Assessment of Tubal Patency: A Prospective Comparison of Diagnostic Hysteroscopy and Laparoscopic Chromopertubation

Ott, Johannes; Hager, Marlene; Nouri, Kazem; Marschalek, Julian; Kurz, Christine

doi:10.1016/j.jmig.2019.03.006

Cited by 24 publications

(50 citation statements)

References 14 publications

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“…One other interesting finding was that, despite having ruled out bilateral Fallopian tube occlusion for all women in the course of routine diagnostic evaluation before CC stimulation, laparoscopy revealed this abnormality in five patients, with a significantly increased risk for women with endometriosis (7.9% versus 1.1%, respectively). Although bilateral tubal spasm cannot be ruled out completely [42], this would point to a clinical relevance of incidental endometriosis in PCOS women.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Incidental Endometriosis in Women Undergoing Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome: A Retrospective Cohort Study and Meta-Analysis

Hager

Wenzl

Riesenhuber

et al. 2019

JCM

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To evaluate the incidence of endometriosis in polycystic ovary syndrome (PCOS) patients who did not present with any endometriosis symptoms and underwent laparoscopic ovarian drilling (LOD) for clomiphene citrate (CC) resistance, 225 and 630 women with CC-resistant PCOS without classic endometriosis symptoms were included in a retrospective study and a meta-analysis, respectively. All women underwent LOD. The main outcome parameter was the prevalence of incidental endometriosis. Laparoscopy revealed endometriosis in 38/225 (16.9%) women (revised American Fertility Society (rAFS) stage I: 33/38, 86.8%; rAFS stage II: 5/38, 13.2%). When women with CC-resistant PCOS without endometriosis were compared, lower body mass index (BMI) and lower 25-hydroxy-vitamin D levels were associated with the presence of endometriosis at laparoscopy (odds ratios (OR): 0.872, 95% confidence intervals (95%CI): 0.792–0.960; p = 0.005 and OR: 0.980, 95%CI: 0.962–0.999; p = 0.036; respectively). The inclusion criteria for the meta-analysis were fulfilled by 4/230 reports about LOD. After correction for study heterogeneity, the pooled prevalence of incidental endometriosis was 7.7% in women with CC-resistant PCOS. In conclusion, the rate of incidental endometriosis in women with CC-resistant PCOS might reflect the prevalence of asymptomatic endometriosis. All cases were affected by minimal or mild disease. Since the literature lacks reports on associated clinical outcomes, the relevance of this entity in such patients should be the subject of further studies.

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Section: Discussionmentioning

confidence: 99%

The Prevalence of Incidental Endometriosis in Women Undergoing Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome: A Retrospective Cohort Study and Meta-Analysis

Hager

Wenzl

Riesenhuber

et al. 2019

JCM

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“…A forward-oblique 30˚hysteroscope (Karl Storz GmbH & Co KG; Tuttlingen, Germany; sheath diameter: 5 m) was used for diagnostic hysteroscopy. A continuous inflow was achieved with an intravenous solution of 0.9% sterile saline, tubing with a drip chamber, and a reusable intravenous pressure bag [5]. As previously described for the Parryscope technique, the minimal amount of inflow resulting in sufficient uterine distention was used, so uterine distension pressures were not quantified [7].…”

Section: Surgical Techniquementioning

confidence: 99%

“…Hysteroscopy is the gold standard for intrauterine evaluation in patients with subfertility [1,2] and can be performed in outpatient and office settings [2−4]. Maximizing insight through a single procedure makes for more efficient and effective clinical care [5]. If hysteroscopy inherently has meaningful value for procreative testing, and tubal patency can be concurrently assessed gently, accurately, safely, and economically, then tubal assessment should also be incorporated into the hysteroscopic evaluation of patients with subfertility.…”

mentioning

confidence: 99%

Hysteroscopic Assessment of Tubal Patency: A Randomized Comparison between the Flow and Parryscope Techniques

Hager¹,

Ott²,

Holzer³

et al. 2020

Journal of Minimally Invasive Gynecology

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To evaluate the accuracy of the "Parryscope" and "flow" techniques for hysteroscopic assessment of tubal patency. Design: Prospective randomized clinical trial. Setting: From May to October 2019, women with subfertility undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate in the study. The primary outcome was accuracy of Fallopian tube patency relative to the gold standard of laparoscopic chromopertubation. Patients: Sixty women with subfertility. Interventions: Hysteroscopy with either the "Parryscope" or the "flow" techniques for tubal assessment, directly followed by laparoscopy with chromopertubation. Measurements and Main Results: Hysteroscopic prediction of fallopian tube patency was possible in a statistically significant manner in both study groups (p <0.05). The Parryscope technique achieved higher sensitivity (90.6%, 95% CI: 61.7 −98.4) and specificity (100%, 95% CI: 90.0−100.0) than the flow technique (sensitivity: 73.7%, 95% CI: 48.8−90.9 and specificity: 70.7%, 95% CI: 54.5−83.9). Conclusion: Using the Parryscope technique to determine if air bubbles traverse the ostia can provide valuable additional information during hysteroscopy and is more accurate in predicting fallopian tubal occlusion than the flow method.

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“…In contrast, distal occlusion can be identified when the solution passes at least into the ampullary segment of the tube but not beyond the fimbria. 2 …”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, slight adhesions inside the fallopian tube can be resolved by the flow of the solution during chromopertubation. 2 …”

Section: Introductionmentioning

confidence: 99%

Green urine sign after laparoscopic chromopertubation as an effect of severe contrast intravasation: a report of three cases

et al. 2020

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Tubal diseases are responsible for 25% to 35% of female infertility. Laparoscopic chromopertubation is the gold standard for assessing tubal patency when female infertility is suspected. Intravasation is a complication of intrauterine procedures involving the passage of fluid filling the uterine cavity into the bloodstream through endometrial vessels (from the myometrial veins to the uterine venous plexuses). This complication has been described during hysterosalpingography and sonohysterosalpingography. We herein present a report of three cases in which severe intravasation occurred during laparoscopic chromopertubation using methylene blue as a contrast agent. The intravasation manifested as green urine (i.e., the “green urine sign”). The presence of methylene blue in the urine and blood was confirmed by laboratory tests. All three patients had risk factors for intravasation as described in the literature (unilateral or bilateral tubal obstruction, endometriosis, and previous intrauterine procedures for Mullerian duct anomalies and Asherman’s syndrome). The green urine sign appeared a few hours after laparoscopic chromopertubation and spontaneously resolved after 24 hours. Cystoscopy was performed to rule out bladder injury. All three patients required only clinical observation.

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Assessment of Tubal Patency: A Prospective Comparison of Diagnostic Hysteroscopy and Laparoscopic Chromopertubation

Cited by 24 publications

References 14 publications

The Prevalence of Incidental Endometriosis in Women Undergoing Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome: A Retrospective Cohort Study and Meta-Analysis

The Prevalence of Incidental Endometriosis in Women Undergoing Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome: A Retrospective Cohort Study and Meta-Analysis

Hysteroscopic Assessment of Tubal Patency: A Randomized Comparison between the Flow and Parryscope Techniques

Green urine sign after laparoscopic chromopertubation as an effect of severe contrast intravasation: a report of three cases

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