Diagnosis of fallopian tube patency.
ABSTRACT To evaluate and compare the diagnostic value of hysterosalpingography (HSG) and laparoscopic chromopertubation (LCP), in the diagnosis of fallopian tube patency.
A comparative prospective study.
The infertility clinic of the Department of Obstetrics and Gynaecology, Ga-Rankuwa hospital (Medical University of Southern Africa), Pretoria, South Africa.
Fifty patients were initially diagnosed with either unilateral or bilateral tubal block using HSG. Six to eight weeks later the same women were subjected to LCP to assess tubal patency.
Diagnostic accuracy of HSG to establish tubal patency, site of occlusion and the presence of other pathologies was compared with results obtained after laparoscopic chromopertubation (LCP).
Hysterosalpingography diagnosed bilateral proximal, bilateral distal and mixed (i.e. one side proximal and the other distal) tubal occlusion in 15(40.5%); 13(35.1%) and five (13.5%) cases respectively. Diagnostic laparoscopy confirmed the above sites of occlusion in nine (24.3%), 71(45.9%) and three (8.1%) cases. Laparoscopy detected bilateral tubal patience in three (8.1%) patients, in whom HSG had diagnosed tubal occlusion. USG was able to detect peritubal Adhesion in only four (10.8%) patients as compared with 11 patients when LCP procedure was used. In comparison with HCP, hysterosalpingography demonstrated 70% specificity for accurately diagnosing proximal tubal occlusion.
On a comparative scale, HSG demonstrated reduced positive predictive value especially for bilateral proximal tubal occlusion. However, in spite of its relatively limited value for accurately identifying tubal patency, HSG should still serve as a useful primary investigation.
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ABSTRACT: Infertility has always been defined with respect to a number of parameters prominent amongst which are time, causes, treatment cost and socio-cultural implications. The most widely accepted practical classifications distinguishes between primary and secondary infertilities with a further sub classification into 3 clearly defined groups that include ovulatory dysfunction, fallopian tube compromise , male factor ( sperm function and delivery disorder) alongside an ambiguous and controversial group labeled as "unexplained infertility". Recent technological developments in the fields of optics, video-imaging and miniaturized surgical instruments, have lead to the emergence of minimal access procedures, with wide and varied applications in the field of gynaecology. The skill in its different forms and various combination modalities is widely applied in the management of the infertile couple especially those with tubal infertility. The economic and safety records of endoscopic procedures are well documented in other surgical acts. Gynaecology in general and tubal infertility in particular, does not seem to constitute an exception, more so when their cost-effective ratio is considered alongside results. The different forms of endoscopic procedures have been shown to de-mystify and redefine the bounds of "unexplained infertility" by producing new diagnostic evidence. Novel minimal access surgical procedures have been shown to play not only a preventive but also a curative role in tubo-peritoneal infertility as well as other forms of infertility. In skilled hands, the various forms of endoscopic procedures can be combined in different ways to improve on the diagnosis and treatment afflicted patients. This management style referred to by some authors as "fertiloscopy" judiciously blends the use of laparoscopy, hysteroscopy, salpingoscopy, fimbroscopy and chromotubation with other conventional infertility work-up procedures to resolve infertility problems with very promising results. Infertility, its work-up and treatment are quite often time consuming with all the consequences, economic, social and particularly psychological attached to it. The ergonomics' of infertility management has developed over time and has come up with the one-stop shop model for infertile couples. Minimal access procedures are apparently set to play a central and determinant role. With this in mind, the need to overview the path covered this far and also ponder on future orientations in view of improving on results can not be over emphasized. AIM OF STUDY In this study, we intended to high-light the capital and central role that minimal access or endoscopic procedures play in the management of tubal infertily as well as demonstrate the positive impact it has both in the fight against infertility and redefining the classification of the pathology.
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ABSTRACT: ABSTRACT OBJECTIVE:Hysterosalpingography (HSG) is a basic diagnostic procedure in infertility. In recent years, diagnostic laparoscopy has become popular and used in almost every infertile patient. However, nowadays agreement on this approach is not so clear.METHOD: In our clinic, between 2004-2006 we evaluated the result of diagnostic laparoscopy of 121 infertile women who had HSG formerly. We classified the cases according to HSG results. In the first group, the HSG results of 68 cases were normal. In the second group, there was unilateral tubal obstruction in 16 cases. In the third group, obstruction was bilateral in 37 cases. Diagnostic laparoscopy and HSG results of 1. and 2. group revealed similarity. In contrast no abnormality was observed in 14 cases of the 3. group. CONCLUSION: HSG is the first line procedure while evaluating tubal alone patency. However, regarding peritubal adhesions alone is of no value. In the case of bilateral tubal obstruction determined in HSG, diagnostic laparoscopy is absolutely indicated. Keywords: Infertility, Hysterosalpingography, Diagnostic laparoscopyMarmara Medical Journal 01/2008;
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ABSTRACT: Tubal occlusion is one of the most frequent causes of infertility in women. The evaluation of the fallopian tube is necessary to determine the management plan for infertility. The two most important diagnostic procedures which are used for the evaluation of tubal patency are hysterosalpingography (HSG) and laparoscopy. The aim of this study was to compare HSG and laparoscopic findings in the diagnosis of tubal patency. In a prospective study sixty two infertile cases were examined by HSG as part of their routine infertility evaluation, three months after HSG, tubs status were assessed by laparoscopy as a gold standard method. The findings of HSG and laparoscopy were compared. The Laparoscopy findings were used as reference standard to calculate sensitivity, specificity, positive and negative predictive values for unilateral and bilateral no tubal patency. The sensitivity and specificity of HSG on bilateral tubal patency or no bilateral tubal patency were 92.1% and 85.7% respectively. The positive and negative predictive values were 97.2% and 66.7%, and the accuracy was 91.1%. The sensitivity and specificity of HSG for evaluation of the bilateral tubal patency and unilateral or bilateral no tubal patency were 77.8% and 52.94%, the positive and negative predictive values were 81.4% and 47.4% respectively, and the accuracy was 71%. HSG is considered to have a high sensitivity and specificity. HSG and laparoscopy are not alternative, but are the complementary methods in the examination of no tubal patency.Nursing and midwifery studies. 06/2013; 2(2):188-192.