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

Abstract

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

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

Abstract

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.

Keywords

• Fallop tüpü
• hidrosalpinks
• histerosalpingografi
• infertilite
• laparoskopi

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