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: To evaluate the effectiveness of hysteroscopy as a method for the diagnosis of tubal patency using saline distention media. In this prospective study, 62 women between 21 and 38 years with a history of at least 1 year of infertility who underwent hysteroscopy and hysterosalpingography (HSG) on two consecutive cycles were studied. Transvaginal ultrasonography carried out before and after hysteroscopy in order to measure the abdominal fluid (in ml) in the peritoneal cavity of the cul-de-sac. The difference between the two results was calculated. A next cycle HSG was performed and patients were divided into three groups according to whether there was no tubal occlusion (group 1), a unilateral occlusion (group 2) or a bilateral occlusion (group 3): Peritoneal fluid measurements were compared among the three groups. Finally, pain and discomfort were recorded at the end of the process. According to the HSG, 34 women were in group 1, 13 in group 2 and 9 in group 3. Peritoneal fluid measurements were 6.88 +/- 2.7 ml in group 1, 4.21 +/- 0.9 ml in group 2 and 1.08 +/- 0.7 ml in group 3. Statistical differences were found between groups 1 and 3 and between groups 2 and 3 (P < 0.05). All of the patients reported significantly less pain during hysteroscopy in response to HSG. Using saline distension media during hysteroscopic evaluation was effective to allow measurement of the accumulating fluid in the peritoneal cavity and to confirm at least one patent tube with minimal pain.Archives of Gynecology 02/2009; 280(4):543-7. · 0.91 Impact Factor
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ABSTRACT: 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.Medicina (Kaunas, Lithuania) 01/2008; 44(6):439-48. · 0.55 Impact Factor
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ABSTRACT: Diagnostic hysteroscopy has become a well-established modality for evaluating the uterine cavity, but provides no information regarding tubal patency. The aim of the present study was to investigate the diagnostic value of transvaginal sonography (TVS), performed directly after diagnostic hysteroscopy, for assessing tubal patency in infertile women, and to compare the findings with those obtained by means of laparoscopic chromopertubation. A total of 56 infertile patients were referred to our endoscopic unit for laparoscopic chromopertubation in the period from September 2008 to January 2010. Diagnostic hysteroscopy, followed by TVS, was carried out prior to laparoscopic chromopertubation. The collection of free fluid in the pouch of Douglas was accepted as evidence of tubal patency. The findings of TVS and laparoscopic chromopertubation were compared. The data were analyzed for the sensitivity, specificity, accuracy, positive-predictivevalue, and negative-predictive value of the combination of hysteroscopy and TVS in detecting unilateral or bilateral tubal patency. The presence of fluid in the pouch of Douglas was observed in 37 of the 56 cases. In 36 of these cases, unilateral or bilateral tubal patency was confirmed by laparoscopic chromopertubation. In 17 of the remaining 19 cases (without fluid in the pouch of Douglas during ultrasound), bilateral tubal occlusion was confirmed by laparoscopic chromopertubation. Diagnostic hysteroscopy followed by TVS showed a high sensitivity and specificity for the assessment of tubal patency. TVS performed directly after diagnostic hysteroscopy in infertile patients provides additional nformation regarding tubal patency.Journal of Clinical Ultrasound 09/2011; 40(2):68-73. · 0.70 Impact Factor