HİDROSALPİNKS TANISINDA ULTRASONOGRAFİ VE HİSTEROSALPİNGOGRAFİ YETERİNCE GÜVENİLİR Mİ?

Year 2018, Volume: 49 Issue: 2, 218 - 222, 27.06.2018

Dilşad Herkiloğlu , Canan Kabaca

https://doi.org/10.16948/zktipb.416720

Abstract

HİDROSALPİNKS TANISINDA
ULTRASONOGRAFİ VE HİSTEROSALPİNGOGRAFİ YETERİNCE GÜVENİLİR Mİ?

 

ÖZET

 

AMAÇ:İnfertil
hastaların uterin boşluğu ve fallop tüplerini ilk basamak değerlendirme ultrasonografi
(USG) ile olup bir sonraki aşamada diğer gelişmiş ve etkili yöntemler olmasına
rağmen histerosalpingografi (HSG) ucuz, kolaylıkla erişilebilir ve yorumlanması
kolay olduğundan yaygın olarak kullanılmaktadır. Çalışmamızda HSG ve USG
sonucunda hidrosalpinks ön tanısı konulan hastaların laparoskopi ile
korelasyonunu değerlendirerek HSG’nin ve USG’nin hidrosalpinks tanısı koymadaki
değeri ve birbirlerine üstünlüğü olup olmadığını  göstermeyi amaçladık.

YÖNTEM:Çalışmaya
1 Ağustos 2015 ile 1 Nisan 2017 tarihleri arasında hastanemizin kadın doğum
polikliniklerine infertilite nedeniyle ile başvuran HSG’de ya da USG’de
hidrosalpinks saptanan 48 hasta dahil edildi. Tüm hastalar genel anestezi
altında, laparoskopi ile opere edildi. Laparoskopide her iki tuba serbest  metilen mavisi geçişi değerlendirildi. HSG
veya USG sonucu ile laparoskopi sonucunun korele olmaması HSG’nin ya da USG’nin
yanlış teşhisi olarak değerlendirildi. 
Laparoskopide patolojik bulguların olması halinde HSG ya da USG teşhisi
doğru olarak kabul edildi.

 

BULGULAR:48
hastanın 30’u primer infertil 18’i sekonder infertildi. 26 hastaya HSG ile
hidrosalpinks düşünüldü. Laparoskopi sonrası 15’inde (%57,7) hidrosalpinks
doğrulandı. 25 hastaya USG ile hidrosalpinks ön tanısıyla laparoskopi yapıldı.
17’sinde (%68)  hidrosalpinks doğrulandı.
3 hastada hem USG de hemde HSG de hidrosalpinks mevcuttu. Bu hastalarda USG
bulgularının laparoskopi ile korelasyonu değerlendirildi. Hsg’nin teşhis
doğruluğu (%57,7) USG’nin teşhis doğruluğu (%68) ile arasında istatistiksel bir
fark saptanmadı. (P=0,638). 

SONUÇ: İnfertilitenin
ilk basamak değerlendirmelerinden olan USG ve HSG ile ucuz ve kolay bir şekilde
hidrosalpinks tanısı konulabilir.

 

Anahtar
sözcükler: Hidrosalpinks, İnfertilte, Laparoskopi

 

Keywords

Hidrosalpinks, İnfertilte

ULTRASONOGRAPHY AND HYSTEROSALPHYNOGRAPHY RELIABLE IN THE DIAGNOSIS OF HYDROSALPİNX?

Abstract

ULTRASONOGRAPHY AND
HYSTEROSALPHYNOGRAPHY RELIABLE IN THE DIAGNOSIS OF HYDROSALPİNX?

SUMMARY

OBJECTIVE: Although the first step
evaluation of infertile patients with uterine cavity and fallopian tubes is
ultrasonography (USG), hysterosalpingography (HSG) is widely used because it is
cheap, easily accessible and easy to interpret, although other advanced and effective
methods are available at the next stage. In our study, we aimed to evaluate the
correlation of HSG and USG with laparoscopy of patients with hydrosalpinx presumptive
diagnosis and to show whether HSG and USG are superior to each other in
hyphrosalpinx diagnosis.

METHODS: Between August 1, 2015 and
April 1, 2017, 48 patients who were admitted to our obstetric gynecology out patient
clinic for infertility, or who underwent hydrosalpinx in USG were included in
the study. All patients underwent laparoscopy under general anesthesia.
Laparoscopy was used to evaluate the incidence of free methylene blue in both
tuba. Correlation of HSG or USG result with laparoscopy result was assessed as
false diagnosis of HSG or USG. In the case of pathological findings on
laparoscopy, HSG or USG diagnosis was accepted correctly.

RESULTS: Of the 48 patients, 30 were primer
infertile 18 were secondary to infertile. 26 patients were considered hydrosalpinx
with HSG. Hydrosalpinx was confirmed in 15 (57.7%) of the patients after laparoscopy.
Twenty-five patients underwent laparoscopy with USG and hydrosalpinx anterior diagnosis.
In 17 (68%) hydrosalpinx was confirmed. In 3 patients, both USG and HSG had
hydrosalpinx. The correlation of USG findings with laparoscopy was evaluated in
these patients. There was no statistically significant difference between the diagnostic
accuracy of HSG (57.7%) and the diagnostic accuracy of USG (68%). (P = 0.638).

CONCLUSION: USG and HSG, which are the
first-line evaluations of infertility, can diagnose hydrosalpinx cheaply and easily.

Keywords

Hydrosalpinx, Infertility

References

• 1. Idrisa A. Infertility. In: Kwawukume EY, Emuveyan EE, editors. Comprehensive Gynaecology in the Tropics. Accra Graphics Packaging; 2005. pp. 333–43.
• 2. William LS, Laura GB, Jolinda M. Hysterosalpingography: A reemerging study. Radiographics. 2006;26:419–31.
• 3. Reis MM, Soares SR, Cancado ML, Camargos AF. Hysterosalpingo-contrast Sonography (Hycosy) with SH U 454 (Echorist) for the assessment of tubal patency. Hum Reprod. 1998;13:3049–52.
• 4. Khalaf Y. ABC of subfertility tubal subfertility. BMJ. 2003;327:610–3
• 5. Imo AO, Adeoye IS. Radiological assessment of the uterus and fallopian tubes in infertile women at Abakaliki, Nigeria. Niger J Clin Pract. 2008;11:211–51.
• 6. Mgbor SO. Pattern of hysterosalphingographic findings in gynaecological patients in Enugu. Niger Med J. 2006;47:14–6.
• 7. Okonofua FE. Infertility in Sub-Saharan Africa. In: Okonofua F, Odunsi K, editors. Contemporary Obstetrics and Gynaecology for Developing Countries. Benin City, Nigeria: WHARC; 2003. pp. 128–56.
• 8. Asaleye CM, Adetiloye VA, Oyinlola TO. Review of hysterosalphingographic reports done for infertility over a 10 year period. Niger J Health Sci. 2004;4:36–9.
• 9. Copperman AB, Wells V, Luna M, Kalir T, Sandler B, Mukherjee T. Presence of hydrosalpinx correlated to endometrial inflammatory response in vivo. Fertil Steril. 2006;86:972–6. doi: 10.1016/j.fertnstert.2006.02.113.
• 10. Franchi L, Patrelli TS, Berretta R, Rolla M, Gizzo S, Gramellini D, Bacchi Modena A, Nardelli GB. Role of D-dimer testing in severe pelvic inflammatory disease: a new usable marker to assess the need for fertility-impairing surgery? Fertil Steril. 2010;94:2372–5.
• 11. Lessey BA, Castelbaum AJ, Sawin SW, Sun J. Integrins as markers of uterine receptivity in women with primary unexplained infertility. Fertil Steril. 1995;63:535–42.
• 12. Koong MK, Jun JH, Song SJ, Lee HJ, Song IO, Kang IS. A second look at the embryotoxicity of hydrosalpingeal fluid: an in-vitro assessment in a murine model. Hum Reprod. 1998;13:2852–6.
• 13. De Wit W, Gowrising CJ, Kuik DJ, et al. Only hydrosalpinges visible on ultrasound are associated with reduced implantation and pregnancy tares after in vitro fertilization. Hum. Reprod. 1998;13:1696-1701.
• 14. StrandellA, LinhardA, Waldensröm U, Thorburn J. Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial. Hum. Reprod 2001;16(11). 2403- 2410.
• 15. Berker B, Şükür YE, Aytaç R, Atabekoğlu CS, Sönmezer M, Özmen B. Infertility work-up: To what degree does laparoscopy change the management strategy based on hysterosalpingography findings?J Obstet Gynaecol Res. 2015 Nov;41(11):1785-90.
• 16. Surrey ES, Schoolcraft WB. Laparoscopic management of hydrosalpinges before in vitro fertilization-embryo transfer: salpingectomy versus proximal tubal occlusion. Fertil Steril 2001;75:612–7.
• 17. Kontoravdis A, Makrakis E, Pantos K, Botsis D, Deligeoroglou E, Creatsas G. Proximal tubal occlusion and salpingectomy result in similar improvement in vitro fertilization outcome in patients with hydrosalpinx. Fertil Steril 2006;86:1642–9.
• 18. Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, et al. Pregnancyrates after in-vitro fertilization in cases of tubal infertility with andwithout hydrosalpinx: a meta-analysis of published comparative studies.Hum Reprod 1999;14:1243–9.
• 19. Zeyneloglu HB, Arici A, Olive DL. Adverse effects of hydrosalpinx on pregnancyrates after in vitro fertilization-embryo transfer. Fertil Steril 1998;70:492–9.
• 20. Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons Salpingectomy for hydrosalpinx prior to in vitro fertilization. Fertil Steril. 2008;90:66–8.
• 21. Camus E, Poncelet C, Goffinet F, Wainer B, Merlet F, Nisand I, Philippe HJ. Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies. Hum Reprod. 1999;14:1243–9. doi: 10.1093/humrep/14.5.1243.
• 22. National Collaborating Centre for Women's and Children's Health (UK) Fertility: Assessment and Treatment for People with Fertility Problems. London: Royal College of Obstetricians & Gynaecologists (UK); 2013.
• 23. Johnson N, van Voorst S, Sowter MC, Strandell A, Mol BW. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. 2010;1:CD002125.
• 24. Johnson N, van Voorst S, Sowter MC, Strandell A, Mol BW. Tubal surgery before IVF. Hum Reprod Update. 2011;17:3. doi: 10.1093/humupd/dmq012.
• 25. Lass A, Ellenbogen A, Croucher C, Trew G, Margara R, Becattini C, Winston RM. Effect of salpingectomy on ovarian response to superovulation in an in vitro fertilization-embryo transfer program. Fertil Steril. 1998;70:1035–8. doi: 10.1016/S0015-0282(98)00357-4.
• 26. Chan CC, Ng EH, Li CF, Ho PC. Impaired ovarian blood flow and reduced antral follicle count following laparoscopic salpingectomy for ectopic pregnancy. Hum Reprod. 2003;18:2175–80. doi: 10.1093/humrep/deg411.
• 27. Orvieto R, Saar-Ryss B, Morgante G, Gemer O, Anteby EY, Meltcer S. Does salpingectomy affect the ipsilateral ovarian response to gonadotropin during in vitro fertilization-embryo transfer cycles? Fertil Steril. 2011;95:1842–4. doi: 10.1016/j.fertnstert.2010.11.061.
• 28. Grynnerup AG, Lindhard A, Sørensen S. Anti-Müllerian hormone levels in salpingectomized compared with nonsalpingectomized women with tubal factor infertility and women with unexplained infertility. Acta Obstet Gynecol Scand. 2013;92:1297–303. doi: 10.1111/aogs.12234.
• 29. Venturella R, Morelli M, Lico D, Di Cello A, Rocca M, Sacchinelli A, Mocciaro R, D’Alessandro P, Maiorana A, Gizzo S, Zullo F. Wide excision of soft tissues adjacent to the ovary and fallopian tube does not impair the ovarian reserve in women undergoing prophylactic bilateral salpingectomy: results from a randomized, controlled trial. Fertil Steril. 2015;104:1332–9. doi: 10.1016/j.fertnstert.2015.08.004.
• 30. Litta P, Saccardi C, Gizzo S, Conte L, Ambrosi G, Sissi C, Palumbo M. Inflammatory cytokine expression following the use of bipolar electrocoagulation, ultracision harmonic scalpel and cold knife biopsy. Mol Med Rep. 2015;12:2985–90.
• 31. Gizzo S, Andrisani A, Esposito F, Oliva A, Zicchina C, Capuzzo D, Gangemi M, Nardelli GB. Ovarian reserve test: an impartial means to resolve the mismatch between chronological and biological age in the assessment of female reproductive chances. Reprod Sci. 2014;21:632–9. doi: 10.1177/1933719113508821.
• 32. Gizzo S, Andrisani A, Noventa M, Quaranta M, Esposito F, Armanini D, Gangemi M, Nardelli GB, Litta P, D’Antona D, Ambrosini G. Menstrual cycle length: a surrogate measure of reproductive health capable of improving the accuracy of biochemical/sonographical ovarian reserve test in estimating the reproductive chances of women referred to ART. Reprod Biol Endocrinol. 2015;13:28. doi: 10.1186/s12958-015-0024-1.
• 33. Ye XP, Yang YZ, Sun XX. A retrospective analysis of the effect of salpingectomy on serum anti-Müllerian hormone level and ovarian reserve. Am J Obstet Gynecol. 2015;212:53.e1–10. doi: 10.1016/j.ajog.2014.07.027.
• 34. Ni L, Sadiq S, Mao Y, Cui Y, Wang W, Liu J. Influence of various tubal surgeries to serum antimullerian hormone level and outcome of the subsequent IVF-ET treatment. Gynecol Endocrinol. 2013;29:345–9. doi: 10.3109/09513590.2012.743004.