Document Detail


Fallopian tube recanalization: lessons learnt and future challenges.
MedLine Citation:
PMID:  20597618     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Technological advances in fiberoptics and endoscopy have resulted in the development of minimally invasive transcervical tubal catheterization procedures with the potential of improved diagnostic accuracy of tubal disease and transcervical treatment of proximal tubal obstruction (PTO) with reduced risks, costs and morbidity compared with surgical procedures. Fallopian tube recanalization can be performed with catheters, flexible atraumatic guidewires or balloon systems under endoscopic (falloposcopy/hysteroscopy/laparoscopy), sonographic, fluoroscopic or tactile guidance. Falloposcopy provides a unique possibility to accurately visualize and grade endotubal disease, characterize and document endotubal lesions, identify the segmental location of tubal pathology without complications, objectively classify the cause of PTO and guide future patient management. This is in contrast to the surgical and radiological gold standards, laparoscopy and hysterosalpingography, respectively, that are often associated with poor or misdiagnosis of PTO. Nonhysteroscopic transuterine falloposcopy using the linear eversion catheter is a successful, well-tolerated, outpatient technique with a good predictive value for future fertility. Hysteroscopic-falloposcopic-laparoscopic tubal aquadissection, guidewire cannulation, guidewire dilatation and direct balloon tubuloplasty may be used therapeutically to breakdown intraluminal adhesions or dilate a stenosis in normal or minimally diseased tubes with high patency and pregnancy rates. However, guidewire cannulation of proximally obstructed tubes yields much lower pregnancy rates compared with other catheter techniques, despite the high tubal patency rates. Laparo-hysteroscopic selective tubal catheterization with insufflation of oil-soluble radiopaque dye has been reported to be an effective treatment for infertility associated with endometriosis. The various disadvantages associated with fluoroscopic and sonographic techniques limit their application, despite the reportedly high patency and intrauterine pregnancy rates. Recanalization is contraindicated in florid infections and genital tuberculosis, obliterative fibrosis and long tubal obliterations that are difficult to bypass with the catheter, severe tubal damage, male subfertilitY and previously performed tubal surgery. Distal tubal obstruction is not amenable to catheter recanalization techniques. Tuberculosis, salpingitis isthmica nodosa, isthmic occlusion with club-changed terminal, ampullar or fimbrial occlusion, and tubal fibrosis have been cited as reasons for recanalization failure. In lieu of the poor pregnancy outcomes in patients with severe tubal disease and poor mucosal health following tubal recanalization, as well as poor available technical skills and results with microsurgery, in vitro fertilization and embryo transfer is a valid option in such women. Despite the high diagnostic and therapeutic power of falloposcopic interventions, technical shortcomings with falloposcopy must be overcome before the procedure gains widespread acceptance.
Authors:
Gautam N Allahbadia; Rubina Merchant
Related Documents :
590538 - The new improved silastic band for ligation of fallopian tubes.
21077528 - Evaluation of serum levels of interleukin-10, interleukin-11 and leukemia inhibitory fa...
20108478 - The ectopic pregnancy, a diagnostic and therapeutic challenge.
3469998 - Tubal resection and anastomosis i. sterilization-reversal.
19434208 - Effect of multiparity on electrolyte composition and blood pressure.
23279498 - Progesterone (pr), oestrogen (er-α and er-β) and oxytocin (otr) gene expression in th...
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Women's health (London, England)     Volume:  6     ISSN:  1745-5065     ISO Abbreviation:  Womens Health (Lond Engl)     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101271249     Medline TA:  Womens Health (Lond Engl)     Country:  England    
Other Details:
Languages:  eng     Pagination:  531-48, quiz 548-9     Citation Subset:  IM    
Affiliation:
Deccan Fertility Clinic, Mumbai, India. drallah@gmail.com
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Reduction in Down's syndrome screening acceptance is predominantly observed in women aged 25-35 year...
Next Document:  Acupuncture in reproductive medicine.