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A Functional Approach to Gynecologic Pain
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
PID can lead to scarring and adhesions in the pelvis and is associated with chronic pelvic pain. Adhesions occur after 90% of all abdominal surgeries,71 but most are clinically silent. Some dense adhesions can limit organ mobility and cause visceral pain. Adhesive disease can be notable to cause partial or even complete bowel obstruction, but laparoscopic adhesiolysis has not been found to cause long-term pain relief in patients with chronic pelvic pain.72 Scarring in the fallopian tube after the resolution of PID can cause it to become blocked. It can then fill with a sterile physiologic fluid and become enlarged. This is known as a hydrosalpinx. The hydrosalpinx can also occur as a result of prior surgery or adhesions.
Ultrasound-Guided Intervention in Assisted Reproductive Technology
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Tubal factor accounts for 25%–30% of female factor infertility, and 30% of these patients have hydrosalpinx identified on USS [1]. Hydrosalpinx is an accumulation of fluid in a distally occluded fallopian tube and appears on USS as a fluid-filled, cystic structure with the “beads of string” sign due to the presence of hyperechoic mural nodules (Figure 12.1) [2]. The sensitivity and specificity of transvaginal ultrasound (TVUS) in diagnosing hydrosalpinx are 84.6 and 99.7%, respectively [3].
Uterine Anomalies and Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Daniel S. Seidman, Mordechai Goldenberg
Hydrosalpinx is known to have a detrimental effect on the outcome of IVF. A Cochrane systematic review identified 5 randomized controlled trials involving 646 women [62]. Although no trial reported on live births, the odds of ongoing pregnancy (OR 2.14%, 95% CI 1.23−3.73) and of clinical pregnancy (OR 2.31%, 95% CI 1.48−3.62) were increased with laparoscopic salpingectomy for hydrosalpinges prior to IVF. In RPL, a prospective randomized controlled trial [63] enrolled 13 patients with a unilateral hydrosalpinx diagnosed by sonography or HSG and in whom other causes of miscarriage had been excluded. The patients were randomized to undergo laparoscopic unilateral tubal fulguration or no surgical intervention. Six of the seven patients in the treatment group and five of the six in the control group conceived. Five patients in the treatment group and none in the control group had a pregnancy progress beyond the first trimester. The progressing pregnancies in the treatment group reached 36–40 weeks’ gestation, a statistically significant difference. The authors concluded that laparoscopic tubal fulguration improves pregnancy outcome in selected patients with previous recurrent early miscarriage and a unilateral hydrosalpinx. This study clearly needs further confirmation in a larger patient sample [63].
Effect of salpingectomy on ovarian response to hyperstimulation during in vitro fertilization: does it really matter?
Published in Gynecological Endocrinology, 2018
Roberta Venturella, Fulvio Zullo, Errico Zupi, Costantino Di Carlo
Hydrosalpinx adversely affect IVF outcomes, by reducing the implantation rate and increasing the risk of miscarriage [4,5]. Among the pathogenic mechanisms proposed, embryo-toxic effects, mechanical flushing and changes in endometrial receptivity are considered the most probable by reproductive gynecologists. According to these pathogenic theories, the rationale behind surgical treatment of hydrosalpinx prior to IVF is to eliminate the negative effect of the hydrosalpingeal fluid either by aspirating it (ultrasound-guided aspiration) or by removing the entire fallopian tubes (salpingectomy) or by isolating them from the uterine cavity (laparoscopic or hysteroscopic proximal occlusion).
The ultrastructural effects of surgical treatment of hydrosalpinx on the human endometrium: a light and electron microscopic study
Published in Ultrastructural Pathology, 2019
Tuğçe Sapmaz, Leman Sencar Gündoğdu, Mehmet Turan Çetin, Ibrahim Ferhat Ürünsak, Sait Polat
Hydrosalpinx is a serious health problem that is common in women. This health problem occurs after pelvic inflammatory disease (PID) and develops based on acute salpingitis. Hydrosalpinx is described as a distally blocked, dilated, fluid-filled uterine tubes with a heterogeneous spectrum of pathology. It is characterized by a marked dilatation of the distal part of the uterine tubes, the lining epithelium which becomes flat and accompanied by a considerable cellular atrophy.3 Structural and functional disorders that occur in the female reproductive system in the presence of hydrosalpinx have not been fully understood yet.
Prognostic value of hysterosalpingography after salpingostomy in patients with hydrosalpinx
Published in Journal of Obstetrics and Gynaecology, 2023
Wen-Xi Yao, Du-Zhou Zheng, Wei-Feng Liu, Mi-Mi Zhou, Li Liu, Ming-Jin Cai
Tubal factors account for about 25% of female infertility, and hydrosalpinx is the most serious manifestation of tubal diseases, comprising 10–30% tubal diseases (Aboulghar et al.1998) .Hydrosalpinx is the dilation or expansion of the fallopian tube during distal tubal obstruction, and the main risk factors include pelvic inflammatory disease (PID), endometriosis, appendicitis and previous pelvic or abdominal surgery (Strandell 2000, Ng and Cheong 2019). Currently, it is admitted that infection by Chlamydia causes fallopian tube inflammation (Park et al.2017), and the formation of hydrosalpinx is associated with increased inflammatory mediators, structural changes of intraciliary epithelial cilia, secretory cell hyperfunction, upregulated cystic fibrosis transmembrane conductance regulator and secretion of ovarian stimulating hormones (Ajonuma et al.2002). Recently, scholars have found that altered redox homeostasis, complement activation and immune cell phagocytosis are related to the formation of hydrosalpinx (Yohannes et al.2019). Multiple studies have demonstrated that hydrosalpinx formation has a negative effect on natural conception and reproductive techniques such as in-vitro fertilisation (IVF), which reduces the success rates of natural pregnancy and embryo transfer (Ajonuma et al.2002, Harb et al.2019, Cohen et al.2018, Hong et al.2018). A recent systematic review also showed that undergoing assisted fertility treatment for hydrosalpinx could increase the success rate of IVF (Xu et al.2017). The mechanism by which hydrosalpinx affects pregnancy remains undefined. However, it is speculated that it may be related to embryo toxicity of hydrops, reduced endometrial receptivity and mechanical flushing of hydrops (Strandell 2000, Strandell and Lindhard 2002).