Minimally invasive radiologic techniques in the treatment of uretero-enteric fistulas.

OBJECTIVES: The goal of this study was to assess the efficacy of minimally invasive interventional radiologic (IR) techniques in the management of uretero-enteric fistulae in comparison to established surgical modalities. MATERIALS AND METHODS: Twenty-five patients (16 men, 9 women) with a mean age of 47 (range: 19-77 years) with uretero-enteric fistulae were treated with percutaneous nephrostomy, double "J" stent, radiologic uretero-neocystostomy, and radiologic uretero-pyelocalicostomy. All patients had a single fistula each. Uretero-enteric fistulas were due to direct or iatrogenic trauma in 14 patients (uretero-ileal fistulas, n=6; uretero-colonic fistulas, n=4; uretero-duodenal fistulas, n=2; uretero-pancreatic fistula, n=1; uretero-fallopian tube, n=1), complications of pelvic neoplasms in 4 patients (uretero-sigmoid fistulas, n=4), inflammatory disease in 4 patients (uretero-ileal fistulas, n=2; uretero-sigmoid fistulas, n=2), and avascular necrosis of renal transplants in 3 patients (uretero-sigmoid fistulas, n=3). RESULTS: Drainage by percutaneous nephrostomy and double "J" stent resulted in closure of 8 uretero-enteric fistulae over 7-16 weeks. Four uretero-enteric fistulae obliterated after re-routing urine flow using 3 radiologic uretero-neocystostomies and one IR pyelocalicostomy. In other patients, flow through the fistulae was substantially decreased by five double "J" stents and 3 percutaneous nephrostomies. The duration of inpatient hospitalization was significantly less for patients managed successfully by IR procedures than those treated by surgical modalities, 5.07 versus 10.5 days mean (P<0.05). CONCLUSIONS: IR procedures provided definitive treatment in 48% of uretero-enteric fistulae at significantly reduced inpatient hospitalization and cost. As palliative treatment, it improved the quality of life.

Multiphasic helical CT criteria for differentiation of recurrent neoplasm and desmoplastic reaction after laparoscopic resection of renal mass lesions.

BACKGROUND AND PURPOSE: Differentiation of recurrent neoplasm and desmoplastic reaction following laparoscopic resection of renal mass lesions poses a problem. The usefulness of multiphasic helical CT-generated criteria based on enhancement and morphologic characteristics was investigated. PATIENTS AND METHODS: The findings in 5 female and 12 male patients aged 29 to 68 years having renal-cell carcinoma (11-38 mm; N = 15) or solitary angiomyolipomas (N = 2) treated by laparoscopic resection (N = 15) or open segmental surgery (N = 2) were analyzed. Multiphasic helical CT was performed in the preenhancement, arterial corticomedullary, parenchymal, and excretory phases generating 2.5- to 7-mm slices. RESULTS: Both recurrent neoplasms showed median postcontrast enhancement of 119 HU in the arterial corticomedullary phase; the median enhancement of desmoplastic masses was 48 HU. In the parenchymal and excretory phase, recurrent neoplasms showed progressive loss of enhancement, whereas desmoplastic lesions sustained enhancement at about the same level. Recurrent neoplasms presented a defined mass with characteristic spiculation, whereas desmoplastic reaction was characterized by an ill-defined mass with spidery projections extending to abutting fat and residual fascial planes. On 2- to 3-month follow-up scans, recurrent neoplasms showed progressive increases in size and desmoplastic reaction a sharp decrease. CONCLUSION: Enhancement of the mass at the operative site on arterial corticomedullary-phase CT to >90 HU strongly suggests recurrent renal-cell carcinoma, while progressive decrease in size on 1- to 3-month follow-up CT suggests a desmoplastic reaction.

Multiphasic helical computerized tomography for the assessment of microscopic hematuria: a prospective study.

PURPOSE: We evaluated multiphasic helical computed tomography for the detection and characterization of lesions responsible for hematuria not diagnosed on prior urological surveillance studies. MATERIALS AND METHODS: A total of 393 men and 207 women with recurrent microscopic hematuria but negative urological surveillance studies were examined at 4 participating institutions by multiphasic helical computerized tomography, consisting of pre-enhancement, arterial corticomedullary, parenchymal and excretory phase sequences generating 2 to 5 mm slices through the kidney and lower pelvis. RESULTS: The cause of microscopic hematuria was established in 256 of 600 patients with prior negative urological surveillance examinations with 0.91 sensitivity and 0.94 specificity. The diagnosis was correct in all subsequently proven cases of calculous and renal vascular disease. A total of 67 of 70 inflammatory kidney lesions, 24 of 25 renal neoplasms, 15 of 16 bladder neoplasms, 27 of 35 inflammatory bladder conditions and 21 of 23 ureteral lesions were also correctly diagnosed. The diagnosis of renal medullary and papillary necrosis, and neoplastic lesions of the kidney and bladder allowed the early institution of medical therapy or appropriate surgery. CONCLUSIONS: Multiphasic helical computerized tomography diagnosed lesions responsible for microhematuria in 42.6% of 600 patients with negative urological surveillance examinations. This relatively low cost and low co-morbidity examination is advocated for patients with negative urological surveillance examinations or even as a first examination.

Detection of medullary and papillary necrosis at an early stage by multiphasic helical computerized tomography.

PURPOSE: Multiphasic helical computerized tomography (CT) is advocated to identify early manifestations of papillary and medullary necrosis based on decreased enhancement of circumscribed areas in the medullary pyramid. At this stage the devascularizing process can be reversed if causative conditions such as infections or diabetes mellitus are effectively treated. MATERIALS AND METHODS: Multiphasic helical CTs were performed in 31 male and 26 female patients with complaints of microscopic hematuria (41), macroscopic hematuria (2), bacteriuria (39) and pyuria (9). Pre-enhancement, arterial, early corticomedullary, parenchymal and excretory phase helical CTs generated 1.25 to 5 mm. thick slices. Followup examination included multiphasic helical CT at 1 and 3 months, and excretory urography for some patients at 3 months. RESULTS: Bacteriuria was identified as the probable cause of medullary and papillary necrosis in 39 patients, of whom 28 were treated with effective antibiotic therapy, resulting in normalization and re-perfusion of the initial lesion in 16, no change in 5 and progressive disease in 7 at 3-month followup. Of 8 lesions not treated with specific antibiotic therapy 4 progressed and 4 remained unchanged. CONCLUSIONS: Multiphasic helical CT unlike the excretory urogram can identify medullary and papillary necrosis at an early stage when effective treatment of the underlying cause can reverse the process of devascularization and prevent sloughing of medullary tissues.

Salpingographic demonstration of "cobblestone" mucosa of the distal tubes is indicative of irreversible mucosal damage.

OBJECTIVE: To establish the predictive value of the observation of a "cobblestone" pattern of the distal tube mucosa shown on the selective salpingogram as an indicator of significant and probably irreparable damage to the ciliated epithelium. DESIGN: Clinical study. SETTING: Fertility and Laser Center and Academic Radiology Department. PATIENT(S): Patients with primary or secondary infertility and obstruction of the fallopian tubes documented on hysterosalpingogram. INTERVENTION(S): Transcervical recanalization of obstructed tubes followed by reassessment by selective salpingogram. MAIN OUTCOME MEASURE(S): Progression of mucosal disease with resultant low likelihood of intrauterine pregnancies and high probability of ectopic pregnancy. RESULT(S): In 32 asymptomatic patients, there was progression to coalescence and agglutination of mucosal folds in 13, to a thick wall pyosalpinx in 4. Five thin wall and 8 thick wall hydrosalpinges in asymptomatic patients showed no significant progression of mucosal disease but increasing peritubular fibrosis. In 12 symptomatic patients, progressive fusion of mucosal folds with polypoid hyperplasia was observed in 11, a thin wall hydrosalpinx in 2. CONCLUSION(S): Cobblestone appearance of the distal tubes heralds significant mucosal damage, prone to progressive disease and hence, a poor chance for conception.

Thoracic outlet syndrome: case report and review.

Thoracic outlet syndrome is caused by a large number of etiologies, which can affect the elements of the neurovascular bundle in combination or separately. The radiology department offers many imaging modalities which can assist in determining which structures may be involved as well as suggest possible etiology. The interventional radiologist, often working in conjunction with the surgeon, can assist in the treatment of many arterial or venous disorders, such as stenosis or thrombosis commonly seen in patients with Thoracic outlet syndrome.

Endourologic management of malignant ureteral strictures.

PURPOSE: This retrospective analysis assessed the efficacy of balloon dilatation, endoureterotomy, percutaneous ureteroneocystostomy with stenting, and insertion of Wallstents in the management of malignant ureteral strictures with an intact or compromised vascular supply. PATIENTS AND METHODS: A series of 127 patients with ureteral strictures secondary to malignancies were assessed after at least 2-year follow-up (range 2-5 years; mean 3.5 years). Balloon dilation (antegrade approach) was applied in 46 patients, endoureterotomy with temporary stenting in 37, percutaneous ureteroneocystostomy with stenting in 34, bougie and stents in 13, and Wallstents in 31. RESULTS: Balloon dilatation was successful in only two of four malignant midureteral stenoses with intact vascular supplies and was even less successful (10%) in midureteral strictures with a compromised vascular supply. Endoureterotomy failed in all cases to prevent ureteral obstruction. Percutaneous ureteroneocystostomy achieved patency in 11 of 34 patients (33%) having a compromised ureteral vascular supply. Wallstents were successful in 18 of 31 patients (58%) with stenoses of the pelvic ureter. CONCLUSIONS: Percutaneous ureteroneocystostomy with stenting meets the requirement for palliation in patients with obstruction secondary to pelvic neoplasms. Wallstents proved to be most successful when used in the pelvic ureter.

Autologous blood clot seal to prevent pneumothorax at CT-guided lung biopsy.

PURPOSE: To determine whether the use of autologous blood clot seal (ABCS) after biopsy of lung lesions can reduce or prevent pneumothorax. MATERIALS AND METHODS: The authors evaluated 100 patients (63 men, 37 women; age range, 27-78 years) with pleural (n = 23) or deep (n = 77) lesions. Thirty-eight patients had emphysema. Patients were randomly assigned to one of two groups: those in whom the biopsy track was sealed with autologous blood clot (n = 50) and those who did not receive autologous blood clot (n = 50). Biopsy was performed with computed tomographic (CT) guidance and a 19-gauge coaxial system. The autologous blood clot, which ranged from 0.5 to 4.5 mL, was injected while the sheath was being withdrawn. RESULTS: Pneumothorax developed in four of the 23 patients (17%) with pleural lesions and 19 of the 77 patients (24%) with deep lesions. Pneumothorax occurred in four of the 45 patients (9%) who had deep lesions and received autologous blood clot and in 15 of the 32 patients (47%) who had deep lesions and did not receive autologous blood clot (P <.001). In patients with emphysema, pneumothorax occurred in three of the 20 patients (15%) who received autologous blood clot and 10 of the 14 (71%) who did not (P <.001). There were seven large pneumothoraces necessitating treatment; all occurred in patients who did not receive autologous blood clot. CONCLUSION: Plugging of biopsy tracks with ABCS, particularly after biopsy of deep lung lesions, significantly reduced the frequency of pneumothorax-particularly of large pneumothoraces-and, therefore, the need for treatment and the attendant cost.

Endourologic management of benign ureteral strictures with and without compromised vascular supply.

OBJECTIVES: To retrospectively assess the efficacy of balloon dilation, endopyelotomy/ureterotomy, and stenting alone in the management of benign ureteral strictures with intact or compromised vascular supply. METHODS: One hundred fourteen patients with benign ureteral strictures were assessed after at least a 2-year follow-up (range 2 to 16 years, mean 6.3). Balloon dilation was performed in 81, endopyelotomy/ureterotomy with temporary stenting in 27, and ureteral stenting alone in 6 patients. Ureteral strictures were divided into strictures with intact or with compromised vascular supply. RESULTS: Balloon dilation was successful in short ureteral strictures with intact vascular supply in 33 of 37 (89.2%), but only in 3 of 8 (37.5%) long ureteral strictures and in 1 of 2 (50%) recurrent ureteropelvic junction strictures. Balloon dilation was less successful when the vascular supply was compromised in 2 (40%) of 5 short strictures, 1 (16.7%) of 6 long strictures, and 2 (33.3%) of 6 recurrent ureteropelvic junction strictures. Endopyelotomy/ureterotomy was successful in 17 (89.5%) of 19 strictures with compromised vascular supply. CONCLUSIONS: Balloon dilation is recommended for management of short strictures with intact vascular supply. Endoureterotomy with stenting is recommended for all long ureteral strictures, for ureteropelvic junction stenoses, and for short ureteral strictures with compromised vascular supply and benign underlying etiology.

Accuracy of diagnosis by guided biopsy of renal mass lesions classified indeterminate by imaging studies.

OBJECTIVES: To define the accuracy, safety, and impact of percutaneous biopsies of indeterminate mass lesions as an additional diagnostic tool. The vast majority of renal mass lesions are routinely diagnosed by radiographic features alone. However, with the increased use of computed tomography scanning and ultrasound, many smaller renal masses, which are "indeterminate" (refractory to categorization on the basis of imaging alone), are now being discovered. METHODS: We retrospectively reviewed 583 patients (364 male and 219 female) with indeterminate renal mass lesions diagnosed by imaging studies that were further investigated by percutaneous biopsy. Patients were followed up for at least 5 years if the biopsy result demonstrated a benign lesion, or they underwent surgical exploration if the biopsy result demonstrated a malignancy. Biopsy or aspiration material was assessed by histopathologic and cytologic evaluation and, when appropriate, with biochemistry, Gram stain, culture, and sensitivity. The biopsy site was localized by computed tomography, ultrasound, or fluoroscopy. RESULTS: Five hundred eighty-three patients with indeterminate renal mass lesions (representing 7.2% of all renal masses diagnosed from 1967 through 1996) were diagnosed by imaging studies complemented by guided biopsy. Sixty-six patients were lost to follow-up, leaving 517 patients who were analyzed. In 393 cases (76%), the imaging-guided biopsy provided a definitive diagnosis. The incidence of false diagnoses was 1.2% (7 biopsies). In 124 of the cases (21%), imaging-guided biopsy was unable to determine the etiology of the lesion with acceptable confidence; of these, 21 biopsies did not provide enough material to establish the diagnosis (16.9%). CONCLUSIONS: Overall, percutaneous biopsy of the kidney has proved to be a safe and accurate diagnostic procedure, with impact on the management of cystic or solid renal lesions.

Efficacy of salpingography and transcervical recanalization in diagnosis, categorization, and treatment of fallopian tube obstruction.

PURPOSE: The efficacy of selective salpingography (SS) and transcervical recanalization (TCR) in diagnosis, categorization, and determination of optimal treatment modality for fallopian tube obstruction was investigated. METHODS: SS and, in some patients, TCR was performed in 430 patients with a diagnosis of obstruction of one or both fallopian tubes, as determined by hysterosalpingograms (HSG). All patients (age 21-46 years) had an infertility problem for at least 18 months. RESULTS: In 196 patients, 325 tubes were patent on SS. TCR recanalized 243 tubes in 176 patients. Disease of the distal tube was demonstrated in 66 patients. There were 39 live babies in a group of 176 patients with successful TCR. Best live birth rate was in 7 of 12 (58%) patients with underlying endometriosis, followed by postsurgical strictures in inflammatory disease, 6 of 31 (19%), and salpingitis isthmica nodosa in 25 of 168 (15%). There were no pregnancies in patients with cobblestone pattern of the distal tubes. CONCLUSIONS: SS and TCR were capable of correcting obstruction of the proximal tubes in 243 of 465 tubes in 176 of 234 patients (75%). With patency of the proximal tube restored, the distal tube could be assessed for changes indicative of damage to the ciliated epithelium which was likely to reduce the ability to become pregnant. This allowed for the triage of patients into groups benefiting from the relatively inexpensive and low complication TCR or patients in need of in vitro fertilization or similar assisted reproductive technologies.

Percutaneous nephrostomy as adjunct management in advanced upper urinary tract infection.

OBJECTIVES: To determine by retrospective review of 315 percutaneous nephrostomies, performed for pyonephrosis, whether this intervention has major clinical advantages. METHODS: From 1977 to 1996, under the direct supervision of the senior author of this report (E.K.L.), at seven hospital sites, 315 patients (181 males, 134 females; 17 to 88 years of age) were treated with percutaneous nephrostomy and antibiotic therapy for infected hydronephrosis. RESULTS: Additional or disparate pathogens were identified in 116 (36.8%) of 315 patients, leading to a clinically significant change in, or addition of, antibiotics and/or antifungal agents in 84 (73%) of 116. Most notably, we often found a clinically important disparity between the results of cultures obtained from the nephrostomy and those obtained from bladder-urine specimens. CONCLUSIONS: This retrospective review confirms previously reported advantages of percutaneous upper urinary tract drainage as a potentially life-saving adjunct in the treatment of pyonephrosis. Several case studies highlight the advantage of this maneuver in difficult cases involving obstruction due to extensive fungus or debris. In particular, our review focuses attention on the clinically important insight that urine cultures from percutaneous nephrostomy drainage often identify pathogens that differ from those detected in concurrent bladder cultures.

Placement of metallic stents in ureters obstructed by carcinoma of the cervix to maintain renal function in patients undergoing long-term chemotherapy.

OBJECTIVE: Metallic stents, sometimes augmented by "J" endostents, were placed in ureters obstructed by advanced carcinoma of the cervix to improve or maintain renal function in these patients at a level necessary to pursue long-term chemotherapy and radiation therapy. SUBJECTS AND METHODS: Seventeen ureters in 11 patients were treated with metallic stents, which were placed by an anterograde approach in 10 patients and by a retrograde approach in one. An anterograde ureteroneocystostomy was necessary in two of the 11 patients. J endostents were placed for I month in all patients. In 10 ureters, J endostents were reintroduced during follow-up 1-48 months later. RESULTS: In 17 ureters, metallic stents were successfully placed; in the remaining three ureters, the procedures were aborted because of technical difficulties. The goal of improving and maintaining renal function was met in 10 patients. Serum creatinine levels returned to normal in four patients and stabilized at a range of 2.7-3.2 mg/dl in six more patients, permitting treatment with chemotherapy, radiation therapy, or both. Four of the 11 patients died within 4 months after treatment, and three more died within 2 years. At the time of death or last follow-up, seven metallic stents and eight combinations of metallic stents and J endostents were patent. Complications were minor. CONCLUSION: Placement of metallic stents is recommended as an effective method to ensure patency and to facilitate cystoscopic replacement of J endostents in ureters compromised by carcinoma of the cervix. Renal function can be maintained, allowing chemotherapy. Survival is governed by the effectiveness of chemotherapy and radiation therapy.

The efficacy of transcervical recanalization of obstructed postoperative fallopian tubes.

The efficacy of transcervical recanalization of obstructed postoperative Fallopian tubes was evaluated in 29 patients who were referred for recanalization. Nineteen had strictures at the site of Fallopian tube reconstruction, and five had strictures, three had fistulae, and two had fistulae and strictures at the site of reversal surgery. A 0.014-inch highly flexible guidewire was passed through the obstruction into the ampullary segment, followed by a 1. 1-2.2 Fr bougie catheter to dilate the stricture. After recanalization, the distal tube was studied by selective salpingography. The method was technically successful in 17 of 19 patients with underlying inflammatory disease and resultant postoperative strictures. The tubes remained patent in 12 patients for a period of 12-48 months; three patients conceived, all delivering healthy babies. Significant disease of the distal tubes was present in seven patients. The technique succeeded in three of five patients with postoperative strictures following reversal surgery. One patient subsequently conceived and delivered a healthy baby. The technique failed in all five patients with fistulae complicating reversal surgery. Transcervical recanalization is thus recommended in the management of patients with postoperative strictures with underlying inflammatory obstruction and strictures complicating reversal surgery.

Reduced systemic toxicity from superselective chemoembolization compared with systemic chemotherapy in patients with high-risk metastatic gestational trophoblastic disease.

PURPOSE: The efficacy of chemoembolization of primary and metastatic gestational trophoblastic neoplasms was studied. METHODS: Six female patients, 19-33 years old, with high-risk trophoblastic disease were subjected to one to five chemoembolizations in 3-week intervals. Three of the patients had metastases to the liver, 2 had local tumor extension to the pelvic wall, and all 5 had failed initial systemic chemotherapy. The sixth patient was treated for a trophoblastic remnant following surgical expression of a tubal pregnancy. For follow-up, beta hCG levels in urine and serum and dynamic or angio-computed tomograms were obtained in biweekly to 6-month intervals. RESULTS: Two of 3 patients with liver metastases are alive and free of disease 6 and 7 years after initial chemoembolization. The third is alive at 3 years but with evidence of recurrent disease. Two patients treated for locally invasive trophoblastic disease died 3 months and 4 years, respectively, after initial chemoembolization. One had a 2 1/2 -year remission. The patient treated for a trophoblastic remnant in the tube is alive and free of disease at 6-year follow-up. Hematologic toxicity occurred in only one. CONCLUSION: Selective chemoembolization in our small series of patients with high-risk trophoblastic disease was equally effective as results reported for multi-drug systemic chemotherapy but had markedly lower renal, liver, and hematologic toxicity.

The use of metallic stents to bypass ureteral strictures secondary to metastatic prostate cancer: experience with 8 patients.

PURPOSE: We evaluated the middle term patency, incidence of infection and ability to preserve renal function using metallic stents to bypass ureteral obstruction secondary to metastatic prostate adenocarcinoma. MATERIALS AND METHODS: We studied 8 patients with ureteral obstruction secondary to metastatic prostate adenocarcinoma at the pelvic ureter with up to 48 months of followup. Metallic Wallstents* 8 mm. in diameter and 64 mm. long were placed across the stricture after preliminary dilation with a high pressure balloon. Double-J catheters were left in all patients for at least 1 month or until mucosal edema had subsided. All stents were placed via an antegrade approach. RESULTS: Average duration of stent patency was 19 months. All 6 patients at risk at 12 months had patent stents compared to 3 of 5 at 24 months, 2 of 2 at 36 months, and 1 of 1 at 48 months. Stent occlusion occurred in 2 patients at 8 and 12 months, respectively, and additional stents were placed telescopically to achieve recanalization. Renal function was preserved in all patients. Two patients died of disease at 1 month and 1 at 26 months after stent placement. CONCLUSIONS: The use of metallic stents to bypass malignant ureteral obstruction is a safe and effective method.

Recanalization of obstructed fallopian tube by selective salpingography and transvaginal bougie dilatation: outcome and cost analysis.

OBJECTIVE: To investigate effectiveness and cost of transcervical salpingography and recanalization in the management of infertility caused by tubal occlusion. DESIGN: Retrospective analysis of patients investigated with transcervical selective salpingography and, in some instances, treated by transcervical recanalization. SETTING: Four hundred patients with hysterosalpingography diagnosis of obstructed fallopian tubes (clinical environment) are investigated. A repeat hysterosalpingogram after administration of a prostaglandin antagonist demonstrated patency of the tubes in 82 patients and selective transcervical salpingography demonstrated patency in an additional 131 patients. INTERVENTION: Transcervical tubal recanalization. Of the remaining 187 patients, recanalization by transcervical technique was successful in 145 patients. The underlying etiology for tubal obstruction was salpingitis isthmica nodosa in 62, salpingitis and perisalpingitis in 71, endometriosis in 8, failed surgical anastomosis in 43, and undeterminate cause in 3 patients. Pregnancy was attained in 24 patients, there were 10 minor and 1 major complication. OUTCOME MEASURE: Attained and maintained patency of tubes, pregnancy, attendant complications. CONCLUSION: A pregnancy rate of 12.8% was attained after transcervical recanalization of obstructed tubes. An attendant increased rate of pregnancy in patients proven patent after selective salpingography, valuable detailed information about proximal and distal tubes after recanalization of the obstructed proximal tube segment, the low rate of complications, and low cost are factors recommending the use of this technique. Moreover, tubal surgery or IVF treatment are not influenced adversely by prior transcervical tubal recanalization and remain an option for patients who failed to attain pregnancy.

Transcervical recanalization of strictures in the postoperative fallopian tube.

PURPOSE: To evaluate use of transcervical recanalization in patients with reocclusion of the proximal fallopian tube after failed surgery to reverse sterilization or failed tuboplasty to treat inflammatory disease. MATERIALS AND METHODS: The standard technique for transcervical recanalization was attempted in seven patients after failed reversal surgery and in 12 after failed tuboplasty. Four of seven patients with failed reversal surgery had fistular tracts and one also had a stricture; the remaining three patients and all 12 patients treated after failed tuboplasty and tube reimplantation had strictures at the site of implantation or anastomosis. RESULTS: Transcervical recanalization failed in all patients with fistulas but succeeded in 13 of 15 with stenoses. Three patients became pregnant 1-16 months after recanalization and two after in vitro fertilization and embryo transfer. Reocclusion occurred in two of 10 patients reexamined 6-36 months after recanalization. CONCLUSION: Transcervical recanalization is recommended as an alternative to repeat microsurgical reimplantation or tuboplasty.

PIP: Transcervical tubal recanalization was performed in 19 patients in whom previous surgery had failed to reverse sterilization (n=7) or to reconstruct fallopian tubes obstructed from inflammatory disease (n=12). The patients were 25-41 years old, had been infertile for more than 18 months after the failed surgery and had no other clinical cause of infertility. 4 of the cases of failed reversal surgery had fistular tracts, and 1 also had a structure. The other 3 reversal patients and all 12 failed tuboplasty and tube reimplantation patients has strictures at the site of implantation or anastomosis. The standard technique for transcervical recanalization was followed. The transcervical recanalization only succeeded in 13/15 patients with stenoses. 3 of these became pregnant naturally 1-16 months after recanalization and 2 after in vitro fertilization and embryo transfer. Reocclusion occurred in 2 of 10 patients reexamined 6-36 months postoperatively. It was concluded that transcervical recanalization is a suitable alternative to repeat microsurgical reimplantation or to tuboplasty in cases such as these.