Tubal Recannulization and Selective Salpingography

About 30% of those with blocked tubes have proximal obstruction. Blockage where the tubes connect to the uterus. This may be due to adhesions, spasm of the opening from the uterus to the tube (tubal osteum) or dryed up dead cells and mucus. The first probably can't be helped. We often see it with a condition called SIN (salpingitis isthmica nodusum) seen after sever pelvic infection. Spasm means the tubes are not really blocked but they show up that way. It's the dried up stuff blocking the tube that makes a difference.

Selective hysterosapingography, or proximal tubal cannulization may open the tubes avoiding surgery. Recannulization is usually painless. It can be performed in X-ray with Xanax, Toradol and local block or during a hysteroscopy procedure in the operating room if you also need laparoscopy. First a 5.5 french 2 mm catheter is steered into the corner (cornua) of the uterus. An attempt is made to pass dye (selective hsg) if this is ok, you probably had spasm. Your tubes were never really blocked. That is one of the weaknesses of regular HSG. If you are scared or in pain, the tubes go into spasm and appear blocked even if they are not.

If they are still not open, I will pass a 1 mm catheter into the tube. Then I pass a .018mm guide wire into the fallopian tube. This dislodges the debris. The other catheters are then passed over the wire. Sometimes I will use a balloon catheter to dilate the tubes. Once the catheter is into the tubes, the selective HSG is repeated. If the end of the tube is ok, your chances of conceiving may be pretty good. About 85-90% of women will have at least one tube opened. 60% will remain open at 6 months if rechecked. 30-40% will conceive. If one tube is already open and the ends of the tube look ok, recannulization is not likely to improve the chances of pregnancy. AGAIN, if one side is perfectly normal, you are not likely to benefit from this procedure.

Risks include: perforating the tube. The wire is so narrow, this is rarely a problem. Pain should not be as bad as regular HSG. Infection and allergy are risks similar to HSG.

This page, and all contents, are Copyright (C) 1995 by Mark Perloe M.D., P.C. Atlanta, GA, USA.

mperloe@mindspring.com