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Introduction: Infertility is a leading psychosocial problem in couples. Diagnostic evaluation of uterine tube is important in the management of infertility. Causes or factors of female infertility can basically be classified regarding whether they are acquired or genetic, age, smoking, sexually transmitted infections (STIs), adhesions in the peritoneal cavity, previous abdomen surgeries, diabetes mellitus, smoking, alcohol, celiac disease, liver and kidney disease and being overweight or underweight can all affect fertility. Proper evaluation of the infertility is needed for better management of the cases of infertility. Aim of the study: To assess the efficacy of Sonosalpingography (SSG) and Hysterosalpingography (HSG) in the diagnosis and management of infertility. Materials and methods: A total 75 cases attending the department with complaint of infertility. Cases between ages 21 years and 44 years were recruited for this study. Duration of this study was two years, from June 2016 to May 2018. All the cases were undergone with baseline transabdominal sonogram, real time transvaginal sonography and saline infusion sonography to examine pelvic region of the cases. All the participants had to undergo SSG on 8th day and HSG on 10th day of the menstrualcycle. Data was collected and sensitivity and specificity of SSG over HSG was assessed. Statistical analysis was done by using SPSS software version 14.0. Results: Diagnosis by SSG showed bilateral tubal patency in 83.93% cases and by HSG showed bilateral tubal patency in 75% cases. SSG and HSG both correlated well (95.3%) and both procedures had similar diagnostic accuracy. In this study, positive predictive value was 95.2% and negative predictive value was 94.6%. Sensitivity was 98.3%, specificity 85.6% and accuracy rate of this study was 95.8%. The outcome of this study indicates that there is no statistically significant difference (p=0.338) between the values of SSG and HSG. Conclusion: SSG is cost effective and radiation free procedure. The outcome of SSG is almost similar to the values of HSG.
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Background: Tubal factor is responsible for infertility and is found in one of three infertile women. The current research was undertaken to compare the efficacy of hysterosalpingo contrast sonography (HyCoSy) with laparoscopy and chromopertubation in infertile women.Methods: A cross-sectional study was conducted from August 2016 to March 2017 among the patients attending outpatient department with complaints of primary or secondary infertility after obtaining written and informed consent. Detailed history of the patient was taken; clinical examination and necessary investigations were done. Data analysis was carried out using SPSS version 22.Results: All the HyCoSy findings showed excellent specificity (84-100%) and the sensitivity ranged from 40-87%.Conclusions: Study conclude that HyCoSy is a good screening method for evaluating uterine cavity lesions and tubal block in infertile women being safe, sensitive, cost effective, non-invasive procedure giving additional information regarding ovarian, adnexal and peritoneal pathology.
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Background: Sonosalpingography has been suggested as the first-line method to study tubal patency. This study is to bring into focus the value of pelvic sonogram in accessing tubal patency in order to overcome the radiation hazard associated with hysterosalpingogram reduce the cost of examination and encourage it at first-line office. Objective of this study was to compare the diagnostic efficacy of sonosalpingogram, hysterosalpingography and diagnostic laparoscopy for tubal patency as a cause for female infertility.Methods: It is a prospective study in 100 patients attending for evaluation of infertility for a period of 2 years were chosen for this study. All cases with primary and secondary infertility who have attended infertility clinic for tubal causes.Results: 68 cases were found to have bilateral patency as per SSG while 58 cases had bilateral patency as HSG. Similarly 24 cases had bilateral block as per SSG while 28 cases had bilateral block as per HSG. 8 cases had unilateral block as per SSG while 14 cases had unilateral block as per HSG. This difference in observations may probably attribute to tubal spasm in HSG. Bilateral patency was observed in 68 cases as against 64 cases in laparoscopy. Out of these 68 cases 9 cases were false positive as bilaterally patent. However bilateral blocks were shown to be 24 in both methods. Out of 12 cases of unilateral block as per laparoscopy 8 cases were detected by SSG. There was false negative rate of 5%. There was false negative rate of 10% for tubal patency with HSG.Conclusions: For low risk subjects for tubal factors in infertility, sonosalpingogram can be employed as a screening test of choice and for high risk subjects HSG and laparoscopy can be used.
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Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla, and most commonly originate from adrenal gland. Most tumors secret large amount of norepinephrine, and epinephrine to a lesser extent. The clinical presentations are due to the over activity of catecholamines. Classical presentations are paroxysmal or sustained hypertension with palpitations, headaches and profuse sweating. Both open and laparoscopic approaches are used for the tumor resection. Anesthetist pays a significant role in the peri-operative management. Hyperlactaemia and lactic acidosis can be complications of the surgery. This can have a significant impact on the outcome.
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@#Recurrent ectopic pregnancy after bilateral salpingectomy is a very rare condition, with only one previous case reported. This is a case of a 29 year old G4P0(0030) who presented with abdominal pain at the background of missed menses and positive pregnancy test, two years after bilateral salpingectomy. Intraoperatively, a 5x4cm bleeding mass was visualized at the right distal tubal remnant, containing an embryo and decidualized tissues. Excision of the adnexal mass and bilateral tubal remnants were completed. In such cases, total salpingectomy is the gold standard in preventing recurrence of another extrauterine gestation. In the presence of tubal remnants, a hysterosalpingography is recommended to assess tubal patency. Ultimately, the rarity of this case demands prompt recognition of risk factors, clinical presentation and appropriate management. It underscores the importance of maintaining vigilance, with high index of clinical suspicion in all women in the reproductive age group, especially those with risk factors.
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Objective To investigate the clinical value of combination of transvaginal fourdimensional hysterosalpingo-contrast sonography(TVS 4D-HyCoSy) with uterine tubal liquid poking in assessment tubal fimbria patency.Methods Sixty-two female infertile patients with obstruction at tubal fimbria,or partial obstruction with pelvic adhesion were included.All of them were underwent 4D-HyCoSy as well as uterine tubal liquid poking,and were followed with laparoscopic chromopertubation (LPC) using Methylene blue in three months.Results Comparing with laparoscopy,the total coincidence rate of 4D-HyCoSy to assess the tubal fimbria patency was 94.3％,with the sensitivity of 90.1％ and specificity of 94.1 ％.Imaging results showed that the obstruction at tubal fimbria,uncircle-like wrapping contrast medium can be seen around ovary accounted for 80％.The patent fallopian tube fimbria,circle-like wrapping of contrast medium can be observed around ovary accounted for 85.5 ％.Conclusions The combination of TVS 4D-HyCoSy with uterine tubal liquid poking is highly in accordance with LPC by providing real-time dynamic visualization on overflowing of contrast medium from tubal fimbria,as well as the pelvic adhesion surrounding ovaries.The 4D-HyCoSy can be the preferred method for assessment of tubal fimbria patency and pelvic adhesion surrounding ovaries with its advantages of accuracy,non invasion and a good safety profile.
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Background: Infertility is a global issue in reproductive health. In many cultures the ability to have children is important sign of an individual's worth. Aim and objective: To compare hysterosalpingography, transvaginal sonosalpingography and laparoscopic chromotubation for evaluation of tubal factor in infertility. Materials and methods: This consisted of 50 infertile women with either primary or secondary infertility. Including investigations for other factors, tubal factor was evaluated by hysterosalpingography, transvaginal sonosalpingography and laparoscopic chromotubation (in one or two cycles). Results: The results of 50 cases of Infertility for Tubal patency by sonosalpingography, HSG, laparoscopy. 36 cases were of primary infertility and 14 cases of secondary infertility. Mean duration of primary and secondary infertility were 5.79 ± 3.19 and 5.97 ± 3.36 years respectively. Maximum number of cases had duration of infertility between 1 to 4 years (45.2 %). The average age in subjects of primary infertility were 26.25 ± 3.85 years and in subjects of secondary infertility were 29.73 ± 4.87 years. Up to 70% of cases had a high school or less than high school education and 92% of women were not employed. 29 patients had bilateral patency, in 14 patients had bilateral block, In 7 patients had unilateral block (either proximal or distal. findings in sonosalpingography, bilateral patency in 34 cases, findings at laparoscopy, bilateral patency number of cases 32 (64%), bilateral block no. of cases 12 (24%) and unilateral block no. of cases 6 (12%). In the group of Patients with Bilateral Patency there were 2 false Negative for HSG i.e. 22%, HSG and Laparoscopy are in agreement with 94%. There were 2 false positives for TVS i.e. 22%, between TVS and Laparoscopy J. Anuradha, K. Aruna Kumari, A. Sujatha. Comparative study of tubal patency by hysterosalpingography, transvaginal sonosalpingography and laparoscopy. IAIM, 2016; 3(9): 126-133. Page 127 were in agreement with 94%. In the group of patients with bilateral block there was 100% agreement between TVS and Laparoscopy. There was 2 false positive for bilateral block, agreement between HSG and Laparoscopy being only 94%. In the group of patients with unilateral block there were 2 false negatives for TVS rate 22%, agreement between TVS and Laparoscopy being 67%, For HSG false positive rate 11%, agreement between HSG and Laparoscopy being 85.5%. Conclusion: Low risk subjects for tubal factors in infertility, sonosalpingography can be employed as a screening procedure to pick up subjects needing HSG and laparoscopy. It is simple, in expensive, minimally invasive and one which would be complimentary to the armamentorium of infertility investigations already available.
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Objective To explore the tubal patency after laparoscopic salpingotomy and embryo removal for tubal ectopic pregnancy. Methods A retrospective analysis was made on 28 patients receiving laparoscopic salpingotomy at other hospitals from September 2013 to September 2014.Within their 6 postoperative months, these patients were given hysterosalpingography in this gynecological minimally invasive center to evaluate the tubal patency. Results There were 6 cases of ipsilateral tubal patency (21.4%) and 22 cases of tubal obstruction or dropsy (78.6%), while 19 cases of contralateral tubal patency (67.9%) and 9 cases of tubal obstruction or dropsy (32.1%).Bilateral tubal embryo removal was carried out in 3 cases, with hysterosalpingography showing bilateral tubal obstruction in 2 cases and bilateral tubal dropsy in 1 case.One patient had ipsilateral tubal obstruction after tubal embryo patency and developed contralateral tubal patency after conservative treatment.Follow-up of the 28 cases for 6-15 months showed 4 cases of intrauterine pregnancy, 4 cases of examination of ovulation, 7 cases of preparation of assisted reproduction, 3 cases of laparoscopic salpingoplasty 1-2 months after hysterosalpingography, 1 case of endocrine regulation monitoring ovulation, 1 case of abnormal uterine bleeding 13 months later ( hysteroscopic examination showed endometritis and diagnostic curettage found proliferative phase endometrium that consistent with the menstrual cycle), and 8 cases without further treatment. Conclusion Laparoscopic salpingotomy for tubal ectopic pregnancy does not improve patient’ s tubal patency.
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Objective To explore the safety and feasibility of conservative laparoscopic salpingotomy and embryo removal . Methods A total of 24 patients with tubal interstitial pregnancy underwent laparoscopic salpingotomy and embryo removal between January 2012 and January 2014.A longitudinal incision was made on the bulge lesions under laparoscope .The gestational sac and affiliated organizations were removed and the incision was continuously sutured with absorption threads .Results The operation was completed in all the 24 patients.The operation time was ( 33.5 ±6.2 ) min, and the blood loss was ( 40.6 ±9.4 ) ml.No postoperative persistent salpingocyesis occurred .The postoperative serum β-hCG recovery time was (14.2 ±4.6) d.Postoperative hysterosalpingography showed unobstructed fallopian tube in 13 patients, connected but not patent in 4 patients, and blocked in 5 patients. Conclusion Laparoscopic salpingotomy and embryo removal is safe and effective , with the patency of fallopian tube partly retained.
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assessment of uterine cavity and tubal patency compare with hysterosalpingography ( HSG ). Thirty four of infertile women undergoing investigation for infertility were enrolled from July 1997 until November 1998 for the current study. HyCoSy using Echovistฎ and HSG were successful carried out during the first half of each patient’s menstrual cycle. The flow of contrast medium through the uterine cavity and each fallopian tube was visualised in real time by transvaginal ultrasonography for HyCoSy. Meanwhile, HSG was performed and reported by consultant radiologists. Regarding the uterine cavity evaluation, 32 of 34 cases ( 94.1 % ) was reported to be normal by both procedures. Only 2 cases were noted with different results. From the 68 fallopian tubes studied, though 47 of 68 tubes were showed patent by the two procedures, HyCoSy could detect occlusion in only 5 of 10 left fallopian tubes and in 5 of 9 right fallopian tubes which were reported to be occluded by HSG. Mean length of time for HyCoSy was 8.7 minutes (range 2-30 minutes, Std. Dev. 5.4) and mild pelvic pain was the only complication incurred. In conclusion, HyCoSy using Echovistฎ is a reliable and safe procedure for outpatient uterine cavity evaluation. However, it does not substitute to HSG for tubal patency assessment in basic infertility investigation.
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Twenty nine fallopian tubes from 15 patients were examined for tubal patency using HyCoSy followed by chromolaparoscopy. The mean volume of contrast medium used was 14.3 ml and the duration of HyCoSy was 8.5 minutes. Concordance, sensitivity, specificity, positive predictive value and negative predictive value were 75.9, 44.4, 90.0, 66.7 and 78.3% respectively. The only adverse effect was mild pelvic pain and this was found in 60%. These results suggest that HyCoSy may become an established method for assessing fallopian tubal patency in the future.