Özge Senem YÜCEL ÇİÇEK, Emek DOĞER, Ahmet Mücahit KARAN, Mehriban ZEYNALLI

Histerosalpingografide Patent Fakat Anormal Tubal Yapı Saptanan Hastaların Değerlendirilmesinde Laparokopinin Tanısal Değeri

Amaç: Tubal açıklığın olduğu durumlarda, tubal patolojileri düşündüren diğer histerosalpingografi (HSG) bulgularının tanısal değeri tartışmalıdır. Fallop tüplerini değerlendirmek için altın standart kabul edilen yöntem ise laparoskopidir. Bu çalışmanın amacı HSG’de tubal açıklık saptanan ancak anormal bulguları olan hastaların laparoskopik bulgularını araştırmaktır. Yöntem: Çalışma popülasyonu, HSG'de saptanan anormal tubal bulguların ileri değerlendirmesi için laparoskopi yapılan infertil kadınları içermektedir. HSG görüntüleri tubal açıklık, kıvrımlı tüpler, peritubal alanda boyanın göllenmesi, tubal ektazi ve fimbrial fimosis varlığı açısından değerlendirilmiştir. Laparoskopik değerlendirmede saptanan pelvik patolojilerin tipi ve sıklığı araştırılmıştır. Bulgular: Toplam 73 laparoskopi vakası çalışmaya dahil edilmiştir. Bunların 18'inde (%25) normal laparoskopik bulgular saptanmıştır. Vakaların %75'inde laparoskopi sırasında en az bir pelvik patoloji tespit edilmiştir. En sık saptanan pelvik patoloji tubal adezyonlardır. 21 olguda (%29) tubal adezyon saptanmıştır. Vakaların %23’ünde endometriotik implantlar saptanmıştır. 11 olguda (%13) fimbrial fimozis, 7 olguda (%10) ise paratubal kistler tespit edilmiştir. Sonuç: HSG değerlendirmesi esnasında sadece tubal açıklığa odaklanmak, diğer tubal patolojilerin tespit edilememesine neden olabilir. Klinisyenler, tubal anormallikleri düşündüren anormal HSG bulgularına aşina olmalıdır. Bu patolojilerin infertiliteye sebep olması ve laparoskopik tedavilerinin fertilite üzerinde olumlu etkisi olması, HSG görüntülerinin bu patolojiler açısından dikkatli bir şekilde incelenmesini gerekli kılmaktadır.

Anahtar Kelimeler:

Fallop tüpü, hidrosalpinks, histerosalpingografi, infertilite, laparoskopi

The Diagnostic Value of Laparoscopy for the Evaluation of Patent but Abnormal Tubes on Hysterosalpingography

Objective: The diagnostic value of hysterosalpingography (HSG) findings suggestive of subtle tubal pathologies is controversial. The gold standard method to evaluate the fallopian tubes is laparoscopy. The aim of this study is to explore the laparoscopic findings of patients with abnormal findings but patent tubes detected on HSG. Methods: The study population included infertile women undergoing laparoscopy for further evaluation of abnormal tuba-related findings on HSG. The HSG views were evaluated for the presence of tubal patency and the convoluted tubes, loculation of the dye in the peritubal area, tubal ectasia, and fimbrial phimosis. The type and frequency of pelvic pathologies detected on laparoscopic examination and the predictive value of patent but abnormal fallopian tube finding on HSG were analyzed. Results: A total of 73 laparoscopy cases were eligible. Of these, 18 (25%) had normal laparoscopic findings. In 75% of the cases, there was at least one pelvic pathology detected during laparoscopy. The most common pelvic pathology detected was tubal adhesions. Tubal adhesions were detected in 21 cases (29%). Fimbrial phimosis was detected in 11 cases (13%). Paratubal cysts were detected in 7 cases (10%). Conclusion: While evaluating a HSG, focusing only on tubal patency may result in the failure of detecting subtle tubal pathologies. Clinicians should be familiar with abnormal HSG findings suggestive of tubal abnormalities. Careful examination of the HSG views regarding other tubal pathologies is warranted as these subtle conditions may impair fertility and laparoscopic correction of these pathologies has a positive impact on fertility.

Keywords:

fallopian tube, hydrosalpinx, infertility, laparoscopy, hysterosalpingography,

PDF

___

Zegers-Hochschild F, Adamson GD, de Mouzon J, et al. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009. Hum Reprod. 2009;24(11):2683-7. doi:10.1093/humrep/dep343
Yuan L, Jingying H, Xiujuan C, et al. Predictive value of a modified classification of fallopian tube status on prognosis of tubal factor infertility after laparoscopic surgery. Medicine (Baltimore). 2019;98(13):e14952. doi:10.1097/MD.0000000000014952
Kawwass JF, Crawford S, Kissin DM, Session DR, Boulet S, Jamieson DJ. Tubal factor infertility and perinatal risk after assisted reproductive technology. Obstet Gynecol. 2013;121(6):1263-1271. doi:10.1097/AOG.0b013e31829006d9
Panchal S, Nagori C. Imaging techniques for assessment of tubal status. J Hum Reprod Sci. 2014;7(1):2-12. doi:10.4103/0974-1208.130797
Chen LS, Zhu ZQ, Li J, et al. Hysterosalpingo-contrast-sonography vs. magnetic resonance-hysterosalpingography for diagnosing fallopian tubal patency: A systematic review and meta-analysis. Eur J Radiol. 2020;125:108891. doi:10.1016/j.ejrad.2020.108891
Ngowa JD, Kasia JM, Georges NT, Nkongo V, Sone C, Fongang E. Comparison of hysterosalpingograms with laparoscopy in the diagnostic of tubal factor of female infertility at the Yaounde General Hospital, Cameroon. Pan Afr Med J. 2015;22:264. doi:10.11604/pamj.2015.22.264.8028
Capmas P, Suarthana E, Tulandi T. Management of Hydrosalpinx in the Era of Assisted Reproductive Technology: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2021;28(3):418-441. doi:10.1016/j.jmig.2020.08.017
Practice Committee of the American Society for Reproductive M. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015;103(6):e44-50. doi:10.1016/j.fertnstert.2015.03.019
Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril. 1995;64(3):486-91. doi:10.1016/s0015-0282(16)57781-4
Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Human Reprod Update. 2001;7(6):567-576. doi:10.1093/humupd/7.6.567
Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod and Genet. 2010;27(8):441-447. doi:10.1007/s10815-010-9436-1
Jacobson TZ, Duffy JM, Barlow D, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev. 2010;(1):CD001398. doi:10.1002/14651858.CD001398.pub2
Saravelos HG, Li T-C, Cooke ID. An analysis of the outcome of microsurgical and laparoscopic adhesiolysis for infertility. Hum Reprod. 1995;10(11):2887-2894. doi:10.1093/oxfordjournals.humrep.a135813
Berker B, Sukur YE, Aytac R, Atabekoglu CS, Sonmezer M, Ozmen B. Infertility work-up: To what degree does laparoscopy change the management strategy based on hysterosalpingography findings? J Obstet Gynaecol Res. 2015;41(11):1785-90. doi:10.1111/jog.12803
Waheed S, Mazhar R, Khan NH, Rafi M. The Comparison of Hysterosalpingography and Laparoscopy in Predicting Fertility. Ann King Edw Med Univ. 1970;13(3):202. doi:10.21649/akemu.v13i3.110
Dechaud H, Reyftmann L, Faidherbe J, Hamamah S, Hedon B. Evidence-based reproductive surgery: tubal infertility. International Congress Series. 2004;1266:96-106. doi:https://doi.org/10.1016/j.ics.2004.01.117
Abuzeid MI, Mitwally MF, Ahmed AI, et al. The prevalence of fimbrial pathology in patients with early stages of endometriosis. J Minim Invasive Gynecol. 2007;14(1):49-53. doi:https://doi.org/10.1016/j.jmig.2006.07.003
Donnez J, Casanas-Roux F. Prognostic factors of fimbrial microsurgery. Fert Steril. 1986;46(2):200-204. doi:https://doi.org/10.1016/S0015-0282(16)49511-7
Karasick S, Goldfarb AF. Peritubal adhesions in infertile women: diagnosis with hysterosalpingography. Am J Roentgenol. 1989;152(4):777-9. doi:10.2214/ajr.152.4.777
Thota J, Abuzeid M, Ashraf M. The predictive value of hysterosalpingogram (HSG) in detecting subtle tubal pathology. Fert Steril. 2001;76doi:10.1016/S0015-0282(01)02565-1