Hydrotubation of Fallopian tubes - Causes, symptoms and treatment. MF.

  • Hydrotubation of Fallopian tubes - Causes, symptoms and treatment. MF.

    Hydrotension( Greek hydōr water + lat tuba tube) - the introduction of fluid through the uterine cavity into the fallopian tubes to establish their patency or for therapeutic purposes. Previously, hydrotubation was widely used for the diagnosis and treatment of tubal infertility. In modern conditions, hydrotubation is performed after plastic operations on the fallopian tubes in order to dynamically observe the passableness of the operated tube and to prevent inflammatory and adhesive processes, as well as after removal of one of the fallopian tubes( salpingoacidomy) to determine the patency of the remaining tube. The use of hydrotubation for the treatment of tubal infertility by many researchers is disputed. To diagnose tubal infertility, chromosalpingoscopy is used - examination of the fallopian tubes during laparoscopy with the simultaneous introduction of solutions of coloring substances( indigo carmine, methylene blue) through the uterine cavity, which allows visually to clarify the patency and functional state of the fallopian tubes, to reveal peritubar adhesions and other causes of infertility.

    The conditions for carrying out hydroturbation are I and II degrees of purity of the vagina, the absence of pathogenic flora in smears from the cervical canal and urethra, and the absence of pathological changes in blood and urine. Hydrotubation is contraindicated in acute and subacute inflammatory processes in the genital organs, tumors of the uterus and its appendages, severe cardiovascular diseases, and infectious diseases.

    Hydrotherapy is performed by a doctor in a hospital or in an outpatient setting. She is held in a procedure room on a gynecological chair. To establish the patency of the uterine tubes, hydrotubation is performed during the 7th to the 24th day of the menstrual cycle. Pre-hydration is emptied of the intestine and bladder, the external genital organs are treated with iodonate solution. In the uterine cavity, an isotonic sodium chloride solution is injected with an intrauterine infusion syringe with a device for sealing the cervical canal or a special device. With complete passability of the fallopian tubes, the solution from the syringe at the pressure on the piston comes in easily and does not flow out after the tip is removed from the cervical canal. If the fallopian tubes are obstructed in the isthmus region, 2-3 ml of the solution is injected freely, then the flow of fluid is suspended and, when the pressure on the piston is relaxed, it flows back. If obstruction of the fallopian tubes in the ampulla, the introduction of fluid is accompanied by pain in the inguinal areas, reflux appears after infusion of 4-5 ml of liquid;often the fluid from the fallopian tubes enters the vagina after a few minutes or hours after administration - the phenomenon of hydrops tubae. If the fallopian tubes are partially passable, the flow of fluid is very slow.

    When carrying out the study with the help of special devices, the pressure in the uterus is recorded on the tape of the recorder. In the case of complete patency of the fallopian tubes, the pressure in the system drops to 60 mm Hg. Art.(as a result of the passage of fluid from the fallopian tubes into the abdominal cavity);with a partial patency of the fallopian tubes, the pressure drop occurs at 100-120 mm Hg.st., with complete obstruction, the pressure drop does not occur. If there is an obstruction in the region of the isthmus, there is no pressure fluctuation in the system;with obstruction in the ampullar part, rhythmic small fluctuations in pressure due to peristalsis of the fallopian tubes are possible. In the case of stretching the fallopian tubes, the pressure drops slightly, pains may appear in the lower abdomen.

    Antibiotics, glucocorticoids, proteolytic enzymes, lidaz and others are used to prevent inflammatory and adhesive processes in the fallopian tubes;preliminary they are dissolved in a 0.25% solution of novocaine or isotonic sodium chloride solution( solutions administered into the uterine cavity should be sterile).The procedures start from the 2nd-3rd day after the end of menstruation and finish 2-3 days before the expected menstruation.