Transcervical fallopian tube catheterization and recanalization for proximal tubal obstruction

Kimberly A. Thompson; Robert J. Kiltz; Timothy Koci; Eileen T. Cabus; Oscar A. Kletzky

doi:10.1016/s0015-0282(16)56510-8

Reproductive Surgery Tubal Surgery

Transcervical fallopian tube catheterization and recanalization for proximal tubal obstruction

Thompson KA, Kiltz RJ, Koci T, Cabus ET, Kletzky OA

Published February 1994 Fertility and Sterility, 61(2), 243-247

DOI 10.1016/s0015-0282(16)56510-8 PMID 8299776

RRM Academy Synopsis

Wire recanalization opened 9 of 29 tubes blocked near the uterus

Repeat dye testing showed about 4 out of 10 tubes first called blocked were open. A 1994 study of 28 women at one UCLA center found wire recanalization opened about 3 out of 10 tubes that stayed blocked.

Key Findings

A repeat hysterosalpingogram (HSG) found 11 of 46 tubes (23.9%) patent. Selective ostial salpingography found 6 more patent tubes among the remaining 35.
Altogether, 17 of the 46 tubes (36.9%) sent in for proximal tubal obstruction needed no wire recanalization.
Wire recanalization worked in 9 of 29 attempted tubes. Of those 9, 8 tubes (88.9%) were also open at the far end (distal patency).
The only complications were 4 tubal perforations, which needed no further evaluation or treatment.
Four intrauterine pregnancies and 1 ectopic pregnancy followed recanalization, the ectopic in the contralateral tube. Two more intrauterine pregnancies followed ostial salpingography.

Interpretation

This prospective case series followed 28 consecutive women at one academic center. Follow-up X-rays 6 to 9 months later showed 4 women with tubes still open and 4 with the blockage back. Cornual spasm or technical trouble often caused the false blockage seen on HSG. The team built a prototype cannula for the procedure. The authors note their lower success rate likely reflects more severe tubal disease in this group. The findings support larger studies of wire recanalization for tubes blocked near the uterus.

RRM Context

Restorative reproductive medicine asks why conception is not happening. A blocked tube is one answer that imaging can find and examine. The authors write that fallopian tube disease plays a role in infertility for 30% to 40% of couples. IVF bypasses the tubes without fixing them. This 1994 study examines opening the tube itself.

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

Abstract

Objective

To evaluate further the safety and efficacy of selective ostial salpingography combined with transcervical wire recanalization for the diagnosis and treatment of proximal tubal obstruction.

Design

Prospective study.

Setting

Division of Reproductive Endocrinology and Department of Radiology at Harbor-University of California Los Angeles (UCLA) Medical Center, a tertiary care academic institution.

Patients

Twenty-eight infertile patients diagnosed with proximal tubal obstruction by hysterosalpingogram (HSG) or by chromopertubation at laparoscopy (total of 46 obstructed tubes).

Interventions

After antibiotic prophylaxis and IV analgesia a conventional HSG was performed. If proximal tubal obstruction was confirmed, selective salpingography was done under fluoroscopic guidance. If proximal tubal obstruction was still present, wire recanalization using a new prototype cannula was then performed. If recanalization was successful, contrast media was injected to confirm tubal patency.

Main Outcome Measures

Proximal tubal patency, complete tubal patency, pregnancies.

Results

Eleven of 46 tubes (23.9%) were patent by HSG. Ostial salpingography of the remaining 35 tubes revealed 6 patent tubes (13%). Nine of the 29 obstructed tubes (31%) had successful wire recanalization, and 8 of these were patent distally. There were 4 intrauterine pregnancies (IUPs) and 1 ectopic pregnancy after recanalization and 2 IUPs after ostial salpingography.

Conclusion

Selective salpingography should be considered at the time of an HSG showing proximal tubal obstruction. If indicated, wire recanalization can also be attempted. Selective ostial salpingography combined with wire recanalization is a safe and effective procedure for the diagnosis and treatment of PTO.

Read the guide

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

Topics

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

Kimberly A. Thompson, Robert J. Kiltz, Timothy Koci, Eileen T. Cabus, Oscar A. Kletzky

K Thompson, Bob Kiltz, Rob Kiltz, Bobby Kiltz, R Kiltz, Tim Koci, T Koci, E Cabus, O Kletzky

PMID 8299776 8299776 DOI 10.1016/s0015-0282(16)56510-8 10.1016/s0015-0282(16)56510-8 Thompson et al. 1994, Thompson 1994

Keywords

Catheterization, Fallopian Tube Diseases/surgery, Female, Humans, Hysterosalpingography, Pregnancy, Prospective Studies

Transcervical fallopian tube catheterization and recanalization for proximal tubal obstruction

Wire recanalization opened 9 of 29 tubes blocked near the uterus

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

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