Salpingoscopic findings in women with occlusive and nonocclusive salpingitis isthmica nodosa

Urman B; Yarali H; Aksu T; Kisnisci HA; Gürgan T

doi:10.1016/s0015-0282(16)56576-5

Diagnostics Tubal and Uterine Imaging

Salpingoscopic findings in women with occlusive and nonocclusive salpingitis isthmica nodosa

Urman B, Yarali H, Aksu T, Kisnisci HA, Gürgan T

Published March 1994 Fertility and Sterility, 61(3), 461-463

DOI 10.1016/s0015-0282(16)56576-5 PMID 8137967

RRM Academy Synopsis

Tube lining damage in 19.2% of tubes with salpingitis isthmica nodosa

In a prospective case study of 20 infertile women, a camera exam inside the tubes found lining damage in 5 of 26 tubes with salpingitis isthmica nodosa. The other 21 tubes looked normal.

Key Findings

Twenty infertile women (38 tubes) had salpingoscopy. Their X-rays and laparoscopy showed salpingitis isthmica nodosa in one or both tubes, and 26 of the 38 tubes carried it.
Among 26 tubes affected by salpingitis isthmica nodosa, 5 (19.2%) had endosalpingeal changes of varying severity, and the other 21 (80.8%) were normal at salpingoscopy.
The 5 abnormal tubes included 2 with separated, flattened major folds, 2 with mild ampullary adhesions, and 1 with extensive loss of mucosal folds.
Damage occurred in 1 of 6 tubes (16%) that were diseased but patent and in 4 of 20 tubes (20%) that were blocked (P> 0.05, Fisher's exact test).
The 10 radiographically and laparoscopically normal tubes also appeared normal at salpingoscopy.

Interpretation

The authors conclude that some women with salpingitis isthmica nodosa may have damage farther out in the tube lining. They regarded proximal disease with abnormal salpingoscopy as bipolar tubal disease. They note that the diagnosis was not confirmed by a tubal biopsy at laparoscopy. What the damage means for treatment and fertility is yet to be characterized, they write.

RRM Context

Looking inside the tube first fits restorative reproductive medicine, which finds the cause before choosing a plan. The authors referred women with abnormal findings to IVF, which bypasses the tube. They scheduled women with normal findings for microsurgery to repair the tube.

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

Abstract

Objective

To characterize ampullary endosalpingeal findings in women with occlusive or nonocclusive salpingitis isthmica nodosa.

Design

Prospective case study.

Setting

Obstetrics and Gynecology Department of a University Hospital.

Patients

Twenty women (38 tubes) with occlusive or nonocclusive salpingitis isthmica nodosa were studied.

Interventions

Salpingoscopy was performed during diagnostic laparoscopy in 20 women (38 tubes) with hysterosalpingographic evidence of salpingitis isthmica nodosa.

Main Outcome Measures

Salpingoscopic findings were recorded and the patients were managed accordingly.

Results

Of the 38 tubes 10 appeared radiographically and laparoscopically normal. Two tubes were occluded distally. Of the 26 tubes with occlusive or nonocclusive salpingitis isthmica nodosa, 5 (19.2%) showed varying degrees of endosalpingeal abnormality. Patients with abnormal salpingoscopy were regarded as having bipolar tubal disease and were referred for assisted conception. The remaining patients were scheduled for microsurgical tubal reconstruction.

Conclusions

One in five patients with proximal tubal disease may have ampullary endosalpingeal damage of varying degrees. However, the significance of this finding in relation to subsequent management strategies and fertility outcome is yet to be characterized.

Read the guide

Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

Topics

Diagnostics › Tubal and Uterine Imaging › Hysterosalpingography · Infertility › Tubal Factor › Proximal Tubal Obstruction · Reproductive Surgery › Tubal Surgery › Tubal Cannulation

Timur Gürgan

T Gürgan

PMID 8137967 8137967 DOI 10.1016/s0015-0282(16)56576-5 10.1016/s0015-0282(16)56576-5 Urman et al. 1994, Urman 1994

Keywords

Adult, Endoscopy, Fallopian Tubes/pathology/surgery, Female, Humans, Hysterosalpingography, Laparoscopy, Prospective Studies, Salpingitis/pathology/surgery

Salpingoscopic findings in women with occlusive and nonocclusive salpingitis isthmica nodosa

Tube lining damage in 19.2% of tubes with salpingitis isthmica nodosa

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

By this author

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Keywords