Letterie, G. S., & Sakas, E. L. (1991). Histology of proximal tubal obstruction in cases of unsuccessful tubal canalization. Fertility and Sterility, 56(5), 831-835. https://doi.org/10.1016/s0015-0282(16)54651-2
Letterie GS, Sakas EL. Histology of proximal tubal obstruction in cases of unsuccessful tubal canalization. Fertil Steril. 1991;56(5):831-835. doi:10.1016/s0015-0282(16)54651-2
Letterie, Gerard S., and E. Lawrence Sakas. "Histology of proximal tubal obstruction in cases of unsuccessful tubal canalization." Fertility and Sterility, vol. 56, no. 5, 1991, pp. 831-835.
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RRM Academy Synopsis
Failed tubal canalization may reflect severe disease inside the tube
Tubes that failed canalization showed abnormal tissue in 93% of segments studied. In this prospective study, the authors examined 27 tubal segments removed during surgery from 15 patients. X-ray-guided canalization, a procedure to open a blockage near the uterus, had failed in each. The authors suggest severe tubal disease may explain the failures.
Key Findings
Examination of the removed tubal segments found histologic abnormalities in 93% of specimens, with segments taken from 15 patients.
The most common abnormalities were obliterative fibrosis (scarring that closes the tube) at 61%, chronic salpingitis at 57% and salpingitis isthmica nodosa at 42%.
More than one histologic abnormality appeared in 65% of cases. One patient from a region endemic for Schistosoma japonica had tubal schistosomiasis and complete luminal obliteration.
Only one patient showed normal tubal architecture. That patient had a microsurgical isthmic-isthmic reanastomosis. No cases of endometriosis were detected.
Inflammation was frequently found immediately adjacent to normal tubal architecture, and focal scarring was found adjacent to patent tube. Finding the areas of inflammation required multiple sections through the entire tubal segment.
Interpretation
This prospective histology study examined tubal tissue from 15 patients. Their average age was 28 years and their average infertility duration was 3.5 years. Canalization had failed in each, and each then underwent proximal tubal surgery. The authors suggest severe intrinsic tubal disease and occlusion may explain the failures. The findings support larger studies of tubal disease as a cause of canalization failure.
RRM Context
Restorative reproductive medicine starts by asking why a tube is blocked. The authors identified the lesions by examining the tube itself. They include scarring, long-standing inflammation and salpingitis isthmica nodosa. The paper also describes focal scarring and inflammation adjacent to healthy tube. IVF bypasses the tubes and leaves the cause of the blockage unidentified.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To determine possible etiologies of unsuccessful fluoroscopically guided tubal canalization, we studied the histology of tubal segments in cases of failed canalization for proximal tubal obstruction. Factors contributing to cases of unsuccessful fluoroscopically guided tubal canalization remain unclear.
Design
Prospective.
Setting
Reproductive Endocrinology Clinic.
Materials and Methods
Twenty-seven cornual and/or isthmic tubal segments from 15 patients who underwent proximal tubal surgery after fluoroscopically guided tubal canalization were studied. Specimens were prepared with hemotoxylin-eosin and Masson trichrome stains.
Results
Histologic examination of excised cornual and isthmic tubal segments revealed abnormalities in 93% of specimens. Obliterative fibrosis (61%), chronic salpingitis (57%), and salpingitis isthmica nodosa (42%) were the most commonly found histologic tubal abnormalities. One case of complete tubal occlusion and tubal schistosomiasis was also detected.
Conclusions
These data suggest that cases of failed fluoroscopically guided tubal canalization may be secondary to severe intrinsic tubal disease and tubal occlusion and not to the technique. Fluoroscopically guided tubal canalization may provide a means of differentiating a functional obstruction amenable to conservative management from true occlusion requiring management by microsurgical techniques or in vitro fertilization.
How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.
