[Diagnostic value of hysterosalpingography in examination of fallopian tubes in infertile women].

UNLABELLED

Hysterosalpingography (HSG) is a radiographic examination of endocervical canals, uterine cavity and Fallopian tube with the use of a radiographic contrast medium [1]. This method is an integral part of gynaecological examination and its value has not been underestimated in the modern gynaecological practice.

GOAL OF THE STUDY

The goal of the study was to evaluate the reliability of HSG in the diagnosis of Fallopian tube and to compare the obtained results with laparoscopic findings.

METHODS

The study included 140 infertile women. HSG was performed in the first half of the cycle, usually on the ninth day, without anaesthesia. The instruments after Schultze were used; 15 mL of Telebrix-contrast was used. Three radiograms were done. Laparoscopic examination was carried out in general endotracheal anaesthesia. A Storz laparoscope was used. CO2 was used for artificial pneumoperitoneum and indigolipstick for tube passage. The obtained findings were elaborated statistically. Descriptive and analytic models were used. p < 0.05 and p < 0.01 were considered as a risk factor of statistical significance.

RESULTS

An approximate time interval between the two procedures was 5.18 months. Normal findings of HSG examination were noted in 53 women (37.9%); tube occlusion in 67 women (47.9%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. A normal finding was found in 56 women (40.0%), tubal occlusion in 64 women (45.7%), and peritubal adhesion with tubal passage in 20 (14.3%) patients. HSG and laparoscopic findings regarding normal tubes were in agreement in 32 women (22.9%), tubal occlusion in 35 women (25.0%) and peritubal adhesion with tubal passage in 5 (3.6%) patients. The best sensitivity of HSG was observed in detection of proximal tubal occlusion (78%), and the smallest in occlusion with the accompanying adhesion (2%). The best specificity of HSG was noted in the diagnosis of combined occlusions (96%), and the smallest in tubal passage with peritubal adhesion (25%). There were 15% of false negative findings and 17.1% of false positive findings.

DISCUSSION

The time interval from one to the other procedure can be considered as an important factor in laparoscopic confirmation or negative HSG findings. With the continuation of the same time interval the conditions are made for the aggravation of old and occurrence of new pathological processes in genital internal female organs. The possible causes of differential diagnosis of tubal occlusion between HSG and laparoscopic examination might be: 1) unequal anaesthesia during HSG and laparoscopic examination; 2) different properties of contrast media; 3) anatomic variations in the width of lumen tubes; 4) erroneous interpretation of the results. The sensitivity of HSG in this study was different in various types of tubal passage. In other studies the sensitivity of HSG was from 65% [10] to 96% [7]. The high specificity was found during detection of combined tubal occlusion (96%). The results of other authors were similar [7, 10]. This is a good contribution to the statement that HSG is a useful test of tubal obstruction. A rather high percent of false positive results of HSG was established in this study. The possible reasons might be tubal spasm and endometrial polyp in the area of the uterine opening of the tubes.

CONCLUSION

On the basis of the obtained results, the following conclusions can be drawn: 1) HSG is a simple method for examination of female sterility; 2) HSG and laparoscopy are the complementary methods in the examination of tubal sterility; 3) HSG is inferior in relation to laparoscopy in the examination of peritubal adhesion.