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PubMed1998

Agreement between hysterosalpingography and laparoscopic chromopertubation in assessment of tubal patency.

BACKGROUND: To assess the agreement between tubal patency assessed by laparoscopy with chromopertubation and by hysterosalpingography using contrast media. SETTING: University Medical School. PATIENTS: 314 consecutive women subjected to laparoscopy and hysterosalpingography for an infertility study. DESIGN: Prospective study. METHODS: Chromopertubation using Methylen blue dye, performed on days 20-24. Hysterosalpingography performed on days 7-10 with water soluble contrast. MAIN OUTCOME MEASURE: Kappa coefficient calculation. RESULTS: Kappa coefficient ranged from 0.40 to 0.36, depending on the categories analyzed, corresponding to a fair agreement. CONCLUSION: The diagnosis of tubal factor requires that both tubal patency tests (Hysterosalpingography and laparoscopy) show an abnormal patency. When one of the aforementioned tests is normal, performing the second one has little clinical advantage. However, it is suggested that when there is a discordant patency the pregnancy rates could be somewhat reduced.

Adult↗

PubMed1963

THE USE OF HYSTEROSALPINGOGRAPHY IN THE DIAGNOSIS OF INFERTILITY AND OTHER GYNECOLOGICAL CONDITIONS.

Hysterosalpingography was performed on 175 patients who had gynecological symptoms but negative pelvic findings, in order to test a new method of introducing the contrast medium into the uterus and tubes and to record the incidence of pathology revealed. In 132 patients, an attempt was made to secure a No. 14 Foley catheter in the uterus for introducing the contrast medium. This method was successful in 124 patients and can be recommended as being simple, less painful and more efficient than older methods. Of 156 patients with the complaints of infertility (68), dysmenorrhea (31), pelvic pain (29) or menstrual disorder (28), hysterosalpingography revealed significant abnormality in 58; most of these (47) had chronic salpingitis. One flare-up of pelvic inflammation occurred but no other complications were observed. It was concluded that hysterosalpingography is now sufficiently safe and reliable to merit wider utilization in gynecological diagnosis.

Catheterization↗

PubMed2003

Oil-soluble contrast during hysterosalpingography in women with proven tubal patency.

To determine if there are therapeutic advantages to oil-soluble contrast medium compared with water-soluble medium during hysterosalpingography.A randomized, controlled trial including 56 infertile patients undergoing hysterosalpingography was performed. After a hysterosalpingogram with water-soluble contrast demonstrated tubal patency, 30 patients were randomized to receive oil-soluble contrast medium (oil group) and 26 patients received no additional contrast medium (control group). The outcome was pregnancy and timing of pregnancy in relation to hysterosalpingography. There were 18 (64%) pregnancies in the oil group and 14 (56%) pregnancies in the control group. Mean time to achieve pregnancy was shorter in the oil group: 3.8 months in the oil group compared with 6.1 months in the control group (P =.06) There was a clinically meaningful improvement in pregnancy rates between the oil group and the control group at 1 month postprocedure (relative risk [RR] 2.1, 95% confidence interval [CI] 0.6, 7.2). However, at 12 months postprocedure, the advantage was diminished. (RR 1.3, CI 0.8, 2.1)Eighteen months after hysterosalpingography, contrast does not appear to influence cumulative pregnancy rates; however, the addition of oil-soluble contrast medium to water-soluble contrast medium may have the potential to reduce the time to conception.

Adolescent↗

PubMed1998

Hysterosalpingography with videofluoroscopy: effect on radiologic practice in an academic medical center.

RATIONALE AND OBJECTIVES: The authors attempted to determine whether videotaping the fluoroscopic portion of hysterosalpingography would result in changed diagnoses or an increase in diagnostic confidence. MATERIALS AND METHODS: Ninety-nine consecutive outpatients underwent routine hysterosalpingography. The fluoroscopic portion of the examination was captured on videotape. Two consecutive interpretations of each hysterosalpingogram were made by attending radiologists. First, spot radiographs were interpreted alone. Second, these images were viewed along with videofluoroscopy. Concordance of and confidence in findings for the two interpretations were assessed with the two-tailed Fisher exact test. RESULTS: Interpretations of spot radiographs alone and with videofluoroscopy were in agreement in 92 of 99 uterine examinations and 164 of 198 tubal examinations. For uterine examinations classified as normal, interpretations of spot radiographs and videofluoroscopy were in agreement in 56 of 57 cases; there was no change in confidence with review of videofluoroscopic images. For uterine examinations interpreted as abnormal, agreement was noted in 36 of 42 cases (P = .04), and confidence increased with videofluoroscopy in 10 of 42 cases (P = .00001). With normal tubal findings, interpretations agreed in 94 of 118 cases, and confidence increased in 56 of 118 cases (P = .002). With abnormal tubal findings, interpretations agreed in 70 of 80 cases, and confidence increased in 20 of 80 cases (P = .002). When findings with and without videofluoroscopy were discordant, confidence was always higher after review of video-fluoroscopic images. CONCLUSION: Review of videofluoroscopic images obtained during hysterosalpingography increases the accuracy and confidence of diagnoses compared with review of spot radiographs alone.

Academic Medical Centers↗

PubMed1983

[Value and possibilities for the improvement of hysterosalpingography].

The diagnostic results of hysterosalpingography and laparoscopy were compared (30 patients). Agreement between the methods was found in 73%. In 17% of the women, findings seen on hysterosalpingography, could not be confirmed at laparoscopy. Conversely, in 10% of negative hysterosalpingograms, adhesions were found at laparoscopy. Possible causes for these differences are discussed. At present three different methods are used for hysterosalpingography. Compared with a metal cannula or a Foley catheter, the use of a baby's feeding tube resulted in a reduction of tubal spasm. A reduction in screening time and consequent decrease in gonadal radiation is possible without loss of diagnostic information.

Female↗

PubMed1997

Sonohysterographic evaluation of uterine abnormalities noted on hysterosalpingography.

Transvaginal sonohysterography was performed on 40 consecutive patients with infertility or recurrent pregnancy loss and uterine abnormalities on hysterosalpingography. The findings were correlated with the hysterosalpingogram and subsequent diagnostic and/or operative hysteroscopy. Hysterosalpingography was incorrect in nine cases. Sonohysterography was more accurate than hysterosalpingography and provided more information about uterine abnormalities. Sonohysterography was in complete agreement with hysteroscopy. Diagnostic hysteroscopy can therefore be avoided if the sonohysterogram is normal. Sonohysterography also provides additional information on the relative proportion of the intracavitary and intramyometrial components of submucus myomas, as well as extracavitary myomas and the adnexae. This may help in planning the surgical procedure.

Abortion, Habitual↗

PubMed1984

Pelvic inflammatory disease after hysterosalpingography associated with Chlamydia trachomatis and Mycoplasma hominis.

A total of 116 women were referred for hysterosalpingography because of primary or secondary infertility. Chlamydia trachomatis was isolated from the cervix of four (3.4%) of the patients whereas Mycoplasma hominis was isolated from 39 (33.6%) of them. Four patients developed acute pelvic inflammatory disease after hysterosalpingography; two of them were chlamydia culture-positive and developed a significant chlamydial antibody response during the course of the disease. One of the other two patients, who developed upper genital-tract infection, was culture positive for M. hominis and developed a significant antibody response to this micro-organism. The results indicate that C. trachomatis should be sought in patients before hysterosalpingography and, if detected, appropriate antibiotic cover should be instituted before the procedure.

Adult↗

PubMed2006

Evaluation of pain in three hysterosalpingography techniques: metal cannula with and without paracervical blockage and balloon catheter.

OBJECTIVE: The objective of this study was to assess discomfort or pain in patients undergoing hysterosalpingography using three different techniques. SUBJECTS AND METHODS: Eighty-nine patients were randomly assigned to one of three groups. In group 1, 30 patients underwent the technique performed with a metal cannula without anesthetic; in group 2, 29 patients underwent the technique performed with a metal cannula with previous paracervical anesthetic block; in group 3, 30 patients submitted to the procedure performed with a flexible balloon catheter. Each patient completed two questionnaires, Q1 and Q2: Q1 assessed their personal, clinical, and surgical history, and Q2 provided the visual analog scale (VAS) for pain assessment. The investigator also evaluated discomfort at each potentially painful stage of the procedure based on the patient's verbal expression, physical manifestations, or both. RESULTS: In terms of global discomfort experienced during hysterosalpingography, group 1 had the highest mean VAS score, whereas scores did not significantly differ between groups 2 and 3. During cervical grasping, group 2 experienced less discomfort than group 1. A comparison of pain associated with cervical grasping and balloon inflation (group 3 only) revealed that the highest levels of discomfort occurred during cervical grasping without anesthesia (group 1), followed by balloon inflation inside the cervix (group 3), and, last, cervical grasping after paracervical block (group 2). CONCLUSION: Performing hysterosalpingography with a flexible balloon catheter or metal cannula with previous paracervical block produced similar levels of pain; however, both techniques appear to be more comfortable than the traditional technique (i.e., metal cannula without anesthesia).

Adolescent↗

PubMed2001

Three-dimensional multiplanar sonohysterography: comparison with conventional two-dimensional sonohysterography and X-ray hysterosalpingography.

The objective of this study was to assess the value of combining transvaginal sonohysterography with three-dimensional multiplanar ultrasonography to optimize assessment of the uterus. To make this assessment, we compared findings on three-dimensional sonohysterography with those on two-dimensional sonohysterography and X-ray hysterosalpingography. Of 20 women who underwent three-dimensional sonohysterography for various indications, 13 also underwent two-dimensional sonohysterography, and 12 had X-ray hysterosalpingography. We reviewed the 3 types of examinations separately and compared the standard techniques with three-dimensional sonohysterography to determine whether three-dimensional sonohysterography provided additional information. In 9 (69%) of 13 comparisons between three-dimensional sonohysterography and two-dimensional sonohysterography and in 11 (92%) of 12 comparisons between three-dimensional sonohysterography and X-ray hysterosalpingography, three-dimensional sonohysterography was advantageous. The coronal plane was most useful for displaying the relationship between lesions and the uterine cavity. Three-dimensional sonohysterography provided additional information compared with standard accepted techniques in the vast majority of women.

Adult↗

PubMed2004

Recanalization of a fallopian tube after detorsion of twisted adnexa: report of a case with follow-up by repeat hysterosalpingography.

BACKGROUND: Detorsion and cystectomy of twisted adnexa have been performed in young women. However, identification was incomplete, and the function of the affected tube was not investigated. CASE: A 23-year-old, nulligravid woman with an acute abdomen was diagnosed with adnexal torsion. An emergency laparotomy revealed that both ovaries were 12x9x9 cm. the right adnexa were twisted and bluish black. Detorsion of the twisted lesion and ipsilateral fallopian tube was performed, with subsequent cystectomy of both lesions. Hysterosalpingography on the 14th postoperative day showed right tubal obstruction; 6 months postoperatively, repeat hysterosalpingography revealed patency of the right tube. CONCLUSION: At least several months may be required for functional recovery of an untwisted tube. For that reason, postoperative repeat hysterosalpingography is a useful method for follow-up of function in an untwisted tube.

Abdomen, Acute↗

PubMed2004

Structural findings at hysterosalpingography in patients with infertility at two private clinics in Kampala, Uganda.

INTRODUCTION: Hysterosalpingography (HSG) is still a commonly used investigation in the evaluation of the female genital tract and the main indication for HSG is infertility. OBJECTIVE: The purpose of this study was to find the pathology detected at HSG in patients with infertility in our setting. MATERIALS AND METHODS: A retrospective review of 289 consecutive patients who underwent hysterosalpingography using ionic water-soluble contrast media was done at 2 private x-ray units in Kampala. Clinical notes and radiological findings were analysed for demographic data, uterine status, tubal and pelvic pathology. RESULTS: The commonest age group seen was 26-30 yrs. Most were of low parity. Secondary infertility was commoner than primary infertility. Abnormal findings at hysterosalpingography were found in 83.4%. The commonest finding was tubal blockage. CONCLUSION: The commonest pathology found on HSG in women presenting with infertility in Kampala is tubal blockage possibly secondary to chronic pelvic inflammation. The fact that secondary infertility is common points to pelvic infection complicating mismanaged pregnancies, septic abortions or sexually transmitted infections. A study to establish associated factors is recommended.

Adolescent↗

PubMed1986

Pregnancy rates after hysterosalpingography with oil- and water-soluble contrast media.

Hysterosalpingography can be accomplished with either oil or water-soluble contrast medium. This randomized prospective study compared pregnancy rates in women who had hysterosalpingography with either water- or oil-soluble contrast material and were followed for six months. Fifteen of 60 (25%) patients who received water-soluble dye conceived compared with 14 of 46 (30%) patients in the oil-soluble group, a statistically insignificant difference. Furthermore, no difference in pregnancy rates within each subgroup of fertility diagnosis was detected. Intravasation was more common in patients administered oil-based contrast materials (six of 46 versus one of 60 patients, P = .02), although no serious consequences occurred. No difference in the amount of pain as assessed by pain scoring was experienced by patients in each group. The authors conclude that pregnancy rates are similar after hysterosalpingography with oil- and water-soluble contrast material, during at least the first six months after the procedure.

Adult↗

PubMed1994

[Hysteroscopy versus hysterosalpingography in diagnosis of sterility and infertility].

In a prospective study of 68 infertile patients the findings of hysterosalpingography and hysteroscopy have been compared. Hysterosalpingography showed in 3 cases false-negative results and in 10 cases false-positive results. Hysterosalpingography is especially limited for diagnostics of intrauterine adhesions. Hysteroscopy should be a necessary component of diagnostics of sterility, also in case of normal hysterosalpingographical findings.

Adult↗

PubMed1994

Pelvic granulomata mimicking endometriosis following the administration of oil-based contrast media for hysterosalpingography.

BACKGROUND: Hysterosalpingography is used commonly in the evaluation of infertility and in the diagnosis of anomalies of the uterus and fallopian tubes. There is continued debate over the safety and diagnostic or therapeutic efficacy of water-soluble versus oil-based contrast media. CASE: A 29-year-old woman with secondary infertility underwent hysterosalpingography with both water-soluble and oil-based contrast. The fallopian tubes appeared normal. Six months later, a plain abdominal radiograph obtained at the occasion of a minor motor vehicle accident revealed evidence of retained loculated pelvic contrast material. Subsequent laparoscopy identified adhesions and cul-de-sac implants strongly suspicious for endometriosis. Biopsy and pathologic study documented lipogranuloma. CONCLUSION: Oil-based contrast media instilled into the pelvis at hysterosalpingography can persist for prolonged periods and create granulomatous lesions mimicking endometriosis. In view of the controversy whether oil-based contrast materials are superior to water-soluble media, the routine use of oil-based contrast media should be considered carefully.

Adult↗

PubMed1993

[Hysterosalpingography using iotrolan--a new contrast medium].

Iotrolan was investigated as a new contrast medium for hysterosalpingography. Fertility rates and side-effects were registered in a series of 108 consecutive patients. The results indicate a higher fertility rate after hysterosalpingography with iotrolan than after the use of other water-soluble contrast media but a lower fertility rate when compared to lipiodol. As for side-effects, the study indicates that the frequencies of low abdominal pain and vaginal bleeding after hysterosalpingography are equal for iotrolan and lipiodol but higher for other, water-soluble contrast media. A prospective, randomized study is recommended for the clarification of these aspects.

Abdominal Pain↗

PubMed1997

The role of hysterosalpingography in the evaluation of infertility.

Hysterosalpingography is the only radiologic procedure routinely performed in the initial evaluation of the infertile woman. Hysterosalpingography is used to assess the anatomy of the uterus and the patency of the fallopian tubes, and is performed in the proliferative phase of the menstrual cycle. It can be performed with either water- or oil-soluble contrast medium. Care should be taken during the procedure that excessive amounts of contrast medium are not injected, because that could obscure the diagnostic findings. Selective salpingography can help evaluate a suspected proximal tubal occlusion. The complications associated with hysterosalpingography include pain, pelvic infection, intravasation of contrast medium and allergic reactions. Abnormal hysterosalpingographic findings include occlusion of one or both fallopian tubes, uterine filling defects and müllerian anomalies. Therapy for abnormal hysterosalpingographic findings depends on the specific clinical scenario and includes endoscopic surgery, laparotomy and in vitro fertilization.

Female↗

PubMed1976

The alleviation of uterocornual spasm of the Fallopian tubes during hysterosalpingography by intravenous administration of orciprenaline.

A simple, safe and reliable method of differentiating between organic obstruction spasm at the uterocornual junction of the oviduct during routine hysterosalpingography is described. Seventeen patients were studied. In all patients uterocornual obstruction was found during hysterosalpingography, which was performed without general anaesthesia. In 8 patients the apparent obstruction was alleviated within 30 seconds of the intravenous administration of 0.25 mg orciprenaline. Surgical and endoscopic findings confirmed the presence of the obstruction in all the other 9 patients. These findings are discussed on the basis of the neuro-anatomy of the Fallopian tube. It is suggested that this form of treatment, in many cases, eliminates the need to perform the procedure under general anaesthesia, which is the only other method of consistently alleviating such a 'spasm'. The use of orciprenaline may facilitate a rapid turnover of patients in units where hysterosalpingography is performed as a screening investigation for infertility. Furthermore, it is suggested that the oral administration of beta-adrenergic agents during the peri-ovulatory period to patients in whom 'tubal spasm' has been diagnosed might offer a rational approach to treatment.

Diagnosis, Differential↗

PubMed1976

A comparative study of hysterosalpingography and laparoscopy in the investigation of infertility.

A comparison of hysterosalpingography and laparoscopy was carried out on 79 infertile women. Out of these, 60 had abnormal and 19 had normal hysterosalpingograms. Of the 19 patients with normal X-rays, nine (47%) had abnormal findings during laparoscopy. In 62% of patients with abnormal hysterosalpingograms, laparoscopic findings confirmed the radiological diagnosis, however in 38% the findings differed. Though hysterosalpingography is an important part of infertility evaluation, a final and definite diagnosis requires endoscopic evaluation of the pelvis.

Female↗