Hysterosalpingo-Contrast Sonography With a Saline-Air Device Is Equivalent to Hysterosalpingography Only in the Presence of Tubal Patency.

OBJECTIVES: To compare hysterosalpingo-contrast sonography with a saline-air device to hysterosalpingography for evaluating tubal patency. METHODS: Eighty women undergoing infertility evaluations were recruited for this prospective cohort study. All patients underwent both office-based hysterosalpingo-contrast sonography with a saline-air device and hysterosalpingography as the reference standard, and the fallopian tubes were individually assessed for tubal patency in each procedure. The Cohen κ coefficient was used to assess agreement between each procedure, and the Student t test and χ(2) test were used to compare differences in time, pain, and procedural preference. RESULTS: In total, 75 patients with 148 fallopian tubes were evaluated. Tubal patency on hysterosalpingo-contrast sonography with the saline-air device was noted in 85.8% (n = 127) of tubes compared to 92.5% (n = 137) on hysterosalpingography, with a positive predictive value of 95.2%. Tubal occlusion was noted in 21 tubes (14.2%) on hysterosalpingo-contrast sonography compared to 11 (7.4%) on hysterosalpingography, with a negative predictive value of 23.8% (24 of 28). Overall, hysterosalpingo-contrast sonography agreed with hysterosalpingography in 126 of 148 fallopian tubes (85.1%; κ = 0.47; P < .001). The procedural time and pain scores were significantly greater for hysterosalpingo-contrast sonography compared to hysterosalpingography. CONCLUSIONS: There was a significant degree of agreement between hysterosalpingo-contrast sonography with a saline-air device and hysterosalpingography when the fallopian tube was patent but not when it was occluded. In the absence of patency, further evaluations with hysterosalpingography may be indicated to avoid false-positive results. Although the procedure time and degree of pain appear to be greater, avoidance of radiation exposure by using hysterosalpingo-contrast sonography with a saline-air device may outweigh the drawbacks.

Clinical value of fluid bolus contrast flow meter during hysterosalpingography.

The purpose of this study was to investigate the clinical value of the fluid bolus contrast flow meter during hysterosalpingography. Hysterosalpingography information of 342 cases, which included a manual handset group of 213 cases and a bolus instrument group of 129 cases were reviewed. Comparative analysis was used to compare the two groups in order to assess the clinical adverse reactions, contrast agent reflux, and image quality. In the instrument bolus group compared with the manual handset group, the clinical adverse reactions decreased from 75.12 to 31.78% (P < 0.001); the backflow phenomenon of the contrast agent decreased from 13.62 to 3.10% (P < 0.01); and image quality significantly improved, with the A class film rate increasing from 54.46 to 68.99% (P < 0.01) and the C class film rate decreasing from 8.92 to 2.33% (P < 0.05). The use of a contrast bolus through the liquid inlet of the hysterosalpingography instrument can provide fully dynamic observation, reducing the contrast agent reflux and adverse reactions as well as improving the image quality and diagnostic accuracy. In addition, the medical staff is not subjected to radiographic radiation. Therefore, it is a safe and reliable imaging method.

Evaluation of pain during hysterosalpingography with the use of balloon catheter vs metal cannula.

Our aim was to investigate the use of a balloon catheter device in comparison with metal cannula for hysterosalpingography (HSG) in terms of patient comfort. A total of 168 patients were randomised for HSG either with a balloon catheter (n = 83) or metal cannula (n = 85). Scores of pelvic pain during insertion of the devices, injection of the contrast medium and 1 h after the procedure were evaluated using the Wong Baker Faces Pain Rating Scale; complications and reinsertion rates were also noted. The pain scores were significantly lower in the balloon catheter group (p < 0.001). The reinsertion rate of metal cannula was higher (8.2% vs 2.4%) as well as the incidence of nausea being the most common short-term adverse effect (14.1% vs 1.2%) in the metal cannula group (p = 0.002). Performing HSG with a balloon catheter is advantageous for decreasing the pain and side-effects related to the procedure, when compared with the use of a metal cannula.

Safety aspects and side-effects of ExEm-gel and foam for uterine cavity distension and tubal patency testing.

A state-of-the-art overview of the safety and side-effects of ExEm-gel for uterine cavity distension and ExEm-foam for tubal patency testing is presented. A literature search was carried out using PubMed, textbooks, pharmaceutical databases and reports of toxicity tests. Information on clinical use in humans and experiments in animal models was collected and grouped according to the following components: glycerol, hydroxyethyl cellulose and purified water; subjects included toxicity test, influence on sperm cells, oocytes, blastocyst development, uterine cavity distension, tubal patency testing, pain and obstetric applications. No unknown side-effects of gel or foam, or unexpected concerns about safety, were reported. More information than expected was available on the absence of effects of the components on various human tissues. Although it is difficult to prove that the search is complete, and it is possible that side-effects remain unreported, the combination of glycerol, hydroxyethyl cellulose and purified water is considered to be safe for intrauterine application and tubal patency testing, indicating an optimal risk-benefit ratio in clinical use. The safest strategy, however, is to restrict clinical examinations with gel and foam to the pre-ovulatory phase of the menstrual cycle.

Hysterosalpingography using a flat panel unit: evaluation and optimization of ovarian radiation dose.

PURPOSE: The aim of the present study was the evaluation and optimization of radiation dose to the ovaries (D) in hysterosalpingography (HSG). METHODS: The study included a phantom study and a clinical one. In the phantom study, we evaluated imaging results for different geometrical setups and irradiation conditions. In the clinical study, 34 women were assigned into three different fluoroscopy modes and D was estimated with direct cervical TLD measurements. RESULTS: In the phantom study, we used a source-to-image-distance (SID) of 110 cm and a field diagonal of 48 cm, and thus decreased air KERMA rate (KR) by 19% and 70%, respectively, for beam filtration: 4 mm Al and 0.9 mm Cu (Low dose). The least radiation exposure was accomplished by using the 3.75 pps fluoroscopy mode in conjunction with beam filtration: Low dose. In the clinical study, D normalized to 50 s of fluoroscopy time with a 3.75 pps fluoroscopy mode reached a value of 0.45 ± 0.04 mGy. Observers' evaluation of diagnostic image quality did not significantly differ for the three different modes of acquisition that were compared. CONCLUSIONS: Digital spot radiographs could be omitted in modern flat panel systems during HSG. Fluoroscopy image acquisitions in a modern flat panel unit at 3.75 pps and a beam filtration of 4 mm Al and 0.9 mm Cu demonstrate acceptable image quality with an average D equal to 0.45 mGy. This value is lower compared to the studied literature. For these reasons, the proposed method may be recommended for routine HSG examination in order to limit radiation exposure to the ovaries.

Transvaginal hydrolaparoscopy for diagnosis of tubal infertility.

OBJECTIVE: Infertility problem affects more than 70 million couples worldwide, 5-15% of which are couples in their reproductive age. Less and less invasive endoscopic methods like transvaginal hydrolaparoscopy have been developed by technological progress. This method enables not only precise identification, but is now increasingly used for treatment of tubal and peritoneal factor pathology, which cause approximately 35 per cent of female infertility. AIM: Evaluation of transvaginal hydrolaparoscopy (HLTV) usefulness for diagnosis of tubal infertility comparing to standard laparoscopy and hysterosalpingography (HSG). RESULTS: In evaluation of patent fallopian tubes results of HLTV and HSG examinations are coincide in 87%, while obstruction diagnosed in HSG is confirmed only in 37% during HLTV examination. Transvaginal hydrolaparoscopy and HSG have similar sensitivity and specificity in diagnosis of hydrosalpinx, which is up to 100% . In comparison with HLTV histerosalpingography is less effective in evaluation of peritubal dilatations and adhesions. Both laparoscopic surgery and transvaginal laparoscopy have the same high sensitivity in diagnostics of the fallopian tubes patency and hydrosalpinx, which is up to 100%. In evaluation of peritubal adhesions and dilatations the results are very similar. CONCLUSIONS: 1. HLTV is a highly useful method in evaluation of the fallopian tubes pathologies which is significantly more sensitive than HSG in evaluation of such lesions as peritubal adhesions and obstructed fallopian tubes. 2. HLTV is as effective as laparoscopy in evaluation of patency and lesions of the fallopian tubes. 3. HLTV is a less invasive method, much better tolerated than laparoscopy and more suitable for the group of overweight patients. 4. Final assessment of HTLV technique will be possible following performance of a greater number of studies, where the foregoing conclusions present only initial observations.

Fast-release orodispersible tramadol as analgesia in hysterosalpingography with a metal cannula or a balloon catheter.

BACKGROUND: This study aimed to evaluate the potential benefit, in terms of pain relief, of the new oral fast-release orodispersible galvanic form of tramadol in women undergoing hysterosalpingography (HSG) with either a metal cannula or a balloon catheter. METHODS: In a randomized, double-blind, placebo-controlled, 2 x 2 factorial-design trial, conducted at a single academic centre, 128 women were assigned into groups: (I) tramadol and a metal cannula, (II) tramadol and a balloon catheter, (III) placebo and a metal cannula or (IV) placebo and a balloon catheter. The primary end-point was pain registered by the patients on 10-cm visual analogue scales (VASs) at various times during and after the procedure. Secondary end-points included side effects and pain as assessed by the same physician during HSG. RESULTS: The main effect of tramadol versus placebo medication (i.e. I and II versus III and IV) was a statistically significant difference (P < 0.001) in self-reported VAS of -0.91 (-1.35 to -0.47) on the absolute and -33% (-48% to -17%) on the relative scale in favour of tramadol. Likewise, there was a significant benefit for tramadol against placebo medication for physician-perceived VAS pain scores (39% relative reduction; P < 0.001). The main effect of the balloon catheter versus metal cannula (i.e. II and IV versus I and III) was a non-significant (P = 0.82) difference in patient-reported VAS of -0.05 (-0.49 to +0.39) and -2% (-21% to +17%). There were no medication-HSG device interactions and no differences in side effects. CONCLUSIONS: During and after HSG, fast-release orodispersible tramadol significantly reduces pain without increasing side effects.

A hybrid radiography/MRI system for combining hysterosalpingography and MRI in infertility patients: initial experience.

OBJECTIVE: We evaluated the feasibility of a prototype hybrid radiography/MRI system in evaluating infertility patients. Pelvic MRI was followed by hysterosalpingography (HSG) without moving the patient. This system allowed evaluation of tubal patency and cross-sectional imaging with one examination. CONCLUSION: Our hybrid radiography/MRI system provided good-quality HSG and MR images. We were able to assess tubal anatomy and patency and uterine anatomy and to detect pelvic abnormalities, including fibroids and adenomyosis. Furthermore, MR images and radiographs were superimposed to clarify HSG findings.

Performing the Parryscope technique gently for office tubal patency assessment.

OBJECTIVE: To demonstrate a novel approach to office tubal patency assessment through infusing air into saline during flexible office hysteroscopy. We also provide data addressing pain and patient experience relative to hysterosalpingography (HSG). DESIGN: Video presentation of clinical technique with supportive crossover data (Canadian Task Force classification II-1). Its University of Mississippi Medical Center Institutional Review Board protocol number is 2013-0230. SETTING: Academic hospital. PATIENT(S): Women undergoing office hysteroscopy and ultrasound, with a subset also having HSG. INTERVENTION(S): Air infusion into saline during office hysteroscopy. MAIN OUTCOME MEASURE(S): The focus is on demonstrating how the technique appears and is performed, with supplemental Likert data addressing subjective pain and preference relative to HSG. RESULT(S): When performed as described, this office technique has 98.3%-100% sensitivity to tubal occlusion and 83.7% specificity. The gentle technique is central to accurate outcomes, which is facilitated through use of a small-caliber (<3 mm), flexible hysteroscope and avoiding uterine overdistention. Patients are far more likely to report maximum discomfort with HSG. Among patients who also had HSG, 92% somewhat or strongly prefer hysteroscopic assessment. Also, 96% of patients reporting maximum discomfort with HSG had mild to no discomfort with the described technique. CONCLUSION(S): Air-infused saline at flexible office hysteroscopy can accurately, gently, and rapidly assess tubal patency. Coupled with strong patient preference for this technique over HSG, it is a promising option for evaluating fertility. CLINICAL TRAIL REGISTRATION NUMBER: NCT02005263.

Evaluation of pain in three hysterosalpingography techniques: metal cannula with and without paracervical blockage and balloon catheter.

OBJECTIVE: The objective of this study was to assess discomfort or pain in patients undergoing hysterosalpingography using three different techniques. SUBJECTS AND METHODS: Eighty-nine patients were randomly assigned to one of three groups. In group 1, 30 patients underwent the technique performed with a metal cannula without anesthetic; in group 2, 29 patients underwent the technique performed with a metal cannula with previous paracervical anesthetic block; in group 3, 30 patients submitted to the procedure performed with a flexible balloon catheter. Each patient completed two questionnaires, Q1 and Q2: Q1 assessed their personal, clinical, and surgical history, and Q2 provided the visual analog scale (VAS) for pain assessment. The investigator also evaluated discomfort at each potentially painful stage of the procedure based on the patient's verbal expression, physical manifestations, or both. RESULTS: In terms of global discomfort experienced during hysterosalpingography, group 1 had the highest mean VAS score, whereas scores did not significantly differ between groups 2 and 3. During cervical grasping, group 2 experienced less discomfort than group 1. A comparison of pain associated with cervical grasping and balloon inflation (group 3 only) revealed that the highest levels of discomfort occurred during cervical grasping without anesthesia (group 1), followed by balloon inflation inside the cervix (group 3), and, last, cervical grasping after paracervical block (group 2). CONCLUSION: Performing hysterosalpingography with a flexible balloon catheter or metal cannula with previous paracervical block produced similar levels of pain; however, both techniques appear to be more comfortable than the traditional technique (i.e., metal cannula without anesthesia).

Innovative percutaneous antegrade clearance of intrahepatic and extrahepatic biliary stones with the use of a hysterosalpingography catheter.

OBJECTIVES: We present a novel modified technique of percutaneous antegrade clearance of intrahepatic and common bile duct stones with the use of a hysterosalpingography balloon (HSG) catheter. METHODS: Technical tips and techniques used, along with the clinical results obtained in six patients whom we treated over a 6-month period have been described. RESULTS: The HSG balloon catheter is shown to demonstrate superior pushability, flexibility, and maneuverability in comparison with other previously described compliant balloons. CONCLUSIONS: The HSG balloon catheter is shown to be a really good device to remove intrahepatic and common bile duct stones percutaneously, allowing, where required, access to both the right and the left intrahepatic biliary systems from a single and smaller Fr hepatic bile duct access.

[Interest of multidetector CT virtual hysterosalpingography in the diagnosis of utero-peritoneal fistulas about 4 cases]. / Intérêt de l'hystéroscanner dans le diagnostic de la fistule utéro-péritonéale à propos de 4 cas.

We report four cases of uterine fistula found with the multidetector CT virtual hysterosalpingography. Patients were received for suspicious of a utero-peritoneal fistula at hysterosalpingography. They were young people at childbearing age (average age of 33 years), multigravidae, two of whom were nulliparous, one primiparous and one multiparous. We noted a history of voluntary interruption of pregnancy by curettage and a cesarean section. For the opacification, we used the classic hysterography standard equipment by means of 1/5 diluted iodine with saline solution as contrast. The multidetector CT virtual hysterosalpingography revealed small uterine perforations including three which were located in uterine posterior face at cervico-isthmic area and corporeal area, bringing about a utero-peritoneal fistula. The multidetector CT virtual hysterosalpingography is a simple and powerful technique for the diagnosis of utero-peritoneal fistula. It is convenient and then deserves an important place in the evaluation of uterine fistula.

Electronic fluorography for the performance of cine hysterosalpingography.

We used electronic fluorography to perform hysterosalpingography in 25 women with infertility or abnormal bleeding. In contrast to the conventional modality of fluoroscopy with intermittent permanent imaging, an image intensifier was used to periodically record dye injection on a moving tape (cine hysterosalpingography). The mean number of electronic fluorographs taken per patient was 10.8 +/- 3.12 (mean +/- SD). The mean radiation exposure per patient for electronic fluorography was 113.4 +/- 52 versus 112 +/- 52.4 mR when a single conventional radiographic image was taken. We conclude that electronic fluorography is a simple yet accurate radiographic method that delivers to the gonads approximately one-eleventh the dose of ionizing radiation that current standard techniques do, and should be accepted as an alternative diagnostic modality.

Foley catheter for salpingography, pneumonography, tubal insufflation, and hydrotubation.

Using a pediatric Foley catheter, salpingography, CO2 insufflation, hydrotubation, pelvic pneumography, pelvic pneumoperitoneum for laparoscopy, and pneumohysterosalpingography were performed in more than 1000 cases. The Foley catheter technic was fully described and the advantages outlined. In general, the Foley catheter proved to be a simple and atraumatic technic, eliminating some of the difficulties associated with the use of the metal cannula.

Presentation of an insufflator-instillator and the use of it.

PIP: A new modified insufflator-instillator is described, and its use in cases of prevention, diagnosis, and cure of infertility is discussed. Carbon dioxide is directed through tubes from a bottle containing compressed carbon dioxide by the reading and recording instruments to the patient. A pressure regulator and reducer is affixed to the bottle. A special safety valve, installed on the control panel, guards against overpressure. The desired maximum gas pressure allowed to pass to the patient is indicated by a metallic manometer on the panel. The manometer is regulated by means of a valve by the operator. An electrical mechanism (220 volts) rotates a paper tape which records the pressure expressed in millimeters of mercury. A scale on the panel indicates the instant carbon dioxide pressure in millimeters of mercury. The extra gas is directed out of the system automatically through a special safety valve. The apparatus can be made portable by supplying the gas from a sparklet. A measuring pot of liquid is attached to the right side of the apparatus. The pouring of the liquid is effected through its displacement by carbon dioxide. The gas passes from the apparatus to the patient through a transparent plastic tube. At the patient's end of the tube is installed a 3-way valve which allows unwanted remaining liquid to drain from the tube. The technique is very simple and safe. The apparatus is used 1) to instill different liquids into the uterine cavity and tubes under controlled pressure for therapeutic reasons; 2) for hysterosalpingography following the insufflation, without any more trouble to the patient than aturning the valve from "carbon dioxide" to "liquid" position, having filled the pot for liquid with contrast medium in advance; 3) for instillation of liquids or insufflation during surgical interventions to locate the damage; and 4) to prevent adhesions and keep the tubes open after tuboplasty.^ieng

New technique for selective transcervical osteal salpingography and catheterization in the diagnosis and treatment of proximal tubal obstruction.

Transcervical fallopian tube catheterization to recanalize the proximal (uterine end) fallopian tube are rapidly gaining acceptance for the diagnosis and treatment of tubal obstruction. We describe a new simplified technique for performing this procedure. Our technique obviates the need for hysterocaths and assures delivery of an atraumatic spherical tip of a cannula to the uterotubal junction. Compared with other techniques, it is quick with no need for IV or paracervical anesthesia or analgesia, no cervical dilatation, nor the use of Hyskon nor CO2 insufflation devices.

Transcervical selective salpingography: a diagnostic and therapeutic approach to cases of proximal tubal injection failure.

OBJECTIVE: Evaluation of selective salpingography for diagnosis and treatment of tubal injection failure during hysterosalpingography (HSG). DESIGN: Prospective study. SETTING: Obstetrics and Gynecology Department, University of Genoa (Italy)--tertiary care. PATIENTS: One hundred eighty infertile women with unilateral or bilateral proximal tubal injection failure during HSG were submitted to the procedure. INTERVENTION: Under fluoroscopy, a 4.5-F nylon catheter (3-F tip) was inserted into the ostium with or without the aid of a J-shaped, coaxial, angiographic guide wire, and 2 to 3 mL of contrast medium were injected. The procedure lasts 20 to 30 sec/tube. MAIN OUTCOME MEASURES: Of 155 tubal ostia, 145 (94.2%) were catheterized. RESULTS: Of the 146 catheterized tubes, 110 (75%) were rendered patent. Of the others, 21 (14.3%) presented hydrosalpinx or distal obstructions, and isthmic obstruction was present in 5 (3.4%). Patency of at least one tube was achieved in 82 (81.2%) of the 101 catheterized women; 8 conceived spontaneously and 11 after gamete intrafallopian transfer to the recanalized tube. CONCLUSIONS: During HSG, selective salpinography can be performed when proximal injection failure is observed to determine its cause or to restore patency.

Intratubal pressure before and after transcervical catheterization of the fallopian tubes.

OBJECTIVE: To assess the intratubal pressure (ITP) and patency status of the fallopian tubes before and after transcervical catheterization of the fallopian tubes (TCFT). DESIGN: Prospective procedural assessment. SETTING: Pope Paul VI Institute for the Study of Human Reproduction. PATIENT(S): Two hundred thirty-four women with either primary or secondary infertility. INTERVENTION(S): Patients underwent selective hysterosalpingography and, in some cases, TCFT with measurement of the ITP before and after the procedure. MAIN OUTCOME MEASURE(S): The ITP before and after TCFT. RESULT(S): The mean (+/-SD) ITP in freely patent tubes was 0.53 +/- 0.06 atm, that in partially obstructed tubes was 1.23 +/- 0.52 atm, and that in completely obstructed tubes was 2.79 +/- 1.40 atm. After TCFT, the mean (+/-SD) ITP in partially obstructed tubes decreased to 0.64 +/- 0.31 atm and that in completely obstructed tubes decreased to 1.86 +/- 1.35 atm. The ITP was normalized in 76% of partially obstructed tubes and in 29.5% of completely obstructed tubes. In all cases of complete obstruction in which surgical correction was attempted, organic pathology was identified. CONCLUSION(S): The procedure described is a safe and easy means of obtaining reliable and significant information on the status of the proximal fallopian tube.