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PubMed2001

Comparison of cervical vacuum cup cannula with metal cannula for hysterosalpingography.

OBJECTIVE: The aim of this study was to compare the use of a cervical vacuum cap cannula with the traditional metal cannula. DESIGN: A prospective, randomised, single-blinded comparative study. SAMPLE: Fifty consecutive infertile women undergoing hysterosalpingography for evaluation of infertility METHODS: Hysterosalpingography was performed either with the traditional metal cannula (n = 25) or a cervical vacuum cap cannula (n = 25). MAIN OUTCOME MEASURES: Length of procedure, fluoroscopic time, amount of contrast medium, pain to the patient while applying the cannula and injecting the contrast medium, level of difficulty to the performer, the need to reapply the cannula, complications, and results of the hysterosalpingography. RESULTS: Using the cervical vacuum cap cannula, compared with the metal cannula, the duration of the procedure was significantly shorter (5.3 vs 9.3 minutes; P < 0.001), less fluoroscopic time was needed (0.9 vs 1.8 minutes; P < 0.001), a smaller amount of contrast medium was used (4.6 vs 15.7 mL; P < 0.001), the procedure caused less pain to the patient (3.2 vs 6.8, respectively; on a scale of 1-10; P < 0.001), and was easier for the physician to perform (1.4 vs 3.4; on a scale of 1-10; P < 0.001). No significant differences were encountered between the two groups in the need to reapply the cannula, in the rate of complications or in the results of the hysterosalpingography. CONCLUSIONS: The cervical cap cannula appears to be superior to the traditional metal cannula for performing hysterosalpingography.

Adult↗

PubMed1988

Uterine leiomyomas in the infertile patient: preoperative localization with MR imaging versus US and hysterosalpingography.

Eleven women with a history of infertility and uterine leiomyomas underwent magnetic resonance (MR) imaging of the pelvis prior to myomectomy. Nine also underwent preoperative pelvic ultrasonography (US), and ten underwent hysterosalpingography. All studies were interpreted prospectively by independent observers. With each imaging modality, the location (one of 11 anatomic segments), size, and appearance of detected uterine leiomyomas were determined and compared with surgical and histologic findings. Among the nine patients who underwent both MR and US, the sensitivity (85%) and accuracy (94%) of MR imaging for abnormal segments was significantly better than that of US (sensitivity = 69%, P = .015; accuracy = 87%, P = .043). For the ten patients who underwent both MR and hysterosalpingography, the sensitivity (91%) and accuracy (96%) of MR imaging was better than that of hysterosalpingography (sensitivity = 18%, P = .0005; accuracy = 72%, P = .0005). The specificities of the three modalities did not significantly differ (100%, 97%, and 98% for MR, US, and hysterosalpingography, respectively). These data suggest that MR imaging is superior to US or hysterosalpingography for preoperatively locating uterine leiomyomas.

Adult↗

PubMed1989

Peritubal adhesions in infertile women: diagnosis with hysterosalpingography.

We studied the efficacy of hysterosalpingography in the detection of peritubal adhesions without tubal occlusion by using laparoscopy as the gold standard for the diagnosis. Peritubal adhesions were diagnosed on hysterosalpingography by using the following radiographic criteria alone or in combination: (1) convoluted fallopian tube, (2) loculation of spillage of contrast medium into the peritoneal cavity, (3) ampullary dilatation, (4) peritubal halo effect (double-contour appearance of the tubal wall), and (5) vertical fallopian tube. The first 100 patients with the diagnosis of adhesions on hysterosalpingography who also had laparoscopy were included in the study. Seventy-five patients had the diagnosis confirmed on laparoscopy, resulting in a 25% false-positive diagnosis of adhesions with hysterosalpingography. Thirty-nine (52%) of these 75 patients had one radiographic finding alone, and 20 of these patients had loculation of spillage of contrast medium. Although the patients with adhesions tended to have two or more of the radiographic findings, the difference was not statistically significant. The most frequent radiographic findings found in combination were convoluted fallopian tube and loculation of spillage of contrast medium. These findings suggest that hysterosalpingography can be the diagnostic procedure of choice in the initial investigation of infertility due to peritubal adhesions.

Fallopian Tube Diseases↗

PubMedDate not supplied

[Systematic preventive antibiotic therapy during hysterosalpingography in an African tropical environment: is this practice justified?].

To find out whether preventive antibiotic therapy can be justified in the practice of hysterosalpingography in a tropical environment where the infectious risk is notoriatly high, the authors performed a prospective study concerning 49 females patients. The patients in genital activity period, were willing and volunteers and were aged from 20 to 44 years. They were examined by hysterosalpingography during a period of three months. Patients were distributed in two homogenous group, one group of 25 patients who had a preventive antibiotic therapy and the second group with 24 patients with no preventive antibiotic therapy. Hysterosalpingography examinations were performed with sterile and single-use equipment. All patients were clinically examined for medical record purposes: gynaecologic, obstetric, pelvic infection, oral contraception, previous hysterosalpingography. Biologic dosages were realized, including blood count and erythrocyte sedimentation, culture of vaginal sampling, C reactive protein rate. The results obtained showed no significant difference between the two groups. The authors conclude that hysterosalpingography can be also performed in a tropical environment without using systematic preventive antibiotic therapy provided that asepsisrules are strictly observed.

Adult↗

PubMed1980

Increased pregnancy rate with oil-soluble hysterosalpingography dye.

The diagnostic value of hysterosalpingography remains unquestioned. Previous studies have suggested that patients who underwent hysterosalpingography with an oil-soluble contract medium (OSCM) rather than a water-soluble contrast medium (WSCM) had higher subsequent fertility rates. This study evaluated subsequent fertility rates in 339 patients who underwent hysterosalpingography in which OSCM or WSCM was used. All forms of infertility were included and over-all, pregnancy occurred in the WSCM group in 21 of 162 patients (13%), in the OSCM group in 51 of 177 patients (29%); these rates were significantly different (P less than 0.001), with the unexplained infertility group and the male factor infertility group showing the most significant difference. Adverse effects of OSCM hysterosalpingography were not corroborated. For this reason it is suggested that initially the patient undergo hysterosalpingography with WSCM. Once patency has been established, 3 ml of OSCM should be injected as a therapeutic modality to increase subsequent fertility.

Clomiphene↗

PubMedDate not supplied

The use and results of laparoscopic chromoperturbation in women previously examinated by hysterosalpingography.

Laparoscopic chromoperturbation in superior to hysterosalpingography in the evaluation of infertile women. Referring women to both investigations is therefore cost ineffective and unacceptable for the patient. To estimate the magnitude of this problem, the records of all women referred to hysterosalpingography in our department during 1989-92 were reviewed. We registered the result of the hysterosalpingography, whether or not she later had laparoscopic chromoperturbation and the results of this procedure if done. One hundred and eighteen women were included. Fifty eighty had a laparoscopic chromoperturbation (49%). The fertility prognosis obtained at hysterosalpingography was different from the fertility prognosis found by laparoscopic chromoperturbation in 34 percent of the women. Women with an abnormal hysterosalpingography had significantly more often a complicated gynecologic history. It is suggested that testing for tubal patency as a primary infertility investigation should be reserved for women with an adverse gynecologic history. Laparoscopic chromoperturbation is the method of choice.

Female↗

PubMed1983

Prevention of acute pelvic inflammatory disease after hysterosalpingography: efficacy of doxycycline prophylaxis.

In an attempt to minimize the infectious morbidity of hysterosalpingography, the efficacy of oral doxycycline prophylaxis was examined. The records and hysterosalpingograms of 278 consecutive women (group 1) were reviewed to correlate the radiologic findings and the development of acute pelvic inflammatory disease (PID) after hysterosalpingography. Four women (1.4%) developed PID and all four had tubal dilatation. The overall frequency of PID in women with dilated tubes was 4/35 (11%). Subsequently, 56 of 326 women (group 2) with tubal dilatation received oral doxycycline prophylaxis. No cases of PID were observed in the 56 women who had antibiotic prophylaxis (p less than 0.02) or in group 2 as a whole. The study suggests that the risk of infection after hysterosalpingography is very low when nondilated tubes are present (0/398 women of groups 1 and 2). The relative risk of PID in women with peritubal disease or proximal tubal occlusion, although apparently low, remains to be determined. Furthermore, in the highest-risk group of women with dilated tubes, doxycycline prophylaxis was effective in reducing infection after hysterosalpingography.

Doxycycline↗

PubMed1986

The accuracy of hysterosalpingography versus laparoscopy in evaluation of infertile women.

Two hundred fifteen infertile women underwent hysterosalpingography (HSG) and laparoscopy. One hundred twenty-eight patients had bilaterally patent tubes on hysterosalpingography. Thirty-one percent of these women had pelvic adhesions diagnosed by laparoscopy. Eighty-seven women had either occluded tubes or suspected pelvic adhesions on hysterosalpingography. Thirty-nine percent of these women had patent tubes without any pelvic pathology on laparoscopy. Inaccurate diagnoses limit the value of hysterosalpingography in evaluation of tubal and peritubal pathology.

Adult↗

PubMed2003

Patient rotation and resolution of unilateral cornual obstruction during hysterosalpingography.

OBJECTIVE: Unilateral obstruction of the proximal fallopian tube is identified in 10-24% of patients undergoing hysterosalpingography for evaluation of infertility. Upon further testing, this obstruction spontaneously resolves 16-80% of the time. We hypothesized that patient rotation during hysterosalpingography might resolve proximal tubal obstruction in some cases by altering either the location of intrauterine air bubbles or the spatial relationship of the tube to the uterine fundus. METHODS: In patients in whom unilateral proximal tubal obstruction was detected during hysterosalpingography performed for standard clinical indications, the patient was rotated on her hip approximately 45 degrees such that the obstructed tube was first superior (ventral) to the patent tube, and dye was reinjected. If obstruction did not resolve, the patient was rotated in the opposite direction so that the obstructed tube was inferior (dorsal) to the patent tube and dye reinjected. RESULTS: Unilateral tubal obstruction was found in 15% of cases (24 of 156). Rotating the patient with obstructed tube superior to the patent tube never resulted in tubal patency, whereas rotating the patient with the obstructed tube inferior resulted in resolution of tubal patency in 63% of cases (15 of 24) CONCLUSION: . Unilateral cornual obstruction during hysterosalpingography is often resolved by rotating the patient such that the obstructed tube is more inferior. Although this observation may be the result of dislodging smaller air bubbles, from a fluid dynamics perspective a more likely explanation is unkinking of the more inferior tube.

Adult↗

PubMed1995

Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography.

The purpose of this study was to investigate the potential value of three-dimensional ultrasound for the assessment of normal uterine anatomy and the diagnosis of congenital uterine anomalies. A total of 61 patients with a history of recurrent miscarriage or infertility and who had previously been investigated by hysterosalpingography were recruited into the study. They first underwent a conventional two-dimensional transvaginal ultrasound scan. At the end of the examination, three-dimensional ultrasound volumes were recorded and stored in the machine computer memory. The examination of planar reformatted sections was than used for the assessment of uterine morphology and the diagnosis of congenital anomalies. On three-dimensional scanning, the most useful plane was a transverse section through the whole length of the uterus from the fundus to the cervix. Hysterosalpingography showed a normal uterus in 44 (72.1%) patients, an arcuate uterus in nine (14.8%) and a major fusion defect in three cases (4.9%). Five patients (8.2%) had large fibroids which were distorting the uterine cavity. Good-quality two-dimensional ultrasound images were obtained in 60 (98.3%) and three-dimensional images in 58 (95.1%) cases. All poor images were caused by large uterine fibroids. Comparison between hysterosalpingography and ultrasound showed that five false-positive diagnoses of arcuate uterus and three of major uterine anomalies were made on two-dimensional scans. Three-dimensional ultrasound agreed with hysterosalpingography in all cases of arcuate uterus and major congenital anomalies. The ability to visualize both the uterine cavity and the myometrium on a three-dimensional scan facilitated the diagnosis of uterine anomalies and enabled easy differentiation between subseptate and bicornuate uteri.

Abortion, Habitual↗

PubMed1994

Hysterosalpingography and hysteroscopy in female infertility.

A total of 323 women of reproductive age (19-40 years) were submitted to a complete investigation of infertility routinely including hysterosalpingography and hysteroscopy. In 177 cases (54.7%) no pathological conditions were found by either of the applied methods, while in 65 cases (20.1%) similar abnormalities were observed by hysterosalpingography and hysteroscopy with a global correlation of 74.8%. Hysterosalpingography also presented false positive results in 11.7% and false negative ones in 13.3% of all the studied cases. In conclusion, the combined use of these techniques in infertility investigation gives complete and accurate information about the uterine cavity, despite the disadvantages of hysterosalpingography due to false positive and false negative results.

Adult↗

PubMed1991

A clinical comparison of sonographic hydrotubation and hysterosalpingography.

OBJECTIVE: To assess the value of vaginal sonographic hydrotubation as a preliminary test of uterine configuration and tubal patency in infertility investigation, and to compare this new test with hysterosalpingography. DESIGN: A prospective blind comparison of the two tests in an unselected group of infertile women. SETTING: Hillbrow Hospital, Johannesburg, South Africa. SUBJECTS: Sixty women undergoing routine infertility investigations agreed to participate in the study. There were no refusals. INTERVENTIONS: Within 4 weeks before or after hysterosalpingography sonographic hydrotubation was performed as follows: The uterus and tubes were identified using a 5 MHz vaginal ultrasound probe and between 10 and 20 ml of normal saline were injected into the uterine cavity through an endocervical catheter. MAIN OUTCOME MEASURES: The shape of the uterus and its cavity, the flow of saline through the tubes, the presence of hydrosalpinges before and after injection of saline and the presence of free fluid in the pouch of Douglas. RESULTS: The sonographic and hysterosalpingographic findings were similar in 82% of the women with respect to uterine assessment and in 72% with respect of tubal findings. In seven women (12%) found to have bipolar tubal disease on sonography and cornual block on hysterosalpingography, the sonographic diagnosis was confirmed at laparoscopy. Septate uterus in three women was diagnosed with greater certainty with sonographic hydrotubation. CONCLUSIONS: Sonographic hydrotubation is a simple office procedure which should be used in the preliminary assessment of the uterine cavity and fallopian tubes. Its use will reduce the need for hysterosalpingography and in some cases laparoscopy.

Diagnosis, Differential↗

PubMed1983

Fertility rate after hysterosalpingography with Sinografin.

Patients undergoing diagnostic hysterosalpingography because of infertility often become pregnant soon after the procedure. Since the discontinuation of Salpix in March 1980, the use of Sinografin for hysterosalpingography has increased. The pregnancy rate after hysterosalpingography using Sinografin has never been reported, however, and now 156 such patients have been evaluated. The pregnancy rate was 10.9% in those who had only a hysterosalpingogram and 26.3% in those who received adjunctive therapy. These results are comparable to those previously reported for hysterosalpingography using water-soluble contrast material, but less than the results using oil-soluble contrast.

Contrast Media↗

PubMed1989

Abnormalities of the uterus and cervix after diethylstilbestrol exposure: correlation of findings on MR and hysterosalpingography.

We determined the value of MR for detecting abnormalities of the uterus caused by in utero exposure to diethylstilbestrol in patients in whom such abnormalities were evident on hysterosalpingography. Of 200 women with a history of diethylstilbestrol exposure in utero, 12 had undergone hysterosalpingography as part of an infertility workup. Five of these volunteered to undergo MR imaging of the pelvis. Hysterosalpingography showed abnormalities in all five patients. Abnormalities included hypoplasia of the uterine cavity (3/5), a T-shaped uterine cavity (3/5), constrictions of the uterine cavity (3/5), irregular margins of the uterine cavity (2/5), bilateral hydrosalpinges (2/5), and a diverticulum of a fallopian tube (1/5). MR images showed abnormalities in all five patients. These included hypoplasia of the uterine cavity, uterine corpus, and cervix (3/5); a T-shaped uterine cavity (3/5); constrictions of the uterine cavity (3/5); and bilateral hydrosalpinges (2/5). There was an excellent correlation between the findings on MR images and those on hysterosalpingograms. A thick junctional zone was identified on MR as the cause of constrictions of the uterine cavity seen on hysterosalpingography. MR failed to show the irregular margins of the uterine cavity in two of five cases and a diverticulum of the fallopian tube. We conclude that MR can be used to detect hypoplasia and other congenital abnormalities of the uterus in women with a history of diethylstilbestrol exposure in utero.

Adult↗

PubMed1977

Laparoscopy and hysterosalpingography in the assessment of tubal patency.

Laparoscopy was performed after hysterosalpingography in 409 patients complaining of infertility. Despite the use of general anesthesia and continuous screening technics during hysterosalpingography, conflicting diagnoses were made in 77 of the 117 patients where an abnormality of patency was detected by one or another technic. Peritubal adhesions were detected by hysterosalpingography in only 18 of the 54 cases where they were demonstrated by laparoscopy. Laparoscopy gave much useful information either at variance with or in addition to that yielded by hysterosalpingography.

Fallopian Tube Patency Tests↗

PubMedDate not supplied

Hysterosalpingography versus chromosalpingolaparoscopy: comparison of results in 174 patients with sterility problems.

The comparison of results of hysterosalpingography and chromosalpingolaparoscopy to which 174 patients with sterility problems were subjected confirmed that chromosalpingolaparoscopy is an altogether more accurate and reliable test than hysterosalpingography. However, it also showed that chromosalpingolaparoscopy can give false positives in the study of tubal accessibility. The Authors consider hysterosalpingography a fundamental test when studying sterile women, since it is the only examination enabling the observation of tubal passages and also because it is able to show the above-mentioned possible false positives of chromosalpingolaparoscopy. In agreement with most experts in gynecological endoscopy, the Authors consider hysterosalpingography and chromosalpingolaparoscopy two complementary examinations when studying the uterotubal approach while chromosalpingolaparoscopy is a balance test to be used, with rare exceptions, at the end of the diagnostic iter.

Adult↗

PubMedDate not supplied

[Hysterosalpingography in sterility].

From 1967 to 1975 the authors performed 500 hysterosalpingographies in 851 women examined for sterility. Hysterosalpingography was carried out under the diascopic control of an electronic amplifier and a tele-monitor. As a contrast medium only the water-soluble Joduron U-S (Cilag) was used. In 286 women (57%) primary sterility and 214 (43%) secondary sterility were established. Radiographic analysis revealed 209 anomalies of the uterus, 114 of which related to hypoplastic uterus. In 286 women with primary sterility there was occlusion of one or both tubes in 62 cases (21.67%) and the sactosalpinx of one or both tubes in 48 cases (16.78%). In 214 women with secondary sterility, there was occlusion of one or both tubes in 66 cases (31.30%) and the sactosalpinx of one or both tubes in 48 cases (22.42%). In 500 hysterosalpingographies the intravasation of the contrast medium into the venous system occurred in 23 cases (4.60%) but there was not a single case of unatoward side-effects. Sixty-six women became gravid 1--6 months after hysterosalpingography, without the use any other kind of therapy.

Adult↗

PubMed1995

[Role of hysterosalpingography in the evaluation of infertility in Black Africa].

Infertility affects a great number of women in Black Africa and tubal obstruction seems to be common. Because of this high incidence, an accurate test for tubal patency is needed and several examinations have been proposed. Recent reports indicate that the method of choice is hysterosalpingography since it is simple, quick, and reliable. Concordance with laparoscopy, the gold standard, is 85% for assessment of tubal patency and 75% for detection of tubal abnormalities. Due to the lack of radiological facilities in most hospitals in Black Africa, a simplified examination is proposed and seems to be useful as an initial screening test. This simplified test consists of obtaining a delayed anteroposterior image after a brief walk. The most severe complication of hysterosalpingography is pelvic infection which occurs in 2 to 4% of cases and requires prophylactic antibiotic therapy. Interestingly an increase in pregnancy rate has been observed in the months after hysterosalpingography. Recent reports concerning infertility workups in developing countries confirm that the method of choice for assessment of tubal function is hysterosalpingography provided that the risk of infection can be controlled.

Africa↗