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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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 laparoscopy
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