contrast to the surgical and radiological gold standards, laparoscopy and hysterosalpingography, respectively, that are often associated with poor or misdiagnosis of PTO. Nonhysteroscopic transuterine falloposcopy using the linear eversion catheter is a successful, well-tolerated, outpatient technique with a good predictive value for future fertility. Hysteroscopic-falloposcopic-laparoscopic tubal aquadissection, guidewire cannulation, guidewire dilatation and direct balloon tubuloplasty may be used therapeutically to breakdown intraluminal adhesions or dilate a stenosis in normal or minimally diseased tubes with high patency and pregnancy rates. However, guidewire cannulation of proximally obstructed tubes yields much lower pregnancy rates compared with other catheter techniques, despite the high tubal patency rates. Laparo-hysteroscopic selective tubal catheterization with insufflation of oil-soluble radiopaque dye has been reported to be an effective treatment for infertility associated with endometriosis. The various disadvantages associated with fluoroscopic and sonographic techniques limit their application, despite the reportedly high patency and intrauterine pregnancy rates. Recanalization is contraindicated in florid infections and genital tuberculosis, obliterative fibrosis and long tubal obliterations that are difficult to bypass with the catheter, severe tubal damage, male subfertilitY and previously performed tubal surgery. Distal tubal obstruction is not amenable to catheter recanalization techniques. Tuberculosis, salpingitis isthmica nodosa, isthmic occlusion with club-changed terminal, ampullar or fimbrial occlusion, and tubal fibrosis have been cited as reasons for recanalization failure. In lieu of the poor pregnancy outcomes in patients with severe tubal disease and poor mucosal health following tubal recanalization, as well as poor available technical skills and results with microsurgery, in vitro fertilization and embryo transfer is a valid option in such women. Despite the high diagnostic and therapeutic power of falloposcopic interventions, technical shortcomings with falloposcopy must be overcome before the procedure gains widespread acceptance.