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Diagnostics Tubal and Uterine Imaging

Chapter 66: Selective Hysterosalpingography and Transcervical Catheterization of the Fallopian Tubes

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 899-905, 2004

RRM Academy Synopsis

Selective HSG measures tube pressure to find partial blockages

Measuring pressure inside each fallopian tube showed higher pressure in more blocked tubes. This textbook chapter covers 441 tubes from women with infertility. Of these, 110 were open, 254 partly blocked and 77 fully blocked. The chapter also describes a wire method it says can lower pressure in partly blocked tubes.

Key Findings

  • The chapter reports pressure readings from 441 tubes: 110 freely patent, 254 partially obstructed and 77 completely obstructed (Table 66-1).
  • Average pressure differed between the freely patent tubes and the obstructed tubes, and between the partially and completely obstructed tubes (p<.0001 for both comparisons).
  • The chapter states that some tubes judged patent because dye flowed down them are actually partially obstructed.
  • The chapter states that catheterization with a flexible guidewire can lower pressure to normal in partially obstructed tubes; Table 66-2 reports a fall in average pressure (p<.0001).
  • In 25 women with complete obstruction who had surgery, tissue diagnoses included salpingitis isthmica nodosa (10) and endometriosis (8). An organic cause appeared in all 25.

RRM Context

Selective hysterosalpingography and tube catheterization are used within NaProTECHNOLOGY, developed by Dr. Thomas W. Hilgers. The chapter states that this NaProTECHNOLOGY practice has replaced standard hysterosalpingography with the selective test. The test looks for a physical cause of a blocked tube before treatment. That fits the restorative principle of finding the cause first. Endometriosis found in some obstructed tubes points to underlying disease.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter describes selective hysterosalpingography (SHSG) with direct measurement of intratubal pressure (ITP), followed by transcervical catheterization of the fallopian tubes (TCFT) with a flexible-tipped guidewire when the pressure is elevated. The chapter states that in this NaProTECHNOLOGY practice, SHSG has completely replaced HSG as a diagnostic approach. The chapter reports that TCFT can lower the pressure to normal in partially obstructed tubes, while the pressure in completely obstructed tubes remains unchanged. In 25 patients with complete tubal obstruction who came for surgical excision and reanastomosis, histopathology identified an organic cause for the obstruction in all cases.

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Diagnostics › Tubal and Uterine Imaging › Hysterosalpingography · Reproductive Surgery › Tubal Surgery › Tubal Cannulation · Infertility › Tubal Factor › Selective Salpingography
Thomas W Hilgers
Tom Hilgers, T Hilgers
Hilgers et al. 2004, Hilgers 2004

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