Thurmond, A. S., Burry, K. A., & Novy, M. J. (1995). Salpingitis isthmica nodosa: results of transcervical fluoroscopic catheter recanalization. Fertility and Sterility, 63(4), 715-722. https://doi.org/10.1016/s0015-0282(16)57471-8
Thurmond AS, Burry KA, Novy MJ. Salpingitis isthmica nodosa: results of transcervical fluoroscopic catheter recanalization. Fertil Steril. 1995;63(4):715-722. doi:10.1016/s0015-0282(16)57471-8
Thurmond, Amy S., et al. "Salpingitis isthmica nodosa: results of transcervical fluoroscopic catheter recanalization." Fertility and Sterility, vol. 63, no. 4, 1995, pp. 715-722.
For EndNote, Zotero or Mendeley:
Open access
Free to read
No reuse license
Free to read at the publisher (reported by Unpaywall and OpenAlex, not verified by RRM Academy)
Catheter reopened 72% of tubes blocked by salpingitis isthmica nodosa
In a case series of 52 women, a catheter guided by X-ray reopened 72% of 65 blocked tubes with salpingitis isthmica nodosa. Of 19 women who could conceive only through a reopened tube, about 3 out of 10 had live births.
Key Findings
Catheters reopened 47 of 65 tubes (72%) that had proximal tubal obstruction with salpingitis isthmica nodosa.
Nineteen women could conceive only through a reopened tube of this kind. Six had live births (32%) and two had tubal pregnancies (10%).
In 48 of 65 tubes (74%), the nodules showed on X-ray only after the tube was opened.
No pregnancies occurred in the 11 women with no patent tube at the end of the procedure. They served as an internal control group.
Among the 18 tubes that stayed blocked, 9 perforations occurred and needed no treatment. Reopened tubes had no perforations.
Interpretation
The study is a retrospective case series from one university center, so chance did not assign anyone to a group. The authors call the 11 women whose tubes stayed blocked an internal control group, but the procedure's own result placed them there. The women came from many referral sources, and the authors did not control other fertility factors. Only 14 couples had documented normal semen and ovulation. Six women were lost to follow-up. The authors call comparison with tubal surgery difficult and suggest the X-ray diagnosis may depend on injection pressure.
RRM Context
RRM looks for the cause of infertility in both partners before choosing a treatment. A tube that looks blocked on one X-ray is a finding to confirm. In this series the nodules showed only after opening in 74% of tubes. The authors judge the condition probably underdiagnosed by hysterosalpingography in women with proximal tubal obstruction. Tubal findings sit alongside semen, ovulation and cycle information, which many couples in this series lacked on record.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To investigate the role of transcervical tubal catheterization in diagnosis and treatment of proximal tubal obstruction associated with salpingitis isthmica nodosa.
Design
Retrospective case study.
Setting
University hospital and outpatient radiology practice.
Patients
Fifty-two women with proximal tubal obstruction associated with salpingitis isthmica nodosa.
Intervention
Selective salpingography and catheter recanalization using fluoroscopic guidance.
Main Outcome Measures
The number of tubes visualized to the fimbria as a percentage of the tubes with proximal tubal obstruction on the initial hysterosalpingogram was determined as a measure of diagnostic efficacy. To evaluate the treatment potential of catheter recanalization, the patients were grouped according to tubal status at the conclusion of the procedure and subsequent pregnancies were evaluated.
Results
Forty-seven of 65 tubes (72%) with proximal tubal obstruction were recanalized successfully. Among the 19 women who were able to conceive only via a recanalized salpingitis isthmica nodosa tube, there were 6 live births (32%) and two tubal pregnancies (10%).
Conclusion
Selective salpingography allows complete tubal diagnosis in almost three fourths of patients with proximal tubal obstruction and salpingitis isthmica nodosa. The radiographic diagnosis of salpingitis isthmica nodosa may be pressure dependent. Intrauterine pregnancies occur via recanalized salpingitis isthmica nodosa tubes, therefore catheter recanalization may be attempted before tubal microsurgery or IVF in patients with proximal tubal obstruction and associated salpingitis isthmica nodosa.
05kwbcj56 