This document discusses hydrosalpinx, which is a distended fallopian tube filled with fluid caused by distal blockage. The main causes are pelvic inflammatory disease from infections like chlamydia. Symptoms can include pelvic pain and infertility. Diagnosis involves ultrasound, HSG, CT or MRI. Treatment depends on whether fertility is desired. For fertility, salpingectomy before IVF improves live birth rates by removing toxic fluid. Tubal surgery may help mild cases. IVF is main treatment if fertility desired. Leaving a non-painful hydrosalpinx in situ is also an option if not trying to conceive.

1. HYDROSALPINX
DR.ARSLA MEMON
KING FAHAD MEDICAL CITY RIYADH

2. DEFINATION
• A hydrosalpinx is a distally blocked fallopian
tube filled with serous or clear(STERILE) fluid.
• The blocked tube may become substantially
distended giving the tube a characteristic
sausage-like or retort-like shape.

3. INCIDENCE
• The incidence is estimated to be 1 in 500,000
women.
• It is often found in reproductive age women
and is found less in prepubertal and
perimenopausal women.

4. incidence
• Hydrosalpinges are found in 10–30% of
couples presenting with infertility from tubal
factors.

5. INCIDENCE
• Hydrosalpinx is not infrequent, and may occur
in almost 10% of patients with pelvic
inflammatory disease or endometriosis

7. • The condition is often bilateral and the
affected tubes may reach several centimeters
in diameter.

8. • A hematosalpinx is most commonly
associated with an ectopic pregnancy.
• A pyosalpinx is typically seen in a more acute
stage of PID and may be part of a tuboovarian
abscess (TOA).

9. Etiology
• The major cause for distal tubal occlusion is
(PID), usually as a consequence of an
ascending infection by chlamydia or
gonorrhea.
• However, not all pelvic infections will cause
distal tubal occlusion.
• Tubal tuberculosis is an uncommon cause of
hydrosalpinx formation.

10. ETIOLOGY
• Other causes of distal tubal occlusion include
adhesion formation from surgery,
endometriosis,
• iucd
• cancer of the tube, ovary or other surrounding
organs

11. OTHER CAUSES
• OVULATION INDUCTION
• POST HYSTRECTOMY (WITHOUT
SALPINGECTOMY)
• TUBAL LIGATION
• TUBAL MALIGNANCY
• POSTABORTION OR DELIVERY
• EARLEIR CASE OF PELVIC INFECTION

12. Tubal phimosis
• refers to a situation where the tubal end is
partially occluded, in this case fertility is
impeded, and the risk of an ectopic pregnancy
is increased

13. MECHANISM
• ciliae of the inner lining (endosalpinx) of the
fallopian tube beat towards the uterus, tubal
fluid is normally discharged via the fimbriated
end into the peritoneal cavity from where it is
cleared.

14. MECHANISM
• If the fimbriated end of the tube becomes
agglutinated, the resulting obstruction does
not allow the tubal fluid to pass; it
accumulates and reverts its flow downstream,
into the uterus, or production is curtailed by
damage to the endosalpinx.

15. Symptoms
• Symptoms can vary.
• asymptomatic.
• lower often recurring abdominal pain
• pelvic pain,
• dysparunia
• infertility is a common symptom.
• Patients who are not trying to get pregnant and have no pain, may go
undetected.
• . As a reaction to injury, the body rushes inflammatory cells into the area,
and inflammation and later healing result in loss of the fimbria and closure
of the tube. These infections usually affect both fallopian tubes, and
although a hydrosalpinx can be one-sided, the other tube on the opposite
side is often abnormal. By the time it is detected, the tubal fluid usually is
sterile, and does not contain an active infection.

16. Differential daignosis
• PARAOVARIAN CYST
• BOWEL OBSTRUCTION(DILATED LOOPS)
• OVARIAN NEOPLASM
• PELVIC PERINURAL CYST
• DEGENERATING FIBRIOD
• ACUTE APPENDICITIS

17. DAIGNOSIS
• US
• HSG
• CT
• MRI
• LAROSCOPY
• LAPROTOMY

18. HYDROSALPIX ON US
• NORMAL FALLOPIAN TUBE NOT VISIBLE ON
SCAN.
• MAJORITY OF SMALL HYDROSALPIX ARE
MISSED,
• SENSITIVITY IS 34%.

19. HYDROSALPIX ON US
• THIN/THICK WALLED C OR S SHAPED FLUID
FILLED STRUCTURE THAT IS DISTINCT FROM
OVARY AND UTERUS.

20. HYDROSALPIX ON US
• Longitudinal folds are present in a normal
fallopian tube may become thickened in the
presence of a hydrosalpinx.
• The folds may produce a characteristic
“cogwheel” appearance when imaged in cross
section.
• These folds are pathognomonic of a
hydrosalpinx.
• Incomplete septae may also give a "beads on a
string" sign

21. HSG
Usual first line approach ,sensitivity 65%
Specificiy 83%
shows the retort-like shape of the distended
tubes and the absence of spillage of the dye into
the peritoneum.
• If, however, there is a tubal occlusion at the
utero-tubal junction, a hydrosalpinx may go
undetected.

22. HSG
• When a hydrosalpinx is detected by an HSG it
is prudent to administer antibiotics to reduce
the risk of reactivation of an inflammatory
process

23. Laparoscopy and hydrosaloinx
• When a laparoscopy is performed, the
surgeon will note the distended tubes, identify
the occlusion, and may also find associated
adhesions affecting the pelvic organs.
• A laparoscopy not only allows for the
diagnosis of hydrosalpinx, but also presents a
platform for intervention

24. Classification of hydrosalpinges based
on salpingoscopy

25. Prevention
• As pelvic inflammatory disease is the major
cause of hydrosalpinx formation, steps to
reduce sexually transmitted disease will
reduce incidence of hydrosalpinx.
• Also, as hydrosalpinx is a sequel to a pelvic
infection, adequate and early antibiotic
treatment of a pelvic infection is called for.

26. complication
• can be hazardous during fertility evaluation
and treatment, since it is prone to re-
infection.
• Tubal torsion.
• Rupture

27. MANAGEMENT
• The management of hydrosalpinx is a
difficult controvarsial problem.

28. MANAGEMENT
A DESIRES FERTILITY
• PELVIC PAIN_ SURGERY
• NO PAIN _ 1 SALPINGECTOMY +IVF
• FUNCTIONAL TUBAL SUREGRY
• B POSTMENOPASL . NO FERTILTY REQUIRED
• NO PAIN _ LEAVE IN SITU
• IF PAIN _ SURGERY

29. • Surgery for hydrosalpinges before in vitro
fertilisation treatment
• Women with hydrosalpinges should be offered
salpingectomy, preferably by laparoscopy,
before IVF treatment because this improves
the chance of a live birth.
• NICE

30. Why salpingectomy?
• embryotoxic properties of the hydrosalpinx fluid,
which include micro-organisms, endotoxins,
cytokines, oxidative stress and lack of nutrients.
• The endometrial receptivity may be reduced as
an effect of disturbed expression of the cytokine
cascade, which is essential for implantation.
• The presence of excessive fluid in the uterine
cavity may also be a mechanical hindrance to
implantation.?mechanical washout.
•

31. • A normally rich and supportive tubal
environment becomes the dead sea of the
hydrosalpinx.

32. • Tubal microsurgery and laparoscopic tubal surgery
• For women with mild tubal disease, tubal surgery may
be more effective than no treatment. In centres where
appropriate expertise is available it may be considered
as a treatment option.
• Tubal catheterisation or cannulation
• For women with proximal tubal obstruction, selective
salpingography plus tubal catheterisation, or
hysteroscopic tubal cannulation, may be treatment
options because these treatments improve the chance
of pregnancy

33. • Surgery is only suitable for a small thin-walled
hydrosalpinx with healthy mucosa.
• These operations can be performed via
laparoscopy or open microsurgery.
• The proper selection of patients for surgical
treatment and of the type of surgical technique
are essential to achieve good results.
• In general, the prognosis of surgery is poor;
however, in well selected cases, good results can
be achieved by an experienced surgeon.

34. • (IVF) is the main line of treatment for
infertility caused by hydrosalpinx.
• The literature is controversial concerning the
effect of transvaginal aspiration of
hydrosalpinx on the outcome of IVF.

35. FUNCTIONAL OR RECONSTRUCTIVE
SURGERY
• Functional or reconstructive tubal surgery
remains another important option for tubal
surgical treatment
• Mild hydrosalpinx
• Normal ovulation
• Young pt
• Want to avoid assissted reproduction
• insurance

36. Fimbrioplasty
•
Fimbrioplasty is the incision of any fibrous or
scar tissue covering the terminal end of the
tube, thus freeing the agglutinated fimbriae
and lysis of peritubal adhesions.
• indicated in patients with fimbrial occlusion
usually with concurrent periadnexal
adhesions.

37. Salpingostomy or Neosalpingostomy
Salpingostomy is the procedure whereby a stoma is
fashioned in the distal fallopian tube using scissors,
electrosurgery or laser.
• The procedure can be performed using
laparoscopy or laparotomy with microsurgical
technique.
• When the procedure is performed for mild
hydrosalpinges, it is associated with better
pregnancy rates

38. Microsurgical Tubocornual
Anastomosis
•
Microsurgical tubocornual anastomosis is a procedure
where the patent portion of the distal tube is joined to
the uterine cavity .
• treatment for proximal tubal occlusion.
• some spontaneous intrauterine pregnancies have been
seen in women with proximal tubal obstruction.
• more effective for women with mild hydrosalpinges
and should be considered especially in centers where
appropriate expertise is available.

39. Prophylactic salpingectomy and
ovarian reserve
• There had been reports about adverse effects
associated with salpingectomy, especially if
performed close to the uterus as it might
disrupt the normal blood flow to the ovary
resulting in fewer oocytes being retrieved
from the side of the operation during IVF
cycles in comparison with intact adnexa.

40. Prophylactic salpingetomy and ovarian
reserve
• NICE guidelines suggested that the evidence
of impairment of ovarian response in
subsequent IVF was inadequate but
emphasize that laparoscopic salpingectomy
should be done with care not to compromise
ovarian blood supply.

41. Essure