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Li J, Mo S, Lin Z, Mo F, Shi Q. Proximal tubal occlusion first or oocyte retrieval first for patients with hydrosalpinx? Arch Gynecol Obstet 2024; 309:1597-1608. [PMID: 38308732 DOI: 10.1007/s00404-023-07359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/21/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Our study aimed to investigate the best time to manage hydrosalpinx to improve pregnancy outcomes during in vitro fertilization-embryo transfer (IVF-ET). METHODS Patients with hydrosalpinx who received IVF treatment were analyzed retrospectively. And two groups were included to compare the effects of different timing treatment of hydrosalpinx on IVF pregnancy outcomes, "Proximal Tubal Occlusion First Group" (Group Ligation-COH) and "Oocyte Retrieval First Group" (Group COH-Ligation). The main outcome measures included: ovarian response indexes, laboratory indexes and clinical pregnancy outcomes. Univariate and multivariate Logistic regression analysis was performed for outcome indicators, and the odds ratios (OR) and 95% confidence interval (CI) were used. RESULTS A total of 1490 patients were included (n = 976 Ligation-COH and n = 514 COH-Ligation). The Gn starting dose and MII rate in group Ligation-COH were significantly higher than those in group COH-Ligation (203.33 ± 58.20 vs. 203.33 ± 58.20, 81.58% vs. 80.28%, P < 0.05). The number of oocytes obtained and the number of available D3 embryos in group COH-Ligation were higher than those in group Ligation-COH (15.10 ± 7.58 vs. 13.45 ± 6.42, 10.92 ± 5.81 vs. 9.94 ± 5.15, P < 0.05). Although the number of ET cycles per IVF cycle in group COH-Ligation was higher than that in group Ligation-COH (1.88 ± 1.00 vs. 1.48 ± 0.70, P < 0.05), the biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, live birth rate and cumulative live birth rate in group Ligation-COH were significantly higher than those in group COH-Ligation (60.83% vs. 46.27% for biochemical pregnancy, 55.69% vs. 38.5% for clinical pregnancy, 26.18% vs. 17.74% for multiple pregnancy, 47.08% vs. 25.26% for live birth, 69.47% vs. 47.47% for cumulative live birth, P < 0.05), and the miscarriage rate in group Ligation-COH was lower than that in group COH-Ligation (10.47% vs. 17.20 for early abortion, 4.49% vs. 15.86% for late abortion, P < 0.05). In logistic regression analysis, after adjustment for age and multiple factors, the above results were still statistically significant differences (P < 0.001). For elderly patients, the clinical pregnancy rate, multiple birth rate and live birth rate in group Ligation-COH were also higher than those in group COH-Ligation (P < 0.001). No significant differences were detected for patients with diminished ovarian reserve. CONCLUSIONS For the choice of ligation operation time, we recommend that patients choose tubal ligation first and then ovulation induction and oocyte retrieval treatment.
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Affiliation(s)
- Jie Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China
- Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Sien Mo
- Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhong Lin
- Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Fuhua Mo
- Reproductive Medicine Department, The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, China.
- School of Public Health, Chongqing Medical University, Chongqing, China.
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Yao WX, Zheng DZ, Liu WF, Zhou MM, Liu L, Cai MJ. Prognostic value of hysterosalpingography after salpingostomy in patients with hydrosalpinx. J OBSTET GYNAECOL 2023; 43:2158322. [PMID: 36606700 DOI: 10.1080/01443615.2022.2158322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
To assess whether post-hysterosalpingography evaluation was associated with pregnancy rate and to identify independent risk factors for pregnancy success after salpingostomy in patients with hydrosalpinx. A retrospective analysis was conducted on the clinical data of 47 patients diagnosed with hydrosalpingography (HSG) in our hospital from 2015 to 2018. These patients received laparoscopic surgery and another salpingography within 2 months after surgery. According to the fallopian tube conditions evaluated by HSG before and after surgery, the patients could be divided into two groups. According to the pregnancy rate and postoperative HSG of patients with hydrosalpinx after laparoscopy, the total pregnancy rate of the tubal improved group was 65.62%, while that of the non-improved group was 20%, with statistical significance (p < 0.05). We found that hysterosalpingography after salpingostomy in patients with hydrosalpinx can provide reference for clinical treatment and improve the prognosis of patients.
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Affiliation(s)
- Wen-Xi Yao
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, PR China
| | - Du-Zhou Zheng
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, PR China
| | - Wei-Feng Liu
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, PR China
| | - Mi-Mi Zhou
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, PR China
| | - Li Liu
- Department of Gynaecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, PR China
| | - Ming-Jin Cai
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, PR China
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Bi B, Han X, Dai W, Fang L, Shi H, Hu L. Comparisons of different treatment outcomes in IVF/ET patients with hydrosalpinx: a retrospective study. Gynecol Endocrinol 2023; 39:2249999. [PMID: 37625443 DOI: 10.1080/09513590.2023.2249999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
AIMS To explore suggestions for clinicians on the most effective treatment for hydrosalpinx undergoing IVF-ET. MATERIALS AND METHODS We reviewed 936 women with hydrosalpinx and 6715 tubal infertile women without hydrosalpinx who underwent IVF/ICSI between January 2014 and August 2019 in our center. Hydrosalpinx patients received different treatments including laparoscopic surgery (only salpingectomy and proximal tubal occlusion/ligation were included), ultrasonic-guided aspiration and hysteroscopic tubal occlusion. Outcomes were analyzed by One-way ANOVA, Chi-Square test and logistic regression. RESULTS The live birth rate (LBR) of laparoscopic surgery was significantly higher compared with hydrosalpinx aspiration (48.3% vs 39.6%, p = .024). The cumulative live birth rate (CLBR) of subsequent laparoscopic surgery was significantly higher compared with subsequent hysteroscopic occlusion (65.1% vs 34.1%, p = .001) and no subsequent treatment (65.1% vs 44.9%, p < .005). Subsequent laparoscopic surgery significantly improved the CLBR of hydrosalpinx patients who received ultrasonic-guided aspiration and didn't get clinical pregnancy in fresh cycles (Odds Ratio (OR) =1.875; 95%CI = 1.041-3.378, p = .036). CONCLUSIONS Laparoscopic surgery leads to significantly higher LBR than ultrasonic-guided aspiration and significantly higher CLBR than hysteroscopic occlusion and no treatment.
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Affiliation(s)
- Beibei Bi
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Xiao Han
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
- Reproductive Medical Center, Jiaozuo Women and Children's Hospital, Jiaozuo, P.R. China
| | - Wei Dai
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Lanlan Fang
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Hao Shi
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Linli Hu
- Henan Provincial Obstetrical and Gynecological Diseases (Reproductive Medicine) Clinical Research Center, Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
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Wu WF, Yi JS, Xie X, Liu CB. Risk factor for interstitial pregnancy following ipsilateral salpingectomy? A retrospective matched case control study. BMC Pregnancy Childbirth 2023; 23:826. [PMID: 38037027 PMCID: PMC10687775 DOI: 10.1186/s12884-023-06132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Interstitial pregnancy may still happen even after ipsilateral salpingectomy, resulting in massive hemorrhage. Therefore, the purpose of the study is to identify risk factors associated with interstitial pregnancy following ipsilateral salpingectomy and discuss possible prevention. METHODS We conducted a retrospective cohort study in a single, large, university-affiliated hospital. Data of 29 patients diagnosed with interstitial pregnancy following ipsilateral salpingectomy from January 2011 to November 2020 were assigned into the case group (IP group). Whereas there were 6151 patients with intrauterine pregnancy after unilateral salpingectomy in the same period. A sample size of 87 control patients was calculated to achieve statistical power (99.9%) and an α of 0.05. The age, BMI and previous salpingectomy side between the two group were adjusted with PSM at a ratio of 1:3. After PSM, 87 intrauterine pregnancy patients were successfully matched to 29 IP patients. RESULTS After PSM, parous women were more common and intrauterine operation was more frequent in the IP group compared with control group (P<0.05). There was only one patient undergoing IVF-ET in the IP group as compared with 29 cases in the control group (3.4% vs. 33.3%, P<0.05). Salpingectomy was performed on 5 patients in the IP group and 4 patients in the control group due to hydrosalpinx (P<0.05). Logistic regression indicated that hydrosalpinx was the high risk factor of interstitial pregnancy following ipsilateral salpingectomy (OR = 8.175). CONCLUSIONS Hydrosalpinx appears to be an independent factor contributing to interstitial pregnancy following ipsilateral salpingectomy in subsequent pregnancy.
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Affiliation(s)
- Wei-Fang Wu
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China.
| | - Jing-Song Yi
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China
| | - Xi Xie
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China
| | - Chao-Bin Liu
- Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, 18, Daoshan Rd, 350001, Fuzhou, Fujian, China.
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Fan L, Li X, Shi J, Duan H. The time interval between laparoscopic tubal ligation and frozen-thawed embryo transfer does not affect the reproductive outcomes. BMC Pregnancy Childbirth 2023; 23:564. [PMID: 37537525 PMCID: PMC10399055 DOI: 10.1186/s12884-023-05880-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/27/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Hydrosalpinx may decrease implantation and pregnancy rates after embryo transfer. Laparoscopic tubal ligation after embryo freeze and before frozen-thawed embryo transfer (FET) is effective at improving reproductive outcomes for hydrosalpinx patients. This study is to find out the optimal interval between laparoscopic tubal ligation and FET. METHODS We retrospectively analyzed 259 infertile women who performed laparoscopic tubal ligation for embryo freeze and FET. Participants were divided into three groups, based on the interval between laparoscopic tubal ligation and FET. Group I: <30 days; Group II: 31- 60 days; Group III: >60 days. Outcomes of cleavage-stage and blastocyst-stage embryo FET were analyzed respectively. RESULTS There was no significant difference in clinical pregnancy rate, live birth rate, implantation rate, biochemical pregnancy rate, ectopic pregnancy rate, miscarriage rate and preterm birth rate among the three groups, in both cleavage-stage and blastocyst-stage embryo FET cycles. In cleavage-stage embryo FET cycle, singleton gestational age was significantly younger in group III (38.11 ± 2.28 weeks) compared with group I (39.29 ± 1.06 weeks, P = 0.001) and group II (38.96 ± 1.05, P = 0.026). Singleton birth weight was significantly heavier in group II (3.65 ± 0.32 Kg) compared with group I (3.38 ± 0.29 Kg, P = 0.001) and group III (3.35 ± 0.60 Kg, P = 0.004). Twin birth weight was significantly heavier in group III (2.72 ± 0.43 Kg) compared to group I (2.23 ± 0.67 Kg, P = 0.002). In blastocyst-stage embryo FET cycles, twin gestational age was significantly younger in group II (34.07 ± 3.18 weeks) compared with group I (35.56 ± 2.27 weeks, P = 0.049) and group III (36.50 ± 1.47 weeks, P = 0.005). Twin birth weight was significantly heavier in group III (2.71 ± 0.39 Kg) compared to group II (2.39 ± 0.67 Kg, P = 0.009). CONCLUSIONS The duration of the interval between laparoscopic tubal ligation and FET does not affect the reproductive outcomes; however, it may affect the neonate outcomes to some extent.
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Affiliation(s)
- Lijuan Fan
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Xiaojuan Li
- Department of Reproductive Gynecology, Northwest Women's and Children's Hospital, No. 73, Houzaimen Street, Xi'an, People's Republic of China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Haixia Duan
- Department of Reproductive Gynecology, Northwest Women's and Children's Hospital, No. 73, Houzaimen Street, Xi'an, People's Republic of China.
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Yip JY, Kanneganti A, Binte Ahmad N, Lim MXK, Chew SLS, Huang Z. Optimizing intrauterine insemination and spontaneous conception in women with unilateral hydrosalpinx or tubal pathology: A systematic review and narrative synthesis. Eur J Obstet Gynecol Reprod Biol 2023; 286:135-144. [PMID: 37267890 DOI: 10.1016/j.ejogrb.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/14/2023] [Accepted: 05/18/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Tubal surgery's role in infertile women with unilateral tubal pathology (e.g. hydrosalpinx, tubal occlusion) who desire spontaneous or intrauterine insemination (IUI) conception where in-vitro fertilisation is infeasible remains unclear. OBJECTIVE To conduct a systematic review on fertility outcomes in women with unilateral tubal pathology desiring to conceive spontaneously or via IUI and to find guidance to support therapeutic tubal procedures to help these women conceive. SEARCH STRATEGY Using a protocol registered on PROSPERO (ID CRD42021248720), we searched PubMed, EMBASE, CINAHL, and Cochrane Library from inception until June 2022. Bibliographies were reviewed to identify other relevant articles. DATA COLLECTION AND ANALYSIS Two authors independently selected and extracted data. Disagreements were resolved by a third author. Studies presenting fertility outcome data in infertile women with unilateral tubal pathologies desiring spontaneous or IUI conception were included. Methodologic quality was assessed using a modified Newcastle Ottawa Scale for observational studies and the Institute of Health Economics Quality Appraisal Checklist for case series. Primary outcomes collated included cumulative pregnancy rate (CPR) and pregnancy rate per cycle (PR/cycle). Secondary outcomes such as ectopic pregnancy, birth outcomes, and pelvic inflammatory disease were collated. These were stratified by the types of unilateral tubal occlusion (UTO) i.e. hydrosalpinx, proximal tubal occlusion (PTO), or distal tubal occlusion (DTO) MAIN RESULTS: Two studies reported spontaneous or IUI pregnancies after treatment of unilateral hydrosalpinx with one reporting a pregnancy rate of 88% within 5.6 months on average. Thirteen studies compared IUI outcomes between women with UTO vs unexplained infertility and bilateral tubal patency (controls). Almost all were retrospective cohort studies and identified UTO by hysterosalpingography. In general, PTOs had no difference in PR/cycle and CPR compared to controls and significantly higher PR/cycle to DTOs. Women with DTOs had minimal incremental CPR benefit with each additional IUI cycle. CONCLUSIONS Therapeutic salpingectomy or tubal occlusion improve IUI or spontaneous conception in women with hydrosalpinx, although more prospective studies are needed. While significant study heterogeneity hampered assessment of fertility outcomes, overall, infertile women with PTOs had similar IUI pregnancy outcomes to those with bilateral tubal patency while DTOs had inferior PR/cycle. This review highlights significant deficiencies in the evidence guiding management for this group of patients.
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Affiliation(s)
- Jia Yun Yip
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Nurulhuda Binte Ahmad
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Mei Xian Karen Lim
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Siong Lin Stephen Chew
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore
| | - Zhongwei Huang
- Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Ridge Road, 119074, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), #04-02, 28 Medical Drive Center for Life Sciences Building, NUS Yong Loo Lin School of Medicine, 117456, Singapore.
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Sugai Y, Kinoshita Y, Kobayashi T, Takahashi Y, Arai Y, Ohyama T, Yokota N, Takano S, Kobayashi A. A rare case of pyosalpinx in adolescent girl with Hirschsprung's disease who underwent transvaginal ultrasound-guided drainage. Surg Case Rep 2023; 9:74. [PMID: 37160491 PMCID: PMC10169977 DOI: 10.1186/s40792-023-01657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Hydrosalpinx and pyosalpinx are rare gynecologic problems during adolescence, especially in girls without a history of sexual activity. They are even rarer in women with Hirschsprung's disease (HD). We herein report a case of pyosalpinx in an adolescent girl with HD treated by transvaginal ultrasound-guided drainage. CASE PRESENTATION The present patient was a 12-year-old girl (weight 83 kg; height 159 cm; body mass index 32.8 kg/m2). She had undergone five laparotomies for long-segment HD by 2 years. Her menarche had occurred at 10 years. She was admitted with lower abdominal and anal pain. Computed tomography (CT), magnetic resonance imaging (MRI), and transvaginal ultrasound showed left pyosalpinx and abdominal abscess. Surgical drainage was necessary; however, she had a history of polysurgery and was severely obese, so laparotomy was considered to carry a high risk. Transvaginal ultrasound was deemed more likely to reach the abscess safely. Therefore, she was treated with transvaginal ultrasound-guided drainage by a gynecologist skilled in the procedure. She was discharged home after 52 days. One year and nine months after discharge, there was no reformation of either the abscess or pyosalpinx. CONCLUSIONS Adolescent girls with HD are at risk of developing hydrosalpinx. Depending on the defecation status, pyosalpinx may also develop. As a less-invasive surgical treatment, transvaginal ultrasound-guided drainage can avoid laparotomy. Collaboration with a gynecologist is essential for the diagnosis and treatment of this clinical condition. Pediatric surgeons should communicate with gynecologists for such cases beginning around puberty for continuous follow-up.
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Affiliation(s)
- Yu Sugai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan.
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Takashi Kobayashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Yoshiaki Takahashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Yuhki Arai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Toshiyuki Ohyama
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Naoki Yokota
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Shoichi Takano
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Akiko Kobayashi
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-754 Asahimati-Dori, Chuo-Ku, Niigata, 951-8520, Japan
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Essolaymany Z, Charifi Y, Aassouani F, El Bouardi N, Haloua M, Alami B, Alaoui Lamrani Y, Maâroufi M, Boubbou M. Hydrosalpinx with adnexal torsion in an adult patient-A case report. Radiol Case Rep 2023; 18:1754-1757. [PMID: 36915602 PMCID: PMC10006302 DOI: 10.1016/j.radcr.2023.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 03/16/2023] Open
Abstract
Adnexal torsion is a common gynecological emergency and a significant cause of acute pelvic pain in women. Hydrosalpinx-induced torsion of the adnexa is a rare situation and requires prompt and accurate management. Twenty-three years old nulliparous woman admitted in our structure for acute pelvic pain. The ultrasound revealed an enlarged right ovary with an adnexal cystic mass. We suspected the diagnosis of a right adnexal torsion due to cystic ovarian mass. Laparotomy revealed torsion of the right adnexa and a second large mass appearing to be a hydrosalpinx. Diagnosis of adnexal torsion is difficult and is based on a range of arguments obtained by anamnesis, clinical examination, ultrasonography and other investigations. Early diagnosis is important for preserving tubal and ovarian function, given the risk of ovarian necrosis in young women. Laparoscopy is the gold standard for diagnosing and treating adnexal torsion. The treatment can be conservative or radical, consisting of detorsion of the twisted adnexa, with or without adnexectomy.
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Affiliation(s)
- Zineb Essolaymany
- Radiology Department of Mother and Child, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, BP. 1893; Km 2.200, Sidi Hrazem Rd, Fez 30000, Morocco
| | - Yahya Charifi
- Radiology Department of Mother and Child, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, BP. 1893; Km 2.200, Sidi Hrazem Rd, Fez 30000, Morocco
| | - Farid Aassouani
- Radiology Department of Mother and Child, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, BP. 1893; Km 2.200, Sidi Hrazem Rd, Fez 30000, Morocco
| | - Nizar El Bouardi
- Radiology Department of Mother and Child, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, BP. 1893; Km 2.200, Sidi Hrazem Rd, Fez 30000, Morocco
| | - Meriem Haloua
- Radiology Department of Mother and Child, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, BP. 1893; Km 2.200, Sidi Hrazem Rd, Fez 30000, Morocco
| | - Badreeddine Alami
- Radiology Department of Mother and Child, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, BP. 1893; Km 2.200, Sidi Hrazem Rd, Fez 30000, Morocco
| | - Youssef Alaoui Lamrani
- Radiology Department of Mother and Child, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, BP. 1893; Km 2.200, Sidi Hrazem Rd, Fez 30000, Morocco
| | - Mustapha Maâroufi
- Radiology Department of Mother and Child, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, BP. 1893; Km 2.200, Sidi Hrazem Rd, Fez 30000, Morocco
| | - Meryem Boubbou
- Radiology Department of Mother and Child, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, BP. 1893; Km 2.200, Sidi Hrazem Rd, Fez 30000, Morocco
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9
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Guo H, Du T, Lyu Q, Wu L, Chai W, Zhu Q. Live birth rate and neonatal outcomes following interventional embolization of hydrosalpinx. Reprod Health 2022; 19:213. [PMID: 36457061 PMCID: PMC9713958 DOI: 10.1186/s12978-022-01522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 11/04/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Hydrosalpinx has a negative effect on the pregnancy outcomes of in vitro fertilization and embryo transfer (IVF-ET), and the pretreatment for hydrosalpinx play an important role in improving the outcomes of IVF-ET. This study aimed to investigate the impacts of interventional embolization of hydrosalpinx on the live birth rate and neonatal outcome after in-vitro fertilization. METHOD In the present retrospective study, 3351 women receiving the first frozen embryo transfer (FET) after freeze-all policy were reviewed. Patients who received interventional embolization of hydrosalpinx (n = 1268) were included in the study group and those with hydrosalpinx-free bilateral fallopian tube obstruction (n = 2083) in the control group. The primary outcome was live birth (LB) rate; the secondary endpoints included rates of implantation, clinical pregnancy (CP), multiple pregnancy, and pregnancy loss. RESULTS The LB rate was similar between embolization group (39.91%) and control group (43.21%) (P > 0.05). The rate of implantation (35.81% vs. 32.24%), CP (50.84% vs. 47%) and multiple pregnancy rate (28.71% vs. 24.16%) in the control group were significantly higher than in the embolization group (P < 0.05). The miscarriage rate (39.91%, vs 43.21%, P > 0.05), ectopic gestation rate (2.35% vs 2.83%, P > 0.05), and ongoing pregnancy rate (41.56% vs 44.89%, P > 0.05) were comparable between two groups. After adjustment for confounding factors, interventional embolization of hydrosalpinx was found to have no influence on the LB rate. The thicker endometrium, more embryos transferred, and transfer of blastocyst stage embryos significantly increased the LB rate and CP rate. CONCLUSION The interventional embolization of hydrosalpinx can achieve the LB rate similar to that of hydrosalpinx-free obstruction patients with less risk, less pain and reduced medical cost. Thus, embolization of hydrosalpinx is one of the preferable clinical treatments for patients with hydrosalpinx.
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Affiliation(s)
- Haiyan Guo
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Tong Du
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Qifeng Lyu
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Ling Wu
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Weiran Chai
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
| | - Qianqian Zhu
- grid.16821.3c0000 0004 0368 8293Department of Assisted Reproduction, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai, Jiao Tong University China Hospital Development Institute, Shanghai, 200011 China
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10
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Thomas J, Chirayath S. Gangrenous Hydrosalpinx with Isolated Fallopian Tube Torsion in Premenarchal Child. J Obstet Gynaecol India 2022; 72:439-441. [PMID: 36457430 PMCID: PMC9701280 DOI: 10.1007/s13224-022-01634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/08/2022] [Indexed: 11/30/2022] Open
Abstract
Hydrosalpinx induced torsion of the adnexa in a premenarchal child without sexual experience is a rare situation and immediate intervention is necessary. This report describes a 10-year old premenarchal female without a history of sexual intercourse who presented with left lower abdominal pain. Ultrasound imaging revealed a left adnexa with thick-walled cystic lesion measuring 5.1 × 3.7 × 2.7 cm suggestive of hydrosalpinx or para ovarian cyst. Diagnostic laparoscopic surgery showed ischaemic tubular shaped cystic left hydrosalpinx that was twisted along its own axis at the level of isthmus. Laparoscopic left salpingectomy was performed within 24 h of presentation leaving behind a healthy left ovary. Early diagnosis is important in preventing further complications including severe infection and peritonitis and to prevent complications that might affect fertility.
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Affiliation(s)
- Jane Thomas
- Department of Obstetrics and Gynaecology, Mar Augustine Jubilee Hospital, Opposite St. George Forane Church, Market Road, Edappally, Kochi, Kerala 682024 India
| | - Sheila Chirayath
- Department of Obstetrics and Gynaecology, Mar Augustine Jubilee Hospital, Opposite St. George Forane Church, Market Road, Edappally, Kochi, Kerala 682024 India
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11
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Maignien C, Bourdon M, Scarano-Pereira JP, Martinino A, Cheloufi M, Marcellin L, Chapron C, Santulli P. ART Outcomes After Hysteroscopic Proximal Tubal Occlusion Versus Laparoscopic Salpingectomy for Hydrosalpinx Management in Endometriosis Patients. Reprod Sci 2021; 29:427-435. [PMID: 34642914 DOI: 10.1007/s43032-021-00737-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
The objective of this paper is to compare assisted reproductive technology (ART) cumulative live birth rates after hysteroscopic proximal tubal occlusion and laparoscopic salpingectomy in endometriosis patients, for management of hydrosalpinx. This is an observational cohort study at a university hospital, including all endometriosis patients with hydrosalpinges undergoing ART, between January 2013 and December 2018. The patients underwent either laparoscopic salpingectomy or hysteroscopic proximal tubal occlusion with Essure® when laparoscopy was not an option (extensive pelvic adhesions at exploratory laparoscopy or a history of multiple abdominal surgeries with frozen pelvis). The diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography (TVUS) and magnetic resonance imaging (MRI). Endometriosis patients with hydrosalpinges diagnosed by hysterosalpingography and/or TVUS and/or MRI were included. The primary outcome was the cumulative live birth rate. A total of 104 patients were included in the study; 74 underwent laparoscopic salpingectomy and 30 underwent proximal tubal occlusion with Essure®. The Essure® group had longer infertility durations (58.9 ± 30.0 months vs. 39.5 ± 19.1 months, p = 0.002) and a higher incidence of associated adenomyosis (76.7% vs. 39.1%, p < 0.001) than the salpingectomy group. The cumulative live birth rate was 56.6% after 44 ART cycles in the Essure® group and 40.5% after 99 ART cycles in the salpingectomy group (p = 0.13). In a population of endometriosis patients undergoing ART, women treated by Essure® for management of hydrosalpinx have similar cumulative live birth rates as women treated by laparoscopic salpingectomy.
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Affiliation(s)
- Chloé Maignien
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal, 75014, Paris, France
| | - Mathilde Bourdon
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal, 75014, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Juan Pablo Scarano-Pereira
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal, 75014, Paris, France
| | - Alessandro Martinino
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal, 75014, Paris, France
| | - Meryam Cheloufi
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal, 75014, Paris, France
| | - Louis Marcellin
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal, 75014, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Charles Chapron
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal, 75014, Paris, France
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Pietro Santulli
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, 12 Rue de l'École de Médecine, 75006, Paris, France.
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, 123 Boulevard de Port Royal, 75014, Paris, France.
- Department "Development, Reproduction and Cancer", Cochin Institute, INSERM U1016 (Professor Batteux), 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
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12
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Hagege R, Sharvit M, Hamou B, Barzilay E, Pansky M, Barel O. Isolated Fallopian Tube Torsion: An Underdiagnosed Entity with Debatable Management. J Minim Invasive Gynecol 2021:S1553-4650(21)00359-9. [PMID: 34371191 DOI: 10.1016/j.jmig.2021.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To study features of isolated fallopian tube torsion (IFTT) to promote early diagnosis of this entity and describe options for management. DESIGN Retrospective cohort study from October 2017 through October 2020. SETTING Tertiary care hospital. PATIENTS All patients with surgically confirmed adnexal torsion or IFTT during the study period. INTERVENTIONS All of the patients underwent gynecological examination, imaging, and laparoscopy. MEASUREMENTS AND MAIN RESULTS During this 3-year period, 64 patients underwent laparoscopy owing to confirmed torsion, of which 55 had adnexal torsion, and 9 had IFTT. Patients with IFTT tended to be younger (21.2 years ± 8.2 vs 29.1 years ± 11.9, p = .06) and had more fever on admission (p = .007). On ultrasound examination, isolated hydrosalpinx was demonstrated only in patients with IFTT (p <.001). During surgery, more para-ovarian cysts were observed in patients with IFTT (44.4% vs 10.9%, p = .01), whereas patients with adnexal torsion had more ovarian cysts (52.7% vs 0%, p = .003). The most common procedure was detorsion in both groups. Most patients that underwent detorsion of the tube had a normal ultrasound scan on follow-up examination. CONCLUSION IFTT is probably underdiagnosed. Its clinical presentation is more equivocal than adnexal torsion, and ovaries are usually of normal size on ultrasonography. Hydrosalpinx or para-ovarian cysts should raise suspicion toward IFTT. Detorsion of the tube is probably a valid management option, although further research with long-term follow-up analyzing tubal patency is necessary to define the optimal management for this condition.
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13
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Scarpa MG, Iaquinto M, Codrich D, Schleef J. Bilateral sactosalphinx and congenital adrenal hyperplasia: case report on two rare conditions in two virgin girls. Ital J Pediatr 2021; 47:141. [PMID: 34187553 PMCID: PMC8244243 DOI: 10.1186/s13052-021-01089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sactosalpinx means a collection of fluid (serum, blood or pus) in the fallopian tube. CAH (Congenital Adrenal Hyperplasia) is a typical 46XX DSD (Disorder of Sex Development) due to a steroidogenic enzymatic defect. Both conditions are rare and can lead to reduced fertility rate. CASE PRESENTATION We describe two post-menarche virgin girls with CAH who were hospitalized for acute abdomen due to laparoscopically confirmed sactosalpinx. Case 1 recovered after conservative management, case 2 after a second-look and bilateral salpingectomy. The first case consisted of right sactosalpinx and previous peritonitis reported; the second one of bilateral symptomatic pyosalpinx and previous vaginal stenosis. Recurrent abdominal pain persisted at follow-up in Case 1: post-operative MRI (Magnetic Resonance Imaging) showed bilateral hydrosapinx that disappeared at a following ultrasound scan control. Follow-up was uneventful 36 months after surgery in Case 2, except for the surgical revision of the vaginal introitus. CONCLUSIONS CAH-sactosalpinx association is a very rare but not negligible event. We suggest a conservative approach for sactosalpinx if tubal and/or ovary torsion can be excluded. Pyosalpinx is more challenging to treat, but during pediatric age we suggest starting with a conservative approach, especially in patients with CAH who have a potential low fertility rate. Careful gynecological follow-up after menarche is recommended to rule out any further causes of infertility.
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Affiliation(s)
- Maria-Grazia Scarpa
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy.
| | - Marianna Iaquinto
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy
| | - Daniela Codrich
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy
| | - Jürgen Schleef
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy
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14
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Liu H, Yao Z, Zhang R, Wu S, Lv S, Yan L. Effect of Recurrence of Hydrosalpinx after Tubal Ligation on the Outcome of In vitro Fertilization Treatment: A Retrospective Cohort Study. Gynecol Minim Invasive Ther 2020; 9:118-122. [PMID: 33101911 PMCID: PMC7545052 DOI: 10.4103/gmit.gmit_27_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 02/11/2020] [Accepted: 03/16/2020] [Indexed: 11/24/2022] Open
Abstract
Objective: The objective of the study was to evaluate the effects of recurrent hydrosalpinx after proximal tubal ligation and distal salpingostomy on the outcomes of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment. Materials and Methods: Seven hundred and twenty-six patients with hydrosalpinx undergoing laparoscopic surgery before IVF were enrolled in the study. Five hundred and sixty-two patients treated with proximal tubal ligation and distal salpingostomy were included in Group A. One hundred and sixty-four cases managed with salpingectomy were grouped into Group B. Group A were further divided into two subgroups. One hundred and forty-six patients in Group A1 had a recurrence of hydrosalpinx. Four hundred and sixteen patients in Group A2 had no repetition of hydrosalpinx. We compared the pregnancy outcomes of their subsequent fresh embryo transfer cycles among the three groups. Results: There were no significant differences among the three groups in terms of age, body mass index (23.56 ± 3.27 vs. 23.13 ± 3.42 vs. 23.63 ± 3.73, P = 0.195), basal hormone level (7.03 ± 1.75 vs. 7.08 ± 2.26 vs. 7.44 ± 2.93, P = 0.195), antral follicle count (12.25 ± 5.92 vs. 12.63 ± 5.71 vs. 11.70 ± 4.98, P = 0.188), duration of gonadotropin (Gn) (11.19 ± 2.1 vs. 10.93 ± 1.84 vs. 10.79 ± 2.03, P = 0.182), consumption of Gn (2136.73 ± 855.65 vs. 1997.15 ± 724.72 vs. 2069.05±765.12 , P = 0.14), endometrial thickness (1.1 ± 0.27 vs. 1.1 ± 0.24 vs. 1.1 ± 0.17, P = 0.352), base follicle-stimulating hormone (6.21 ± 3.43 vs. 6.52 ± 3.20 vs. 5.89 ± 3.10, P = 0.1), number of embryos transferred (1.87 ± 0.36 vs. 1.83 ± 0.42 vs. 1.88 ± 0.37, P = 0.224), and number of high-grade embryos (3.77 ± 2.42 vs. 4.01 ± 2.72 vs. 4.17 ± 2.74, P = 0.41). No differences were detected in clinical pregnancy rate (50% vs. 54.8% vs. 50%, P = 0.439), the live birth rate (86.3% vs. 82.0% vs. 87.8%, P = 0.398), fertilization rate (64.1% vs. 64.4% vs. 64.7%, P = 0.928), and biochemical pregnancy rate (4% vs. 4.5% vs. 7%, P = 0.332) among the three groups. Conclusion: The recurrence of hydrosalpinx after tubal ligation does not affect the outcomes of IVF/ICSI. It is not necessary to worry about the effect of recurrent hydrosalpinx on pregnancy outcomes of IVF/ICSI that may due to the spread of inflammation through lymphatic circulation or blood circulation.
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Affiliation(s)
- HaiLing Liu
- Department of Reproductive Medicine, People's Hospital of Rizhao, Jinan, China
| | - ZhiNa Yao
- Department of Obstetrics and Gynecology, School of Medicine, Jinan, China.,Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China.,Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, China
| | - Rougxiu Zhang
- Center for Reproductive Medicine, Changle People's Hospital, Changle, China
| | - SheLing Wu
- Center for Reproductive Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - ShangGe Lv
- Department of Obstetrics and Gynecology, School of Medicine, Jinan, China.,Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China.,Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, China
| | - Lei Yan
- Department of Obstetrics and Gynecology, School of Medicine, Jinan, China.,Center for Reproductive Medicine, Reproductive Hospital Affiliated to Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan, China.,Shandong Provincial Key Laboratory of Reproductive Medicine, Jinan, China
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15
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Rippentrop SM, Huo Z, Zhou Z, Zaldana F, Hernandez S, Robinson RD, Zhong G. Effectiveness of Platelet-Rich Plasma in the Prevention of Chlamydia-Induced Hydrosalpinx in a Murine Model. Reprod Sci 2021; 28:1031-40. [PMID: 32989630 DOI: 10.1007/s43032-020-00329-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
Chlamydia trachomatis (C. trachomatis) is a major pathogen implicated in the formation of hydrosalpinx in the female reproductive tract. In mice, a related strain of Chlamydia, Chlamydia trachomatis (C. trachomatis) can induce almost 100% bilateral hydrosalpinx. This model was used as a hydrosalpinx induction model to test whether oviduct delivery of platelet-rich plasma (PRP) can attenuate chlamydia induction of hydrosalpinx in a mouse model. Mice were infected intravaginally with Chlamydia muridarum organisms, and 21 days after the infection, PRP was instilled into the lumen of one oviduct, and a sham instillation with phosphate buffer solution was performed on the contralateral oviduct. Mice were then sacrificed at designated time points after infection for oviduct pathologic evaluation including incidence, severity, and histopathologic grade of chronic inflammation. Oviduct instillation of PRP was associated with a 36% reduction in the incidence of hydrosalpinx and a 33% reduction in severity compared with sham. The median grade of chronic inflammation on histopathology was significantly lower with PRP instillation compared with sham and control. No differences were observed in vaginal or rectal shedding of C. muridarum between the test group and the control group. In short, the results suggest that oviduct instillation of PRP can significantly reduce the incidence and severity of C. muridarum-induced hydrosalpinx without affecting chlamydial infection courses in CBA/J mice.
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16
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Martín-Vallejo J, Garrigós-Llabata EE, Molina-Bellido P, Clemente-Pérez PA. Isolated fallopian tube torsion associated with hydrosalpinx in a 12-year-old girl: a case report. J Med Case Rep 2020; 14:165. [PMID: 32921316 PMCID: PMC7488696 DOI: 10.1186/s13256-020-02462-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/27/2020] [Indexed: 12/07/2023] Open
Abstract
Background Isolated fallopian tube torsion associated with hydrosalpinx is a rare condition in the pediatric population. We present this unusual clinical case study in a sexually inactive girl. Case presentation a12-year-old Caucasian girl presented symptoms of acute abdominal pain. Pelvic ultrasound revealed a normal looking uterus and ovaries and next to left ovary a imaging compatible with hydrosalpinx. She was discharged 48 hours later after clinical monitoring with oral analgesia and normal blood workup. At 3 weeks, she was readmitted for acute abdominal pain. Leukocytosis with left shift and raised C-reactive protein were observed. Her clinical condition worsened, and complication of the preexisting hydrosalpinx was suspected. Exploratory laparoscopy confirmed torsion of the fallopian tube. Left salpingectomy was performed. Histopathologic study confirmed a fallopian tube with hemorrhagic infarct. Conclusion Torsion of the fallopian tube must be considered in the event of acute abdominal pain. Early diagnosis and trying conservative management with a view to preserving fertility in this group of patients are essential.
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Affiliation(s)
- Javier Martín-Vallejo
- Department of Obstetrics and Gynecology, Hospital de Denia, Avenida Marina Alta, s/n, 03700, Denia, Alicante, Spain.
| | - Enrique E Garrigós-Llabata
- Department of Obstetrics and Gynecology, Hospital de Denia, Avenida Marina Alta, s/n, 03700, Denia, Alicante, Spain
| | - Patricia Molina-Bellido
- Department of Obstetrics and Gynecology, Hospital de Denia, Avenida Marina Alta, s/n, 03700, Denia, Alicante, Spain
| | - Pedro A Clemente-Pérez
- Department of Obstetrics and Gynecology, Hospital de Denia, Avenida Marina Alta, s/n, 03700, Denia, Alicante, Spain
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17
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Fouda UM, Elshaer HS, Youssef MA, Darweesh FF. Extended doxycycline treatment versus salpingectomy in the management of patients with hydrosalpinx undergoing IVF-ET. J Ovarian Res 2020; 13:69. [PMID: 32532326 PMCID: PMC7293118 DOI: 10.1186/s13048-020-00665-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this study was to determine whether the treatment with doxycycline before and after oocyte retrieval is as effective as salpingectomy in minimizing the detrimental effect of hydrosalpinx on the outcomes of IVF-ET. Methods A retrospective analysis was done for the outcomes of the IVF-ET cycles of patients with hydrosalpinx who underwent laparoscopic salpingectomy prior to IVF cycle (n = 260) or were treated with extended doxycycline treatment during the IVF cycle (n = 45). In doxycycline group, doxycycline (100 mg twice daily) was started 1 week before anticipated oocyte retrieval and was continued for 1 week after oocyte retrieval. In salpingectomy group, the mesosalpinx was coagulated as close as possible to the fallopian tube. Results The implantation, clinical pregnancy, ongoing pregnancy and live birth rates were significantly higher in the salpingectomy group (20.87% Vs. 9.91%, P value =0.007, 44.62% Vs. 20%, P value = 0.002, 39.62% Vs. 17.78%, P value = 0.005 and 37.31% Vs. 15.56%, P value = 0.005 respectively). Conclusion Salpingectomy is more effective than extended doxycycline treatment in improving the outcomes of IVF-ET in patients with hydrosalpinx undergoing IVF-ET. Further, larger well designed randomized controlled trials should be conducted to confirm the findings of this study.
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Affiliation(s)
- Usama M Fouda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt. .,Riyadh Fertility and Reproductive Health Center, Giza, Egypt.
| | - Hesham S Elshaer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt.,Riyadh Fertility and Reproductive Health Center, Giza, Egypt
| | - Mohamed A Youssef
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt
| | - Fatma F Darweesh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Al-Ainy Hospital, Al-Saraya Street, Cairo, Egypt.,Riyadh Fertility and Reproductive Health Center, Giza, Egypt
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Bertozzi M, Noviello C, Molinaro F, Ratta A, Lisi G, Cobellis G, Federici S, Chiesa PL, Martino A, Messina M. Isolated fallopian tube torsion in pediatric age: An Italian multicenter retrospective study. J Pediatr Surg 2020; 55:711-714. [PMID: 31130349 DOI: 10.1016/j.jpedsurg.2019.04.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to quantify the experience of five Italian centers on the diagnosis and management of isolated fallopian tube torsion (IFTT) in children. METHODS We retrospectively reviewed the data of 20 patients aged 1-16 years of age with surgically diagnosed IFTT between 1991 and 2017 from five Italian centers of pediatric surgery. We analyzed common presenting signs, symptoms, and radiographic findings, as well as surgical interventions to describe management offering further insight into the diagnosis and treatment of this rare entity. RESULTS Twenty cases of IFTT were collected. Median age was 13.1 years. Menarche was present in 14 cases. A clinical history of abdominal pain was present in 13 patients, whereas in 7 patients the clinical picture was an acute abdomen. Ultrasonography was the first diagnostic examination in 16 cases. Surgical approach was by laparoscopy in 16 cases and laparotomy in 4 cases. In 11 patients IFTT was associated with another pathologic condition. In 7 of the remaining 9 IFTT without pathologic association, the girls played sports. Salpingectomy was performed in 13 patients and de-torsion in 7. CONCLUSIONS IFTT is a rare condition that seems to occur in younger adolescents. Vague clinical presentation contributes to low preoperative suspicion. IFTT should be considered in girls with abdominal pain who practice sports with sudden body movements. Preoperative suspicion may be increased based on radiographic findings of an enlarged tubular/cystic structure with adjacent normal ovary. Conservative management is controversial but could be preferred in order to provide the best option for future fertility of these girls. TYPE OF STUDY Treatment Study (Retrospective Study) - Level IV.
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Affiliation(s)
- Mirko Bertozzi
- Pediatric Surgery Unit- University of Perugia - Azienda Ospedaliera di Perugia - S. Maria della Misericordia Hospital -, Perugia, - Italy.
| | - Carmine Noviello
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnica delle Marche University, Ancona, Italy
| | - Francesco Molinaro
- Pediatric Surgery Unit, Department of Medical Science, Surgery and Neuroscience, University of Siena -, Siena, - Italy
| | - Alberto Ratta
- Pediatric Surgery Unit - Infermi Hospital -, Rimini, - Italy
| | - Gabriele Lisi
- Pediatric Surgery Department - G. D'Annunzio University of Chieti - Pescara -, Chieti, - Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnica delle Marche University, Ancona, Italy
| | | | - Pierluigi Lelli Chiesa
- Pediatric Surgery Department - G. D'Annunzio University of Chieti - Pescara -, Chieti, - Italy
| | - Ascanio Martino
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnica delle Marche University, Ancona, Italy
| | - Mario Messina
- Pediatric Surgery Unit, Department of Medical Science, Surgery and Neuroscience, University of Siena -, Siena, - Italy
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Volodarsky-Perel A, Buckett W, Tulandi T. Treatment of hydrosalpinx in relation to IVF outcome: a systematic review and meta-analysis. Reprod Biomed Online 2019; 39:413-432. [PMID: 31324437 DOI: 10.1016/j.rbmo.2019.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/21/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
Salpingectomy is the most widely used treatment for hydrosalpinx. The effect of salpingectomy on the stimulation response during subsequent IVF treatment, however, remains unclear. The aim of this systematic review was to evaluate the ovarian response and pregnancy outcome of IVF treatment carried out after salpingectomy compared with other pre-IVF treatment options for hydrosalpinx. We conducted a literature search using PubMed, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. Five randomized studies and nine observational studies were included in the systematic review and evaluated using Cochrane Collaboration's tool for randomized, Newcastle-Ottawa scale for observational studies and GRADE guidelines for certainty of evidence assessment. The mean number of retrieved oocytes was similar between the groups in randomized (mean difference [MD] = -0.03, 95% CI -0.75 to 0.70) and observational studies (MD = -0.15, 95% CI -2.32 to 2.02). Live birth (RR 1.59, 95% CI 1.17 to 2.16), clinical pregnancy (RR 1.27, 95% CI 1.02 to 1.57) and implantation rates (RR 1.55, 95% CI 1.16 to 2.08) were higher in the salpingectomy group in randomized studies. The present systematic review and meta-analysis showed that salpingectomy does not impair the ovarian response during subsequent IVF treatment.
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Affiliation(s)
- Alexander Volodarsky-Perel
- Department of Obstetrics and Gynecology, McGill University Health Centre, 1001 Decarie Blvd, Montreal QC, H4A 3J1, Canada.
| | - William Buckett
- Department of Obstetrics and Gynecology, McGill University Health Centre, 1001 Decarie Blvd, Montreal QC, H4A 3J1, Canada
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University Health Centre, 1001 Decarie Blvd, Montreal QC, H4A 3J1, Canada
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20
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Katz SI, Ramchandani P, Torigian DA, Siegelman ES. Hydrosalpinx in patients with hysterectomy without salpingo-oophorectomy referred for pelvic magnetic resonance imaging. Clin Imaging 2019; 55:95-99. [PMID: 30798017 DOI: 10.1016/j.clinimag.2018.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/11/2018] [Accepted: 12/27/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Women with ovarian-sparing hysterectomy before 2007 are more likely to have retained Fallopian tube remnants which can become fluid-filled, distended masses, potentially mistaken for a cystic adnexal neoplasm on imaging. Here we assess the prevalence and appearance of hydrosalpinx in women with ovarian-sparing hysterectomy prior to 2007 referred for pelvic MRI. METHODS A total of 3044 consecutive pelvic MRI exams performed over a two-year period (2003-2004) were selected from our radiology database and retrospectively reviewed. Examinations performed on male patients (N = 858), duplicate examinations on the same patient (N = 675) and examinations performed for MR guided biopsy (N = 1) were excluded from the study. From the remaining female pelvic MRI examinations (N = 1510), patients with hysterectomy without oophorectomy were identified. The frequency of hydrosalpinx in this population was then determined visually by two experienced radiologists and kappa analysis was then performed to assess for interobserver agreement. RESULTS Of the 3044 pelvic MRI examinations, 1510 were performed on females and 76 (5%) of these women had ovarian-sparing hysterectomy. Of these 76 women, 14 patients (18%) had hydrosalpinx (kappa = 0.8) of which 11 were unilateral and 3 bilateral. A total of 9 of the 14 cases positive for hydrosalpinx in patients with ovarian-sparing hysterectomy were referred to MRI for evaluation of cystic adnexal masses detected on other modalities. CONCLUSION Hydrosalpinx should be considered in the differential diagnosis of cystic adnexal lesions in women with prior hysterectomy and retained ovaries.
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Affiliation(s)
- Sharyn I Katz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America.
| | - Parvati Ramchandani
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Drew A Torigian
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
| | - Evan S Siegelman
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America
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Ng KYB, Cheong Y. Hydrosalpinx - Salpingostomy, salpingectomy or tubal occlusion. Best Pract Res Clin Obstet Gynaecol 2019; 59:41-47. [PMID: 30824209 DOI: 10.1016/j.bpobgyn.2019.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
Abstract
Tubal factors account for approximately 25% of cases of infertility, and the most severe manifestation of tubal disease is hydrosalpinx, accounting for 10-30% of tubal diseases. Hydrosalpinx is a distension or dilatation of the fallopian tube in the presence of a distal tubal occlusion, and the most common cause is pelvic inflammatory disease. Women with hydrosalpinges have lower implantation and pregnancy rates in assisted reproductive technology (ART), due to a combination of mechanical and chemical factors thought to disrupt the endometrial environment. Current guidance is removal of the tube by salpingectomy (preferably laparoscopically) before IVF treatment. Salpingostomy, or distal tubal plastic surgery in the management of hydrosalpinx, is an alternative for women desiring natural conception, although ectopic pregnancy rates as high as 10% have been reported. Proximal tubal occlusion with Essure® devices placed hysteroscopically can be considered particularly in cases of distorted pelvic anatomy or pelvic adhesions making abdominal surgery complex. However, low clinical pregnancy and live birth rates have been reported with the use of these devices before IVF. In this review, we discuss salpingostomy, salpingectomy and tubal occlusion as possible management options for the reproductive women with hydrosalpinx.
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Affiliation(s)
- Ka Ying Bonnie Ng
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK; Department of Obstetrics and Gynaecology, Princess Anne Hospital, Level F, Coxford Road, Southampton, SO16 5YA, UK.
| | - Ying Cheong
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK; Department of Obstetrics and Gynaecology, Princess Anne Hospital, Level F, Coxford Road, Southampton, SO16 5YA, UK
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22
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Garrido-Marín M, Argacha PM, Fernández L, Molfino F, Martínez-Soler F, Tortosa A, Gimenez-Bonafé P. Full-term pregnancy in breast cancer survivor with fertility preservation: A case report and review of literature. World J Clin Cases 2019; 7:58-68. [PMID: 30637253 PMCID: PMC6327133 DOI: 10.12998/wjcc.v7.i1.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/20/2018] [Accepted: 12/01/2018] [Indexed: 02/05/2023] Open
Abstract
A 43-year-old woman with an associated history of gynecological pathology and breast cancer with only one cryopreserved embryo wished to be a mother. Several factors that influenced the success of the pregnancy in this case were analyzed. Favorable factors included: triple positive breast cancer [positive hormone receptors and positive human epidermal growth factor receptor 2], which is more hormosensitive and chemosensitive; absence of metastasis; correct endometrium preparation; and the patient’s optimistic attitude and strict health habits. In contrast, the factors against success were: breast cancer; adjuvant breast cancer therapy gonadotoxicity; the age of the patient (> 40-year-old); endometriosis; ovarian cyst; hydrosalpinx; submucosal fibroids and the respective associated surgery done for the above-mentioned pathology (all resolved prior to the embryo transfer); and a low quantity of ovules (low ovarian reserve) after ovarian stimulation. This is a very special clinical case of a patient with theoretically low pregnancy success probability due to the consecutive accumulation of gynecological and oncological pathologies, who nonetheless became pregnant and delivered a full-term infant and was able to provide adequate breastfeeding.
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Affiliation(s)
- Marta Garrido-Marín
- Department of Physiological Sciences, Physiology Unit, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, IDIBELL, L’Hospitalet del Llobregat, Barcelona 08907, Spain
| | | | - Luís Fernández
- Servicio de Oncología Médica, Consorcio Corporación Sanitaria Parc Taulí, Barcelona, Sabadell 08208, Spain
| | | | - Fina Martínez-Soler
- Department of Basic Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, IDIBELL, L’Hospitalet del Llobregat, Barcelona 08907, Spain
| | - Avelina Tortosa
- Department of Basic Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, IDIBELL, L’Hospitalet del Llobregat, Barcelona 08907, Spain
| | - Pepita Gimenez-Bonafé
- Department of Physiological Sciences, Physiology Unit, Faculty of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, IDIBELL, L’Hospitalet del Llobregat, Barcelona 08907, Spain
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Vignarajan CP, Malhotra N, Singh N. Ovarian Reserve and Assisted Reproductive Technique Outcomes After Laparoscopic Proximal Tubal Occlusion or Salpingectomy in Women with Hydrosalpinx Undergoing in Vitro Fertilization: A Randomized Controlled Trial. J Minim Invasive Gynecol 2019; 26:1070-5. [PMID: 30366115 DOI: 10.1016/j.jmig.2018.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To evaluate the outcomes of assisted reproductive technology (ART) after proximal tubal occlusion (PTO) or salpingectomy in patients with hydrosalpinx undergoing in vitro fertilization-embryo transfer (IVF-ET). DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING All India Institute of Medical Sciences, New Delhi, India. PATIENTS A total of 165 patients were randomized and subsequently allocated to a PTO group (n = 83) or a salpingectomy group (n = 82). INTERVENTIONS PTO and salpingectomy. MEASUREMENTS AND MAIN RESULTS Following surgery, compared with the PTO group, the salpingectomy group showed significant decreases in the ovarian reserve parameters serum anti-Müllerian hormone (AMH; 3.7 ng/mL vs 2.6 ng/mL; p ˂ .001) and antral follicle count (AFC; 10.6 vs 8.6; p ˂ .001). The salpingectomy group also required a significantly higher dose of gonadotropins (3901 vs 3260; p ˂ .001) and more days of stimulation (11.3 vs 10.2; p ˂ .001) compared with the PTO group. The salpingectomy group had a significantly lower fertilization rate (0.74 vs 0.83; p ˂ .001) and a lower number of grade 1 embryos (4.1 vs 5.6; p = .02); however, there was no significant difference between the 2 groups with respect to rates of implantation (22.8% vs 23.7%; p = .87), clinical pregnancy (26.3% vs 33.7%, p = .25), live birth (27.5% vs 32.5%; p = .42), and miscarriage (4.7% vs 3.5%; p = .90) CONCLUSIONS: PTO is a superior to salpingectomy for the surgical management of patients with hydrosalpinx undergoing IVF-ET in terms of ovarian reserve. However, the 2 surgical techniques are associated with comparable pregnancy rates.
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24
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Palazón P, Saura L, de Haro I, Martín-Solé O, Albert A, Tarrado X, Julià V. Bilateral hydrosalpinx in patients with Hirschsprung's disease. J Pediatr Surg 2018; 53:1945-1950. [PMID: 29467083 DOI: 10.1016/j.jpedsurg.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/30/2017] [Accepted: 01/09/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Hirschsprung's disease (HD) is uncommon in females. There are very few reports on the patients' obstetric and gynecological outcome. Hydrosalpinx causes pain and infertility. It is rare in nonsexually active teenagers. It may be because of an intrinsic disease of the fallopian tubes or secondary to surgery. AIM to describe the relationship between hydrosalpinx and HD or its surgical approach; to report the impact of bilateral hydrosalpinx on fertility in HD. METHODS The records of all females with HD since 1980 were reviewed. Only patients who reached menarche were included. Prevalence of hydrosalpinx and hydrosalpinx-free survival were compared after abdominoperineal (A) or transanal (T) surgery. Treatment for hydrosalpinx was reviewed. RESULTS Seventeen out of 27 patients had reached menarche (Group A: 13 patients; Group T: 4 patients). Five patients in group A and none in group T presented bilateral hydrosalpinx (p=0.261). There were no statistical differences in hydrosalpinx-free survival between groups (p=0.344). Hydrosalpinx treatment: two bilateral and one unilateral salpingectomy, one pyosalpinx evacuation and one untreated. Three patients had conception desire: one has children; two are on IVF program. CONCLUSION An association between hydrosalpinx and HD was observed. The development of hydrosalpinx was not associated with surgical approach in our study. Females with HD should have a gynecological follow-up for the development of hydrosalpinx, which can impair fertility. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Pedro Palazón
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Laura Saura
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Irene de Haro
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Oriol Martín-Solé
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Asteria Albert
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Xavier Tarrado
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Victoria Julià
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
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Wu YC, Huang XF, Yang HY, Chen X, Wang PY, Hu Y, Lin F. Fibered platinum coil: A novel option for the patients of hydrosalpinx with laparoscopic contradiction. Eur J Obstet Gynecol Reprod Biol 2018; 229:179-184. [PMID: 30205314 DOI: 10.1016/j.ejogrb.2018.08.579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/31/2018] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the feasibility of proximal tubal occlusion with fibered platinum coils in subfertile women with hydrosalpinx, and to observe the clinical outcomes of subsequent treatment with in vitro fertilization and embryo transfer (IVF-ET). STUDY DESIGN A prospective study was carried out in a university-affiliated teaching hospital. 56 women with uni- or bilateral hydrosalpinx received fibered platinum coil placement before IVF-ET. The clinical pregnancy rate and live birth rate was evaluated. Data analysis was performed with SPSS version 22.0 (SPSS, Inc., Chicago, IL, USA), using two-sided test, and a p value < 0.05 was considered statistically significant. The study has been registered in the ClinicalTrials. gov with the number of NCT03395301. RESULT(S) Successful placement was achieved in 106 fallopian tubes of 55 patients. The fibered platinum coils induced complete proximal occlusion in 52 out of 55 patients in the following 3-month HSG examination. In the 52 patients, 44 patients received following IVF-ET. The clinical pregnancy rate reached 60.5%(23/38)and live birth rate reached 60.87% (14/23) in patients less than 40 years old. CONCLUSION(S) Fibered platinum coil is a new, safe and valuable device for hysteroscopic tubal proximal occlusion in subfertile women with hydrosalpinx but with laparoscopic contradictions to improve the reproductive outcomes of IVF-ET. Capsule: Fibered platinum coil is a new, safe and valuable device for hysteroscopic tubal proximal occlusion in subfertile women with hydrosalpinx to improve the reproductive outcomes of in vitro fertilization and embryo transfer.
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Affiliation(s)
- Yan-Cheng Wu
- The Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, PR China
| | - Xue-Feng Huang
- Reproductive Medicine Center, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, PR China
| | - Hai-Yan Yang
- Reproductive Medicine Center, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, PR China
| | - Xia Chen
- Reproductive Medicine Center, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, PR China
| | - Pei-Yu Wang
- Reproductive Medicine Center, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, PR China
| | - Yan Hu
- The Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, PR China.
| | - Feng Lin
- The Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Zhejiang, Wenzhou, 325000, PR China.
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Baradwan S, Baradwan A, Baradwan A, Al-Jaroudi D. Hydrosalpinx with acute abdominal pain during the third trimester of pregnancy: A case report. Case Rep Womens Health 2018; 20:e00077. [PMID: 30225201 DOI: 10.1016/j.crwh.2018.e00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/01/2018] [Accepted: 09/07/2018] [Indexed: 11/21/2022] Open
Abstract
Background Acute abdomen in pregnancy is a unique clinical challenge. We report a rare case of hydrosalpinx presenting as acute abdomen in the third trimester of pregnancy in the absence of infection and hormonal treatment. Case A 38-year-old Caucasian woman (gravida 4, para 3), at an estimated 29 weeks of a spontaneous singleton pregnancy, presented to the emergency department with severe abdominal pain in the right lower quadrant, which had been present for three days. Magnetic resonance imaging (MRI) demonstrated a right-sided hydrosalpinx. It was successfully treated with conservative treatment and the patient delivered vaginally at term without complication. Conclusion Hydrosalpinx should be considered as one of the differential diagnoses for acute abdomen during pregnancy. A multidisciplinary approach is recommended, with a careful work-up, due to the risks to both fetus and mother.
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Yu X, Cai H, Zheng X, Feng J, Guan J. Tubal restorative surgery for hydrosalpinges in women due to in vitro fertilization. Arch Gynecol Obstet 2018; 297:1169-73. [PMID: 29445925 DOI: 10.1007/s00404-018-4695-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study was carried out to clarify the IVF outcome after laparoscopic neosalpingostomy for infertile patients affected by hydrosalpinx stage III. MATERIALS AND METHODS From January 2010 to June 2015, 91 subjects of hydrosalpinx stage III were treated in out center by laparoscopic surgery before IVF cycle. 43 underwent neosalpingostomy (group 1) and the remaining 48 underwent salpingestomy (group 2). We compared these patients and their IVF outcomes after two different surgical techniques. RESULTS There were no significant differences between the two groups, except a higher number of patients with bilaterial hydrosalpinges was noted in the neosalpingostomy group (79.1% vs. 56.3%, respectively). 25 patients with neosalpingostomy and 29 with salpingectomy achieved pregnancy by IVF. The ongoing pregnancy rate per cycle in group 1 and group 2 was 51.1 and 47.2%, respectively. Two cases of ampullary ectopic pregnancies were noted in group 1 and one case of right tube interstitial pregnancy in group 2. No significant difference was observed in live birth rate between the groups (48.9% vs. 45.3%, respectively). CONCLUSIONS The outcomes of IVF after neosalpingostomy were matchable with salpingectomy. For patients desire to preserve fallopian tubes, we recommend laparoscopic neosalpingostomy as an alternative choice to manage moderate hydrosalpinx before IVF.
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Maia ALRS, Brandão FZ, Souza-Fabjan JMG, Veiga MO, Balaro MFA, Facó O, Fonseca JF. Transrectal ultrasound evaluation in tropical dairy goats: an indispensable tool for the diagnosis of reproductive disorders. Trop Anim Health Prod 2017; 50:787-792. [PMID: 29264820 DOI: 10.1007/s11250-017-1496-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/07/2017] [Indexed: 11/25/2022]
Abstract
In Brazil, great milk productivity was achieved after the implementation of a genetic improvement program. However, reproductive efficiency is still far from optimal, possibly due to the high number of undiagnosed disorders that may affect fertility. The aim of this study was to evaluate occurrences of the main reproductive disorders in dairy goats in southeastern Brazil. Data were collected between January 2015 and May 2017 from 23 commercial herds of different breeds, with goats ranging from 8 months to 12 years of age. Transrectal ultrasound exams were performed in 2680 goats. A total of 14.8% of the does showed a disorder in the reproductive tract: hydrometra (10.0%), ovarian follicular cysts (2.3%), gestational loss (1.5%), and hydrosalpinx (1.1%). This was the first study evaluating reproductive disorders in live animals that used a high number of Brazilian dairy goats. Considering that all these diseases affect fertility to different degrees, the performance of transrectal ultrasonography exams twice a year is strongly suggested, in order to guide precocious treatment or discard the animal as soon as possible, thus reducing economic losses in dairy goat farming.
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Affiliation(s)
- A L R S Maia
- Faculdade de Veterinária, Universidade Federal Fluminense, Av. Vital Brazil Filho, 64, Niterói, RJ, CEP 24230-340, Brazil.
| | - F Z Brandão
- Faculdade de Veterinária, Universidade Federal Fluminense, Av. Vital Brazil Filho, 64, Niterói, RJ, CEP 24230-340, Brazil
| | - J M G Souza-Fabjan
- Faculdade de Veterinária, Universidade Federal Fluminense, Av. Vital Brazil Filho, 64, Niterói, RJ, CEP 24230-340, Brazil
| | - M O Veiga
- Departamento de Medicina Veterinária, Universidade Federal de Lavras, Av. Doutor Sylvio Menicucci, 1001, Lavras, MG, CEP 37200-000, Brazil
| | - M F A Balaro
- Faculdade de Veterinária, Universidade Federal Fluminense, Av. Vital Brazil Filho, 64, Niterói, RJ, CEP 24230-340, Brazil
| | - O Facó
- Embrapa Caprinos e Ovinos, Estrada Sobral/Groaíras, km 04, CP 145, Sobral, CE, CEP 62010-970, Brazil
| | - J F Fonseca
- Embrapa Caprinos e Ovinos, Estrada Sobral/Groaíras, km 04, CP 145, Sobral, CE, CEP 62010-970, Brazil
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Sun X, Tian Q, Wang L, Xue M, Zhong G. IL-6-mediated signaling pathways limit Chlamydia muridarum infection and exacerbate its pathogenicity in the mouse genital tract. Microbes Infect 2017; 19:536-545. [PMID: 28864426 PMCID: PMC6034988 DOI: 10.1016/j.micinf.2017.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/29/2017] [Accepted: 08/18/2017] [Indexed: 12/19/2022]
Abstract
Chlamydia muridarum induction of mouse hydrosalpinx, depending on both tubal infection and inflammation, has been used for investigating Chlamydia trachomatis pathogenesis. We now report that IL-6 both inhibits C. muridarum infection and exacerbates pathogenicity in the mouse genital tract. When intravaginally inoculated with a high dose of C. muridarum, IL-6-deficient mice developed more extensive genital tract infection with severe hydrosalpinx, suggesting that IL-6 is required for controlling the high dose infection but not essential for C. muridarum-induced pathology. However, at a low dose, IL-6-deficient mice still developed more extensive infection in the genital tract but no longer with significant pathology, suggesting that IL-6 is required for both controlling the low dose infection and exacerbating the low dose infection-induced pathology. The lack of hydrosalpinx in IL-6-deficient mice correlated with significantly reduced inflammatory infiltration in the oviduct tissue and decreased spleen CD4+ and CD8+ T cells that produce TNFα. Thus, IL-6-dependent pathways are important for both limiting chlamydial colonization in the genital tract mucosal tissues regardless of the infection doses and exacerbating chlamydial pathogenicity in the upper genital tract when IL-6-independent pathogenic mechanisms are not yet activated with a low infection dose.
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Affiliation(s)
- Xin Sun
- Department of Obstetrics and Gynecology, 3rd Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China; Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Qi Tian
- Department of Obstetrics and Gynecology, 3rd Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China; Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Luying Wang
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Min Xue
- Department of Obstetrics and Gynecology, 3rd Xiangya Hospital, Central South University, Changsha, Hunan 410008, PR China.
| | - Guangming Zhong
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Bertozzi M, Magrini E, Riccioni S, Giovenali P, Appignani A. Isolated fallopian tube torsion with hydrosalpinx: Review of a debated management in a pediatric population. J Pediatr Surg 2017; 52:1553-1560. [PMID: 28735977 DOI: 10.1016/j.jpedsurg.2017.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/07/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To quantify our experience with and assess the literature on diagnosis and management of isolated fallopian tube torsion (IFTT) with hydrosalpinx (HSX) in children. METHODS A PubMed search was performed on pediatric cases of IFTT with HSX to provide a comprehensive review analyzing details and management of this association, focusing on the problem of fertility preservation. RESULTS In addition to our 3 cases, 17 patients of pediatric IFTT associated with HSX were identified, for a total of 21 cases (median age 12.2 years). Menarchal status was present in 10/13 (76.9%); blood tests were reported in 9/20 (42%) showing leucocytosis in 7/9 (75%). Ultrasonography was performed in all cases except one. Laparoscopy was the surgical approach in 84.6% of the reported cases. The torsion was to the right in 36.8%, and to the left in 63.2% of the cases. In one case the torsion was bilateral and asynchronous. Performed procedures were salpingectomy (52.4%) and partial salpingectomy (14.3%); conservative management was reported in 33.3% of the cases. CONCLUSIONS The literature describes different management techniques. Salpingectomy is the most frequently performed procedure but recently conservative management seems to be increasingly applied. A long-term study is necessary to define the most effective treatment for the preservation of future fertility in pediatric patients. TYPE OF STUDY Treatment study (Retrospective Study): LEVEL IV.
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Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy.
| | - Elisa Magrini
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Sara Riccioni
- Sezione di Radiologia, Dipartimento di Scienze Chirurgiche, Radiologiche ed Odontostomatologiche, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Paolo Giovenali
- S.S. Dipartimentale Citologia ed Istologia Diagnostica, S. Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
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Noventa M, Gizzo S, Saccardi C, Borgato S, Vitagliano A, Quaranta M, Litta P, Gangemi M, Ambrosini G, D'Antona D, Palomba S. Salpingectomy before assisted reproductive technologies: a systematic literature review. J Ovarian Res 2016; 9:74. [PMID: 27809927 PMCID: PMC5094031 DOI: 10.1186/s13048-016-0284-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/19/2016] [Indexed: 11/26/2022] Open
Abstract
Salpingectomy is largely used in case of hydrosalpinx in infertile women scheduled for assisted reproductive technologies (ART), whereas there is no consensus on its role in absence of hydrosalpinx. The current is a systematic literature review to collate all available evidence regarding salpingectomy as fertility enhancement procedure before ART in infertile patients. Our primary endpoint was to assess the impact of the surgical procedure on ovarian reserve, and secondary outcomes were to evaluate its benefits and harms on ART outcomes. We identified 29 papers of which 16 reporting data on the impact of tubal surgery on ovarian reserve and 24 (11 previously included) on ART outcomes. Available data suggested an absence of variation in ovarian reserve markers after unilateral salpingectomy while contradictory results were reported for bilateral surgery. Considering ART outcomes, data reported a significant improvement in ongoing pregnancy/live-birth rate in treated subjects without significant reduction in ovarian response to gonadotropin stimulation. In case of tubal disease, a surgical approach based on unilateral salpingectomy may be considered safe, without negative effects on ovarian reserve and ovarian response to controlled ovarian stimulation whilst having a positive effect on pregnancy rate. Data regarding bilateral salpingectomy and ovarian reserve are conflicting. Further trials are needed to confirm both the benefits of salpingectomy before ART and the safety of bilateral salpingectomy on ovarian reserve, and to clarify the role of uni- or bilateral surgery in case of tubal blockage without hydrosalpinx.
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Affiliation(s)
- Marco Noventa
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Carlo Saccardi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Shara Borgato
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | - Michela Quaranta
- Department of Obstetrics and Gynecology, NHS Trust - Northampton General Hospital, Northampton, United Kingdom
| | - Pietro Litta
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Michele Gangemi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Guido Ambrosini
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Donato D'Antona
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Stefano Palomba
- Unit of Reproductive Surgery and Medicine, ASMN-IRCCS of Reggio Emilia, Reggio Emilia, Italy.
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Bulir DC, Liang S, Lee A, Chong S, Simms E, Stone C, Kaushic C, Ashkar A, Mahony JB. Immunization with chlamydial type III secretion antigens reduces vaginal shedding and prevents fallopian tube pathology following live C. muridarum challenge. Vaccine 2016; 34:3979-85. [PMID: 27325352 DOI: 10.1016/j.vaccine.2016.06.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/25/2016] [Accepted: 06/14/2016] [Indexed: 11/26/2022]
Abstract
Chlamydia trachomatis infections in women are often asymptomatic and if left untreated can lead to significant late sequelae including pelvic inflammatory disease and tubal factor infertility. Vaccine development efforts over the past three decades have been unproductive and there is no vaccine approved for use in humans. The existence of serologically distinct strains or serovars of C. trachomatis mandates a vaccine that will provide protection against multiple serovars. Chlamydia spp. use a highly conserved type III secretion system (T3SS) composed of both structural and effector proteins which is an essential virulence factor for infection and intracellular replication. In this study we evaluated a novel fusion protein antigen (BD584) which consists of three T3SS proteins from C. trachomatis (CopB, CopD, and CT584) as a potential chlamydial vaccine candidate. Intranasal immunization with BD584 elicited serum neutralizing antibodies that inhibited C. trachomatis infection in vitro. Following intravaginal challenge with C. muridarum, immunized mice had a 95% reduction in chlamydial shedding from the vagina at the peak of infection and cleared the infection sooner than control mice. Immunization with BD584 also reduced the rate of hydrosalpinx by 87.5% compared to control mice. Together, these results suggest that highly conserved proteins of the chlamydial T3SS may represent good candidates for a Chlamydia vaccine.
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Affiliation(s)
- David C Bulir
- M. G. DeGroote Institute for Infectious Disease Research, Canada; St. Joseph's Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Steven Liang
- M. G. DeGroote Institute for Infectious Disease Research, Canada; St. Joseph's Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Amanda Lee
- St. Joseph's Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Sylvia Chong
- St. Joseph's Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Elizabeth Simms
- St. Joseph's Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Christopher Stone
- St. Joseph's Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Charu Kaushic
- M. G. DeGroote Institute for Infectious Disease Research, Canada; Department of Pathology and Molecular Medicine, McMaster University, Canada
| | - Ali Ashkar
- M. G. DeGroote Institute for Infectious Disease Research, Canada; Department of Pathology and Molecular Medicine, McMaster University, Canada
| | - James B Mahony
- M. G. DeGroote Institute for Infectious Disease Research, Canada; Department of Pathology and Molecular Medicine, McMaster University, Canada; St. Joseph's Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
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El-Mazny A, Ramadan W, Kamel A, Gad-Allah S. Effect of hydrosalpinx on uterine and ovarian hemodynamics in women with tubal factor infertility. Eur J Obstet Gynecol Reprod Biol 2016; 199:55-9. [PMID: 26897399 DOI: 10.1016/j.ejogrb.2016.01.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/01/2016] [Accepted: 01/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of hydrosalpinx on uterine and ovarian blood flows in women with tubal factor infertility. STUDY DESIGN In a cross-sectional study at a university teaching hospital, 60 women with hydrosalpinx-related tubal infertility (hydrosalpinx group) were compared with 60 women with male or unexplained infertility (non-hydrosalpinx group). In the mid-luteal (peri-implantation) phase of the cycle, endometrial thickness, uterine and ovarian artery pulsatility index (PI) and resistance index (RI), and endometrial and ovarian volume and 3D power Doppler vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured in both groups. RESULTS The endometrial VI (p=0.002), FI (p=0.041), and VFI (p=0.018), and ovarian VI (p=0.011), and VFI (p=0.015) were significantly lower in the hydrosalpinx group than in the non-hydrosalpinx group. However, the endometrial thickness, uterine artery PI and RI, ovarian artery PI and RI, endometrial volume, and ovarian volume and FI were not significantly different between the two groups. CONCLUSION Hydrosalpinx is associated with impaired endometrial and ovarian blood flows which may adversely affect endometrial receptivity and oocyte quality.
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Affiliation(s)
- Akmal El-Mazny
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt.
| | - Wafaa Ramadan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Kamel
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt
| | - Sherine Gad-Allah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt
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34
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Nohuz E. [How I do... the aspiration of an adnexal cyst without iterative needle punctures neither irrigation-aspiration device during a laparoscopy]. ACTA ACUST UNITED AC 2015; 44:63-6. [PMID: 26701109 DOI: 10.1016/j.gyobfe.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Indexed: 10/22/2022]
Affiliation(s)
- E Nohuz
- Service de gynécologie-obstétrique, centre hospitalier de Thiers, route du Fau, 63300 Thiers, France; EA 4681, PEPRADE, Clermont université, université d'Auvergne, 63000 Clermont-Ferrand, France.
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35
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Dai J, Tang L, Chen J, Yu P, Chen Z, Zhong G. The p47phox deficiency significantly attenuates the pathogenicity of Chlamydia muridarum in the mouse oviduct but not uterine tissues. Microbes Infect 2015; 18:190-8. [PMID: 26645958 DOI: 10.1016/j.micinf.2015.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/07/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022]
Abstract
The Chlamydia muridarum induction of the upper genital tract pathology in mice has been used to investigate the mechanisms of chlamydial pathogenesis. We report that the NCF1 (neutrophil cytosolic factor1)-encoded p47phox (phagocyte oxidase), an essential subunit of nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase, contributes significantly to C. muridarum induction of hydrosalpinx. Mice lacking p47phox (p47phox-deficient) were no longer able to develop significant hydrosalpinx following an intravaginal infection with C. muridarum. However, there was no significant difference in uterine horn dilation (as a result of the endometrial glandular duct dilation) between the p47phox-deficient and -sufficient mice. Thus, the role of NADPH oxidase in chlamydial pathogenesis is restricted to the oviduct tissue rather than the entire upper genital tract. Interestingly, both the p47phox-deficient and -sufficient mice displayed similar levels of chlamydial live organism shedding from the lower genital tract, suggesting that the NADPH oxidase is not required for the mouse control of chlamydial infection in the lower genital tract. Furthermore, the p47phox deficiency did not affect the infectious organism burden in the upper genital tract tissues, indicating that the NADPH-oxidase activity is not necessary for the mouse prevention of chlamydial ascension from the lower to upper genital tracts. However, the p47phox-defieicnt mice displayed a significantly reduced chronic inflammatory infiltration in the oviduct but not uterine tissues, supporting the finding that the NADPH oxidase activity is required for chlamydial induction of dilation in the oviduct but not the endometrial glandular duct. Thus, we have demonstrated a significant role of the host NADPH oxidase in promoting chronic inflammatory pathology in the oviduct following chlamydial infection.
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Affiliation(s)
- Jin Dai
- College of Life Sciences, Hunan Normal University, 36 Lushan Rd., Changsha 410081, Hunan Province, PR China; Department of Microbiology and Immunology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Lingli Tang
- Second Xiangya Hospital, No. 139 Renmin Rd., Changsha 410011, Hunan Province, PR China
| | - Jianlin Chen
- Second Xiangya Hospital, No. 139 Renmin Rd., Changsha 410011, Hunan Province, PR China
| | - Ping Yu
- Xiangya School of Medicine, Central South University, 88 Xiangya Rd., Changsha 410008, Hunan Province, PR China
| | - Ze Chen
- College of Life Sciences, Hunan Normal University, 36 Lushan Rd., Changsha 410081, Hunan Province, PR China.
| | - Guangming Zhong
- Department of Microbiology and Immunology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Liu S, Shi L, Shi J. Impact of endometrial cavity fluid on assisted reproductive technology outcomes. Int J Gynaecol Obstet 2015; 132:278-83. [PMID: 26792140 DOI: 10.1016/j.ijgo.2015.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 07/12/2015] [Accepted: 11/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of endometrial cavity fluid (ECF) on assisted reproductive technology (ART) outcomes has not been evaluated in a meta-analysis. OBJECTIVES To evaluate the impact of ECF on the outcome of ART cycles. SEARCH STRATEGY PubMed, China Academic Journals Full-text Database, and China Doctoral/Masters Dissertations Full-text Databases were searched for reports published in any language before January 1, 2015, using relevant keywords. SELECTION CRITERIA Studies were included if they compared the outcome of ART in women with and without ECF. DATA COLLECTION AND ANALYSIS Background information, participants' characteristics, and study outcomes were recorded. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method. MAIN RESULTS Six studies evaluating 5928 ART cycles were included. The pregnancy rate was significantly lower in the group with ECF than in the group without ECF (OR 0.74, 95% CI 0.55-0.98; P=0.03). The same association was observed if the analysis included only patients with hydrosalpinx (OR 0.36, 95% CI 0.15-0.86; P=0.02). CONCLUSIONS The clinical pregnancy rate after ART is significantly lower among patients with ECF than among those without ECF. In addition, if ECF is found in patients with hydrosalpinx, ART cycles should be cancelled after oocyte retrieval.
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Affiliation(s)
- Shan Liu
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Lin Shi
- Department of Immunology and Microbiology, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China.
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Limberg J, Ginsburg H, Lala S, Tomita S. Recurrent Pelvic Infections and Salpingitis after Perforated Appendicitis. J Pediatr Adolesc Gynecol 2015; 28:e177-8. [PMID: 26342348 DOI: 10.1016/j.jpag.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The effect of perforated appendicitis on the adnexa is an issue of concern and controversy. Long-term fertility studies have been conflicting. CASE We present the case of a patient with chronic pelvic infections, salpingitis, and hydrosalpinx after perforated appendicitis. SUMMARY AND CONCLUSION Magnetic resonance imaging was helpful in diagnosing a chronically obstructed fallopian tube, likely secondary to the dense adhesions from her previously treated perforated appendicitis. Salpingectomy relieved her symptoms of chronic pain and recurrent infections.
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Affiliation(s)
- Jessica Limberg
- Department of Surgery, Division of Pediatric Surgery, New York University Langone Medical Center, New York, New York
| | - Howard Ginsburg
- Department of Surgery, Division of Pediatric Surgery, New York University Langone Medical Center, New York, New York
| | - Shailee Lala
- Department of Radiology, Division of Pediatric Radiology, New York University Langone Medical Center, New York, New York
| | - Sandra Tomita
- Department of Surgery, Division of Pediatric Surgery, New York University Langone Medical Center, New York, New York.
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Cabral MDI, Siqueira LM. Hydrosalpinx in Postmenarchal Nonsexually Active Girls: A Review of 6 Cases in a Children's Hospital. J Pediatr Adolesc Gynecol 2015; 28:e203-7. [PMID: 26117410 DOI: 10.1016/j.jpag.2015.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objective of the study was to identify the presence of hydrosalpinx in postmenarchal nonsexually active girls in a children's hospital and to review the available literature on hydrosalpinx in this population. CASES In a tertiary care children's hospital, we performed a retrospective review of charts from January 1, 2000 to December 31, 2014 and identified six cases of hydrosalpinx in postmenarchal nonsexually active female adolescents ranging in age from 12 to 19 years old. The diagnosis of hydrosalpinx was made using imaging studies. Four of six patients were symptomatic at presentation, and two patients were diagnosed when seen for unrelated reasons. Five of these six girls had previous abdominopelvic surgery. Four girls were given empiric antibiotic treatment for presumed pelvic inflammatory disease related to hydrosalpinx. Two patients required surgical intervention that resulted in complete resolution of the hydrosalpinx. The oldest patient in the series underwent ultrasound-guided drainage of the pyo- and/or hydrosalpinx with subsequent recurrence with tubal ovarian abscess five months later. SUMMARY AND CONCLUSIONS The presence of hydrosalpinx might be discovered in the workup of pelvic pain in nonsexually active adolescents or on routine follow-up in patients with previous abdominal surgery, some of whom are asymptomatic. The underlying pathophysiology for hydrosalpinx in this population remains unclear. Among our cases, postsurgical adhesions appeared to be the most likely predisposing factor for tubular obstruction. Early detection and prompt diagnosis will allow for appropriate conservative or definitive treatment.
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Affiliation(s)
- Maria Demma I Cabral
- Division of Adolescent Medicine, Department of Pediatric Medicine, Nicklaus Children's Hospital, Miami Children's Health System, Miami, Florida.
| | - Lorena M Siqueira
- Division of Adolescent Medicine, Department of Pediatric Medicine, Nicklaus Children's Hospital, Miami Children's Health System, Miami, Florida
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Kazmi Z, Gupta S. Best practice in management of paediatric and adolescent hydrosalpinges: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 195:40-51. [PMID: 26476798 DOI: 10.1016/j.ejogrb.2015.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/17/2015] [Accepted: 09/25/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hydrosalpinx is a rare cause of abdominal pain in paediatric patients, though cases are documented in the literature. Its aetiology differs considerably from traditional hydrosalpinx due to ascending sexually transmitted infection. Hydrosalpinx can present mimicking an acute abdomen or can be asymptomatic. Management of paediatric hydrosalpinx varies, but often involves surgical removal of the affected tube. METHODS In June 2015, a literature search using relevant keywords was completed on MEDLINE and EMBASE databases to determine best management of paediatric hydrosalpinx. RESULTS We found 66 cases from 38 articles. Surgical intervention took place in 74% of cases (n=49). The most common surgical intervention was salpingectomy. In 3% of cases (n=2), nonsurgical medical management with hormonal therapy was utilized, with post-operative improvement in symptomology. In 23% of cases (n=15), conservative management was utilized: 2 of these cases torted, 4 cases persisted and 9 cases resolved. CONCLUSION Overall, the results of this review demonstrate that there are comparable outcomes between surgical, medical and conservative management. However, medical and conservative management was not often offered, and more research is needed on the subject.
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Affiliation(s)
- Zainab Kazmi
- University of Manchester School of Medicine, Stopford Building, Oxford Road, Manchester M13 9PT, United Kingdom.
| | - Sujata Gupta
- Women's Health Directorate, Royal Preston Hospital, Sharoe Green Lane North, Preston, Lancashire PR2 9HT, United Kingdom
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40
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Sills ES, Walsh DJ, Jones CA, Wood SH. Endometrial fluid associated with Essure implants placed before in vitro fertilization: Considerations for patient counseling and surgical management. Clin Exp Reprod Med 2015; 42:126-9. [PMID: 26473113 PMCID: PMC4604296 DOI: 10.5653/cerm.2015.42.3.126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/03/2015] [Accepted: 08/07/2015] [Indexed: 11/16/2022] Open
Abstract
Essure (Bayer) received approval from the U.S. Food and Drugs Administration as a permanent non-hormonal contraceptive implant in November 2002. While the use of Essure in the management of hydrosalpinx prior to in vitro fertilization (IVF) remains off-label, it has been used specifically for this purpose since at least 2007. Although most published reports on Essure placement before IVF have been reassuring, clinical experience remains limited, and no randomized studies have demonstrated the safety or efficacy of Essure in this context. In fact, no published guidelines deal with patient selection or counseling regarding the Essure procedure specifically in the context of IVF. Although Essure is an irreversible birth control option, some patients request the surgical removal of the implants for various reasons. While these patients could eventually undergo hysterectomy, at present no standardized technique exists for simple Essure removal with conservation of the uterus. This article emphasizes new aspects of the Essure procedure, as we describe the first known association between the placement of Essure implants and the subsequent development of fluid within the uterine cavity, which resolved after the surgical removal of both devices.
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Affiliation(s)
- E Scott Sills
- Reproductive Research Section, Center for Advanced Genetics, Carlsbad, CA, USA. ; Department of Molecular and Applied Biosciences, Faculty of Science and Technology, University of Westminster, London, UK
| | - David J Walsh
- Division of Reproductive Endocrinology, Sims IVF/The Sims Institute, Dublin, Ireland. ; Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Christopher A Jones
- Global Health Economics Unit, Vermont Center for Clinical and Translational Science, University of Vermont, College of Medicine, Burlington, VT, USA
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Botwe BO, Bamfo-Quaicoe K, Hunu E, Anim-Sampong S. Hysterosalpingographic findings among Ghanaian women undergoing infertility work-up: a study at the Korle-Bu Teaching Hospital. Fertil Res Pract 2015; 1:9. [PMID: 28620514 PMCID: PMC5424425 DOI: 10.1186/s40738-015-0001-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/14/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hysterosalpingography (HSG) is one of the commonly used radiological modalities for investigating infertility in women. In developing countries such as Ghana it remains the main tool for investigating some of the underlying causes of female infertility. The purpose of this study was to determine the predominance of various hysterosalpingographic results in patients that went through infertility work-up at the Korle-Bu Teaching Hospital between January 2011 and December, 2014. This is to help plan for preventive measures for the communities. RESULTS This study collected retrospectively, 1140 consecutive radiologic reports from January 2011 to December, 2014 from the Department of Radiology, Korle-Bu Teaching Hospital. These reports were reviewed and diagnoses made were evaluated with Microsoft Excel. Secondary infertility was 52.4 % prevalent and primary infertility was 41 % prevalent. While 453 (39.7 %) patients presented with normal findings, 153 (13.4 %) had hydrosalpinx, 498 (43.6 %) had tubal blockage, and 290 (25.4 %) had fibroids. Also there were 10 (0.9 %) cases of patulous cervices, 8 (0.8 %) cases of uterine synechiae, 62 (5.4 %) of irregular uterine outline, 15 (1.3 %) of irregular cervical outline, 3 (0.3 %) of arcuate uteri, and 5 (0.4 %) cases of retroverted uteri. CONCLUSION Tubal blockage which presented in 43.6 % of patients was the most common abnormal finding at HSG examinations carried out between January 2011 and December, 2014 at the KBTH. This was followed by fibroids with 25.4 % and hydrosalpinx with 13.4 %. Factors such as chronic pelvic inflammatory disease or pelvic infection following STIs, mismanaged pregnancies and septic abortions, may have accounted for this since the majority of the women presented with secondary infertility.
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Affiliation(s)
- Benard Ohene Botwe
- Department of Radiography, University Ghana School of Biomedical and Allied Health Sciences, College of Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
| | - Kwabena Bamfo-Quaicoe
- Department of Radiography, University Ghana School of Biomedical and Allied Health Sciences, College of Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
| | - Edem Hunu
- Department of Radiography, University Ghana School of Biomedical and Allied Health Sciences, College of Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
| | - Samuel Anim-Sampong
- Department of Radiography, University Ghana School of Biomedical and Allied Health Sciences, College of Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
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Bao HC, Wang MM, Wang XR, Wang WJ, Hao CF. Clinical application of operative hysteroscopy in treatment of complex hydrosalpinx prior to IVF. Iran J Reprod Med 2015. [PMID: 26221131 PMCID: PMC4515239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND In vitro fertilization and embryo transfer (IVF-ET) is the best option for patients with hydrosalpinx. However, if hydrosalpinges is not pre-treated, the therapeutic outcomes of IVF-ET would be compromised. OBJECTIVE This study aims to investigate the safety and effects of operative hysteroscopy in the treatment of patients with hydrosalpinx prior to IVF-ET, who were not indicated for laparotomy due to extensive pelvic adhesion. MATERIALS AND METHODS The study analyses retrospectively data from 10 women with hydrosalpinx, who were unable to undergo laparotomy due to extensive pelvic adhesion and treated by operative hysteroscopy prior to IVF-ET, and was assessed the effects and safety of the procedure. RESULTS Postoperative Hystero-salpingography demonstrated complete tubal occlusion of the diseased side in all cases. Being applied with IVF-ET for fertility after their hysteroscopy operation, 5 out of 10 patients acquired clinical pregnancy. CONCLUSION Hysteroscopic tubal occlusion of the proximal part of the hydrosalpinx can effectively prevent the hydrops backflow to endometrial cavity and benefit subsequent implantation in the course of assisted reproduction without significant complications.
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Cheng F, Li T, Wang QL, Zhou HL, Duan L, Cai X. Effects of hydrosalpinx on ultrasonographic parameters for endometrial receptivity during the window of implantation measured by power color Doppler ultrasound. Int J Clin Exp Med 2015; 8:6103-6108. [PMID: 26131211 PMCID: PMC4483946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/26/2015] [Indexed: 06/04/2023]
Abstract
AIM The aim of this study is to assess the effects of hydrosalpinx on ultrasonographic parameters for endometrial receptivity during the window of implantation, as measured by power color Doppler ultrasound. METHODS The women recruited to this study included sixty with unilateral or bilateral hydrosalpinx and fifty-seven prior to in vitro fertilization-embryo transfer (IVF-ET) or artificial insemination (AI) performed due to male infertility. Ultrasonographic parameters for endometrial receptivity were measured during the window of implantation by power color Doppler ultrasound. RESULTS The proportion of triple-line endometrial pattern and uterine contractions from the cervix to the fundus were significantly lower in the hydrosalpinx group than in the control group. In addition, patients in the hydrosalpinx group had a significantly lower pulsatility index (PI) of uterine spiral arteries. There were no significant differences in endometrial thickness, subendometrial blood flow distribution pattern, uterine artery PI, uterine artery resistance index (RI), or uterine spiral artery RI between the two groups. CONCLUSIONS Hydrosalpinx may be involved in the regulation of endometrial receptivity through its influence on endometrial pattern, uterine contractions, and PI of the uterine spiral arteries.
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Affiliation(s)
- Fang Cheng
- Reproductive Center, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
- Department of Obstetrics, Fifth Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Tao Li
- Department of Liver Transplantation and Laparoscope, Digestive-Vascular Surgical Center, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Qing-Li Wang
- Reproductive Center, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
| | - Hui-Li Zhou
- Department of Gynecology and Obstetrics Ultrasound, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, China
| | - Li Duan
- Department of Gynecology and Obstetrics Ultrasound, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, China
| | - Xia Cai
- Reproductive Center, First Affiliated Hospital, Xinjiang Medical UniversityUrumqi, Xinjiang, China
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Hata T, Kanenishi K, Mashima M, Nitta E, Mori N, Hanaoka U, Tanaka H. HDlive rendering image of adnexal tumors: preliminary report. J Med Ultrason (2001) 2014; 41:181-6. [PMID: 27277771 DOI: 10.1007/s10396-013-0489-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Our objective is to present our first experience of adnexal tumors reconstructed employing the HDlive rendering mode. METHODS Seven adnexal tumors (one case each of chocolate cyst, benign cystic teratoma, serous cystadenofibroma, and torsion of the hydrosalpinx, and three cases of ovarian cancer) were studied using the HDlive rendering mode. RESULTS In the case of the chocolate cyst, the smooth inner wall with numerous tiny projections was clearly identified. In the case of benign cystic teratoma, a smooth hair ball inside the cyst was evident. In the case of the serous cystadenofibroma, a smooth, solid projection and relatively smooth septum were noted. In the three cases of ovarian cancer, numerous irregular papillae and irregular, thick septae were depicted. In the case of the bilateral hydrosalpinx with torsion of the right tube, different fluid contents were recognized. CONCLUSION The HDlive rendering mode provides anatomically realistic features such as macroscopic specimens for physicians and pathologists due to the complete depiction of the inner surface of the adnexal tumors.
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Affiliation(s)
- Madhusudan Dey
- On Study Leave (Materno-Fetal Medicine), AIIMS, New Delhi, India
| | - Reema Kumar
- Classified Specialist (Obstetrics & Gynaecology), Military Hospital, Jalandhar Cantt, C/O 56 APO, India
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Zhu L, Chen J, Sun Y, Huang X, Xu H, Zhang X. Loss of nerve fibers in the oviduct isthmus in women with hydrosalpinx. Acta Histochem 2013; 115:609-15. [PMID: 23622972 DOI: 10.1016/j.acthis.2013.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 10/26/2022]
Abstract
Apart from the abnormalities of tubal anatomy, the main concern linked to infertility is impaired tubal motility associated with hydrosalpinx, which is thought to be controlled by hormones and nerves. The objective of this study was to determine the distribution of nerve fibers in the oviduct isthmus in women with and without hydrosalpinx. Histological sections of the oviduct isthmus tissue were obtained from 18 women undergoing salpingectomy for hydrosalpinx, and from 15 women undergoing hysterectomy and salpingectomy for benign gynecologic diseases. The tissues were immunohistochemically stained for protein gene product (PGP) 9.5, protein S100, neuropeptide tyrosine (NPY), and vasoactive intestinal peptide (VIP) to reveal all nerve fibers, as well as sympathetic and parasympathetic nerve fibers, in the oviduct isthmus. We detected the presence of PGP9.5, S100, VIP, and NPY-immunoreactive nerve fibers in the oviduct isthmus in all study subjects. However, the densities of PGP9.5, S100, VIP, and NPY-immunoreactive nerve fibers in the oviduct isthmus were all significantly decreased in women with hydrosalpinx compared with those in women without hydrosalpinx (P<0.01). Our results suggest that reduced nerve fibers in the oviduct isthmus in women with hydrosalpinx compared with women without hydrosalpinx may have an important function in the mechanism of hydrosalpinx-associated infertility.
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Na ED, Cha DH, Cho JH, Kim MK. Comparison of IVF-ET outcomes in patients with hydrosalpinx pretreated with either sclerotherapy or laparoscopic salpingectomy. Clin Exp Reprod Med 2012; 39:182-6. [PMID: 23346530 PMCID: PMC3548078 DOI: 10.5653/cerm.2012.39.4.182] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/09/2012] [Accepted: 11/23/2012] [Indexed: 12/22/2022] Open
Abstract
Objective Many studies have demonstrated that hydrosalpinx has a detrimental effect on the outcome of IVF. Treating hydrosalpinges prior to the IVF procedure in women with hydrosalpinges is thought to improve the likelihood of successful IVF outcome. Vaginal ultrasound-guided aspiration of hydrosalpinx fluid (HSF) with injection of the sclerosing agent in situ might be simpler than invasive procedures like salpingectomy. Therefore, we carried out a retrospective study on the effects of ultrasound-guided HSF aspiration and injection of the sclerosing agent of ultrasonically diagnosed hydrosalpinx on IVF outcome. Methods In our retrospective study, 97 tubal factor infertile female patients that underwent IVF treatment between January 2005 and December 2012 at the Reproductive Medicine Center of CHA Hospital were divided into two study groups. Fifty-six patients underwent interventional ultrasound sclerotherapy (group 1), and the remaining 41 patients received laparoscopic salpingectomy (group 2) before IVF. We compared the IVF outcomes of the two groups. Results The results showed that ultrasound-guided HSF aspiration and sclerotherapy have IVF outcomes comparable to laparoscopic salpingectomy. Conclusion Interventional ultrasound guided sclerotherapy before IVF is an effective and less invasive prophylactic intervention alternative to salpingectomy with hydrosalpinx.
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Affiliation(s)
- Eun Duc Na
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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Parihar M, Mirge A, Hasabe R. Hydrosalpinx functional surgery or salpingectomy? The importance of hydrosalpinx fluid in assisted reproductive technologies. J Gynecol Endosc Surg 2009; 1:12-6. [PMID: 22442504 PMCID: PMC3304258 DOI: 10.4103/0974-1216.51903] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The first IVF baby, Louise Brown, was born in a natural cycle IVF of a woman who had bilateral tubal block making IVF the only option for having a child. The last 3 decades has seen astounding progress in the field of ART. Today thanks to ART, tubal disease and tubal factor infertility is easily overcome. The accepted theory today is that the hydrosalpinx fluid plays a causative role in the reduced pregnancy rate with ART. It is well known that the success of ART for patients with tubal disease with hydrosalpinx is reduced by half compared with patients without hydrosalpinx. Ideal would be removal of a hydrosalpinx by laparoscopic salpingectomy to improve pregnancy rates. However in some cases this is not feasible due to dense pelvic adhesions making access difficult. In such cases it is recommended that even de-linking the tube from the uterus would help in improving the ART outcome. There is suggestion that sonographically visible hydrosalpinges and those affected bilaterally have a poorer prognosis than those seen incidentally at laparoscopy. While there is clinical evidence supporting the causative role of the fluid itself, there is a lack of knowledge as to how the fluid exerts its negative effects. It is generally believed that the fluid holds a key position in impairing implantation potential. The aim of this review is to highlight the importance of identifying hydrosalpinges and its association with reduced fertility outcome using assisted reproductive technologies. Here we have discussed the different options available for the same, and highlighted the current modes of treatment.
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