[Pyosalpinx: anatomo-clinical experience and therapeutic inferences. Apropos of a retrospective study of 58 cases].

Data from a series of 58 patients admitted with pyosalpinx, and representing 17.3% of cases of upper genital infections, were used to provide detailed information on therapy. Diagnosis was confirmed by celioscopy or laparotomy in all cases, and treatment essentially multiple antibiotic therapy by parenteral administration of wide spectrum compounds. Three subgroups of patients were distinguished: group 1 (15 cases) received immediate surgery due to severity of clinical picture or doubt as to diagnosis: in 54% the treatment was radical (hysterectomy-castration); group II (26 cases) received medical treatment only; group III (17 cases) underwent surgery after failure of medical treatment; operation was conservative in 52% of cases. Failure of medical treatment was related to a pyosalpinx volume of 8 cm3 or more in 86% of cases. No patient needed recovery surgery, while 3 had long term complications. Microbial flora was mainly anaerobic, diagnosis being dependent of celioscopy findings. Medical treatment alone allowed young women desiring pregnancy to conserve their genital apparatus in 44.8% of cases. When there is a lack of response to treatment, incomplete regression or recurrence then only surgery can be curative: the uterus and ovarian parenchyma should be conserved as far as possible because of new therapeutic perspectives.