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.     

Fluoroscopy-guided, transcervical, selective salpingography and fallopian tube recanalisation

This study is a retrospective review of the transcervical fluoroscopy-guided fallopian tube recanalisation (FTR) procedures done in a multi-ethnic south-east Asian population, over 9 years. A total of 100 patients with infertility and documented proximal tubal obstruction (PTO) were referred for FTR. On-table hysterosalpingography under sedation demonstrated true PTO in 96 patients. At selective-salpingography, the PTO cleared in 16 patients; 78 required FTR and two had fimbrial blockage. The technical success rate of FTR was 86.8% and the post-FTR pregnancy rate was 36.84% at a mean follow-up interval of 12.2 months. There were no major, immediate procedure-related complications. There was an ectopic pregnancy in a single treated patient. Fluoroscopy-guided FTR is a safe treatment option in patients with infertility from PTO, with high technical success rate, low complication rate and increased chances of pregnancy; therefore it should be preferred before attempting more expensive and resource-intensive procedures.     

A new approach to hysteroscopic cannulation of the fallopian tube

Hysteroscopic cannulation of the fallopian tube has become an essential part of the treatment of interstitial fallopian tube obstruction. This report describes the use of a flexible instrument that can be introduced through a rigid hysteroscope for the purpose of hysteroscopic tubal cannulation.     

原发性输卵管癌诊断方法

原发性输卵管癌(PFTC)是恶性程度很高的妇科肿瘤,具有症状隐匿、发病率低、诊断符合率低等特点。文章总结了当前应用于PFTC术前诊断的影像学特征及分子标记物等方法,并探讨了     

Selective fallopian tube cannulation: initial experience in an infertile population

We have studied a group of 19 patients presenting with proximal tubal occlusion. Seventy-three percent (22/30) of tubes attempted were successfully cannulated. Sixty-two percent (5/8) of tubes remained patent in limited follow-up at 3 to 6 months. We conclude that selective fallopian tube cannulation may provide an alternative to microsurgical tubal anastomosis in selected patients.     

Attempted transcervical occlusion of the fallopian tube with the Nd:YAG laser

A prospective multi-center trial was initiated to test the efficacy and safety of transcervical occlusion of the fallopian tube with the Nd:YAG laser. A multi-center approach was deemed necessary because of the large sample size required to test adequately the effectiveness of sterilization procedures. However, efforts to continue the study as designed were abandoned because, of the 17 subjects completing the study, only four (24%) had bilateral tubal occlusion at the site of laser treatment. We conclude that the hysteroscopic method, as tested, is inadequate to provide permanent sterilization. Modification of the technique or alterations in patient preparation may improve the outcome.     

Role of GnRH agonists in managing proximal fallopian tube obstruction

OBJECTIVE: To assess the response of proximal fallopian tube obstruction to a medically induced hypoestrogenic state after control for spasm at the uterotubal ostium. STUDY DESIGN: This was a prospective, randomized, placebo-controlled, pilot study in a tertiary care, university-affiliated infertility practice. Twenty-one infertile women with unilateral or bilateral proximal tubal obstruction previously diagnosed by standard hysterosalpingography or laparoscopic chromotubation were randomized into two groups in a 2:1 design. Group I, 14 patients (27 occluded tubes), was administered a depot preparation of the gonadotropin-releasing hormone (GnRH) agonist leuprolide acetate, 3.75 mg intramuscularly every 28 days. Group II, seven patients (11 occluded tubes), was administered a placebo. Follow-up hysterosalpingography was performed after administration of the antispasmodic glucagon within four weeks of completion of the protocol. RESULTS: Evidence of ovarian suppression was confirmed within four weeks in group I. A trend toward higher posttherapy patency rates was noted in group I (74.7% vs. 40%). The lack of statistical significance may have been a function of sample size. Similarly, spontaneous intrauterine pregnancy rates were also higher in GnRH agonist-treated patients (35.1% vs. 16.6%, P < .05). Tubal patency rates were significantly greater in patients with documented estrogen-sensitive disorders who received the agonist (75% vs. 20%, P < .05) CONCLUSION: Proximal tubal obstruction may be an estrogen-sensitive phenomenon in a subset of infertile patients. The administration of GnRH agonists may successfully overcome this state and result in enhanced conception rates.     

Diagnosis and 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.     

Association between secondary infertility and fallopian tube obstruction on hysterosalpingography

OBJECTIVE: To determine whether women with secondary infertility have a lower prevalence of tubal pathology as evidenced by hysterosalpingographic (HSG) analysis. STUDY DESIGN: A cross-sectional study was performed on 551 women seen for evaluation of infertility at an academic medical center. Each patient's chart was reviewed for the presence of primary vs. secondary infertility. History of sexually transmitted infection, prior surgery and details of prior pregnancies were recorded. HSG reports and films were evaluated for evidence of tubal disease. RESULTS: Controlling for 5-year age category, history of sexually transmitted disease and history of surgery, the adjusted risk ratio for abnormal HSG in women with secondary vs. primary infertility was 1.75 (95% CI 1.16-2.64). Among patients with secondary infertility, there was no difference between mode of delivery in the prior pregnancy (vaginal vs. cesarean delivery) and abnormal HSG. CONCLUSION: In the population we studied, accounting for confounding variables, women with secondary infertility had a higher likelihood of having fallopian tube obstruction on hysterosalpingography than did those with primary infertility. Our study supports continued routine evaluation for tubal patency in patients with secondary infertility. Among parous women, there is no evidence that cesarean delivery places patients at increased risk of abnormal hysterosalpingograms.     

Transcervical cannulation of the fallopian tube for the management of ectopic pregnancy: prospective multicenter study.

OBJECTIVE: To determine the efficacy of transcervical tubal cannulation and intraluminal methotrexate injection for the management of tubal ectopic pregnancy (EP). DESIGN: Prospective multicenter study of 33 patients with tubal pregnancies. SETTING: Four university-based gynecology and radiology departments in three different countries: France, England, and Germany. PATIENTS: Thirty-three patients who presented with a clinical diagnosis of EP. INTERVENTIONS: Patients underwent transcervical tubal cannulation under fluoroscopic or ultrasound control and local injection of methotrexate (up to 50 mg). MAIN OUTCOME MEASURES: We evaluate the feasibility of transcervical tubal cannulation for the management of tubal pregnancy. RESULTS: Two patients elected to withdraw from the protocol. In the remaining 31 patients there was complete resolution of the EP in 27 (87%). Surgery was performed in 4 patients. Seventeen patients, 14 of whom desired pregnancies, were available for follow-up to assess the return of reproductive potential. Seven of 7 patients who subsequently underwent hysterosalpingography had patency of the affected tube. Five patients later had an intrauterine pregnancy. One patient had an early miscarriage, two have given birth, and two singleton pregnancies are still ongoing. The remaining patients are symptom free. CONCLUSIONS: This study demonstrates that transcervical tubal catheterization in patients with tubal pregnancies is feasible and can be performed without anesthesia or analgesia in most cases. Intraluminal methotrexate per se is capable of causing regression of the EP. This approach offers a new alternative for the treatment of selected patients with tubal EP.     

Primary fallopian tube carcinoma

Primary fallopian tube cancer constitutes 1% of gynecologic malignancies. Early clinical manifestation and prompt investigations lead to diagnosis in the early stage of disease accounting for a better survival compared with ovarian cancer. Principles of management generally follow that of epithelial ovarian cancer. This article reviews the current understanding of this rare cancer. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the clinical features of a patient with fallopian tube carcinoma, to list the prognostic factors associated with fallopian tube cancer, and to outline the treatment options for a patient with fallopian tube cancer.     

Primary fallopian tube carcinoma

Primary fallopian tube carcinoma (PFTC) is a rare gynaecological tumour that accounts for 0.14–1.8% of genital malignancies. The most common age of occurrence is between 40 and 65 years, and the mean age is 55 years. The factors that contribute to its appearance are not well known. Population studies show that the mean incidence of PFTC is 3.6 per million women per annum. Overall survival percentages for patients with PFTC are generally low, in the range of 22–57%. Pre-operative diagnosis is rare and PFTC is usually confirmed by a pathologist, but earlier diagnosis with early clinical manifestation and prompt investigation improves the prognosis. Both PFTC and epithelial ovarian cancer (EOC) are treated with similar surgical and chemotherapy methods. Studies have shown that the prognosis for PFTC is worse than that for EOC or other primary gynaecological tumours. This article reviews and presents the current updates of this rare gynaecological malignancy.     

Obstructing fallopian tube papilloma

A grossly well-defined papilloma was found in the fallopian tube of a 41-year-old woman who had a total hysterectomy and bilateral salpingo-oophorectomy for carcinoma in situ of the cervix. The papilloma was unassociated with significant inflammation, hormone administration, or endogenous hormone excess. It presented as a hydrosalpinx developing over a period of several months. This may represent the second true fallopian tube papilloma to be recorded.     

Post-hysterectomy fallopian tube prolapse

Post-hysterectomy fallopian tube prolapse is a rare complication with only 80 cases described since 1902. Symptoms are non-specific and often of delayed onset. Final diagnosis is confirmed by vaginal biopsy with salpingectomy being the treatment of choice, preferably performed laparoscopically. Following surgery, complete symptom resolution is usually observed and no recurrence has been reported.