Hydrosalpinx: treatment and symptoms, diagnosis and causes. Hydrosalpinx is a severe complication of inflammation of the appendages

One of the main causes of female infertility, which accounts for 20-54%, is pathological disorders in the fallopian tubes. As a rule, this is the result of inflammatory processes of the pelvic organs, a complication of which is often hydrosalpinx. It is an accumulation of fluid in the lumen of the fallopian tube due to a violation of its patency. The frequency of detection of this pathology by reproductive specialists ranges from 10 to 30%.

Structure and physiological functions of the fallopian tube

It is also called the oviduct. It is a hollow, with a lumen width of up to 1 mm, paired anatomical formation about 10-12 cm long, connecting the fundus of the uterus with the pelvic cavity. With one hole, the fallopian tube opens into the uterine cavity. Its distal end ends on the ovary and contains a second opening, bordered by fimbriae.

The walls of the fallopian tube consist of three membranes - serous, muscular and mucous. The serous membrane covers the outside of the oviduct, the muscular membrane consists of two differently directed layers of smooth muscle fibers, which provide the oviduct with peristalsis (contractions) in the direction from the ovaries to the uterus. The mucous membrane forms longitudinal folds and is a layer of columnar ciliated epithelium cells with villi.

Between the epithelial cells are glandular cells that secrete mucus into the lumen of the tube. This mucus ensures the constancy of the internal environment of the tube, helps maintain the activity of sperm, the viability of the egg and the embryo in the early stages of its formation.

During the period of ovulation, the egg is captured by the fimbriae and then, as a result of peristalsis and vibrations of the villi of the ciliated epithelium, moves into the uterine cavity. Mucus secreted by glandular cells also freely enters the uterine cavity.

So, the physiological functions of the fallopian tubes are:

1. Capture of an egg through fimbriae at the moment of its release from the follicle into the abdominal cavity (ovulation).
2. Ensuring the movement of the egg and delivery of sperm from the horn (corner) of the uterus to the egg.
3. Ensuring the vital activity of germ cells, preparing them for fusion and creating conditions for fertilization.
4. Movement of the embryo into the uterus through peristalsis and increased activity of the epithelial cilia.
5. Ensuring the development of the embryo until the implantation of the fertilized egg in the uterus.

What is hydrosalpinx

The formulation “chronic hydrosalpinx” that is sometimes used is not entirely correct. This pathology in itself cannot be acute or chronic. It develops as a result of the following reasons:

1. Acute or chronic inflammatory process caused by sexually transmitted infectious agents. The most common cause is considered to be, less often - gonococcus, Trichomonas and other STIs or opportunistic microflora (Mycobacterium tuberculosis).
2. Salpingitis suffered and cured in the past.
3. Pyosalpinx (purulent inflammation of the fallopian tube).
4. Active external genital endometriosis.
5. Uterine fibroids in the area of ​​the uterine opening of the tube, reducing its diameter.
6. Tubal pregnancy.
7. Damage during laparoscopic manipulations in the abdomen or operations in the pelvic area (uterine fibroids, restoration of reproductive function after sterilization, etc.) and the abdominal cavity (appedicitis, intestinal diverticulum, peritonitis, etc.).
8. Developmental anomalies.

All these reasons lead to the formation of an adhesive process outside or in the lumen of the oviducts, deformation of the tube and disruption of the outflow of fluid from it. A unilateral process more often occurs with anatomical disorders or as a result of pyosalpinx, when the purulent contents resolve and only serous fluid remains. Bilateral hydrosalpinx usually develops with chronic inflammation caused by the infection listed above.

Inflammation of the mucous membrane leads to the formation of adhesions in the lumen, disruption of the innervation of the walls and blood circulation in them, damage to the ciliated epithelium, increased vascular permeability and the entry of a significant amount of serous fluid into the lumen of the oviduct.

In addition, during inflammation, the production of mucus by the glandular cells of the mucous membrane increases, and impaired blood circulation in the walls leads to atrophy of muscle fibers, thinning of the walls, a decrease in their tone and elasticity, and impaired peristalsis. All this, in turn, also supports the chronic course of the inflammatory process.

Thus, excessive formation of fluid and disruption of its outflow, changes in the structure of the muscle layer and deterioration of peristalsis lead to overstretching of the walls and the formation of a “bag” with liquid contents. Sometimes, when the openings are not completely closed, it can empty (draining hydrosalpinx). In these cases, the liquid contents enter the uterine cavity or the pelvic cavity. The pathological formation can also be simple or multi-chamber (follicular), when adhesions divide the cavity, forming several chambers.

Symptoms

Subjective symptoms of hydrosalpinx are few. It may be accompanied by:

1. Chronic pelvic pain.
2. Intermittent “pulling” pain in the lower abdomen.
3. The periodic appearance of abundant light discharge from the genital tract during emptying of the tube through the uterus, after which for some time the pain may disappear completely or its intensity is significantly reduced.
4. Deterioration in general well-being and a slight increase in body temperature during exacerbation of the inflammatory process.

Pain is more often observed during the period of exacerbation of chronic inflammation. The addition of a secondary infection can cause purulent salpingoophoritis and pelvioperitonitis, requiring surgical treatment.

Hydrosalpinx and pregnancy

According to statistical data, the probability of pregnancy with this pathology is reduced by at least two times, and the number of cases of spontaneous termination of pregnancy (miscarriages) increases by the same amount.

Due to the widespread use of in vitro fertilization (IVF), many reports have emerged indicating a significant number of cases of failure of the procedure in women with this disease. The frequency of implantation of a fertilized egg, embryo development and pregnancy is 2-5 times lower in them compared to women with other causes of infertility. Moreover, the degree of negative IVF results generally depends little on the methods of assisted reproductive technologies (ART).

In addition, some authors consider ART to be one of the risk factors for the development of ectopic pregnancy. However, the frequency of this complication after IVF associated with hydrosalpings is the same as with other tubal pathology. What is fundamental in these cases is the presence of the very fact of damage to the oviducts, regardless of the particular variant. So why is hydrosalpinx dangerous during IVF, as well as during natural conception and during pregnancy in general?

Mechanisms of influence of the disease

An unsuccessful attempt at natural conception and pregnancy, as well as pregnancy through treatment methods close to the natural process, in conditions of a preserved menstrual cycle, is explained by several reasons already described above:

• mechanical obstacle - narrowing or fusion of the openings of the oviduct, the presence of adhesions in it;
• disruption of tubal blood supply and innervation;
• damage to the muscle layer and ciliated epithelium;
• disturbance of peristalsis of the tube and loss of folding of the mucous membrane.

However, the listed factors cannot prevent the use of in vitro fertilization, implantation of an already fertilized egg into the endometrium and the development of the fetus. The participation of hydrosalpinx in these processes is evidenced by the fact that removal of diseased appendages contributes to an increase (on average 3 times) in the frequency of pregnancy as a result of IVF.

This dependence on the disease is mainly explained by the following reasons:

1. Mechanical effect: the periodic outpouring of accumulated fluid into the uterine cavity during the emptying of the hydrosalpinx mechanically washes away the embryo from the endometrium in the early stages of its development. In addition, the mechanical effect of hydrosalpinx on blood circulation in the ovaries and their function is also affected.
2. The damaging effect of fluid on the uterine endometrium. The implantation process occurs with the participation of various biochemical reactions between the fertilized egg and the endometrium. They are hampered by the influence of fluid, which is a transudate (plasma effusion through the walls of blood vessels), intercellular fluid and the secretion of the glands of the mucous membrane (mucus). The fluid also includes microorganisms and their toxins, destroyed mucosal cells, cytokines, prostaglandins, etc., which cause damage and normal functioning of the surface layer of the endometrium and epithelial cells, somewhat similar to chronic endometritis.
3. Toxic (in some cases) effect of elements of the leaking fluid on the developing embryo.
4. Activation of local cellular immunity in the endometrium and an intense immune inflammatory response of the body to the contents of the hydrosalpinx, which leads to autoimmune rejection of the developing embryo.
5. A significant decrease in the number of receptors in the fallopian tube and a decrease in the sensitivity of endometrial receptors that perceive the effects of female sex hormones. As a result, the hormonal regulation of the preparation of the endometrium for the implantation of the egg is disrupted.

Diagnosis and treatment of hydrosalpinx

Basic diagnostic methods

A convenient method is one that allows one to diagnose the disease with high reliability. However, the fallopian tube may not contain fluid (draining hydrosalpinx) at the time of ultrasound or may not be dilated, which greatly complicates diagnosis.

In these cases, it is possible to suspect the disease and check the patency of the lumen of the fallopian tubes with an X-ray contrast agent injected into the uterine cavity. The hydrosonography method is considered more accurate, that is, checking patency through ultrasound examination with the simultaneous administration of a sterile solution.

After such a diagnosis, cases of effective natural intrauterine pregnancy are noted. However, the main disadvantages of these methods are:

• insufficient reliability of the results, due to which it is impossible to completely exclude pathological changes in the pipes or accurately determine their nature;
• the possibility of exacerbation of a chronic inflammatory process.

A more reliable method is diagnostic laparoscopy, which allows one to assess the condition of the tubes and take their contents for culture in order to determine the presence of an infectious pathogen and its sensitivity to antibacterial drugs. With laparoscopy, it is also possible to correct existing pathological changes to a certain extent - dissect, restore the anatomical position of the appendages, etc.

At the same time, doctors try to refrain from performing this procedure, due to its invasiveness and the possibility of developing the adhesive process to an even greater extent, as well as because of the financial cost.

The results of instrumental studies, including endoscopic ones, make it possible to establish a number of prognostic factors that influence the choice of treatment tactics:

1. The extent of the lesion is unilateral or bilateral hydrosalpinx.
2. Its (their) diameter is up to 15 mm (according to other authors - up to 25 mm) or more.
3. The presence of thickening of the walls.
4. The degree of preservation of the folds of the mucous membrane.
5. The degree of severity of the adhesive process in the fallopian tube (single or multiple adhesions), as well as the nature of the adhesions - delicate membranous or rough stranded.

The degree of damage is assessed depending on the presence of several criteria or the severity of one of them.

Principles of treatment

Conservative therapy is aimed at reducing the activity of the inflammatory process, preventing exacerbations and transformation into pyosalpinx. It includes drug treatment of hydrosalpinx, the use of physiotherapeutic and balneological procedures, and mud therapy.

Conservative therapy can be recommended for low severity of hydrosalpinx and its spontaneous periodic emptying, as well as for women who no longer plan pregnancy in the future and/or for some reason refuse more reliable but radical methods of treatment.

In the presence of a mild degree of changes in the fallopian tubes, especially with a unilateral process, surgical options in 60-76% can lead to an independent natural intrauterine pregnancy. In this case, the risk of ectopic pregnancy is no more than 5%. Surgical treatment, depending on the nature of the pathological changes, is carried out using various endoscopic methods:

• salpingo-ovariolysis - dissection of adhesions around the tube and ovary and restoration of their anatomical location, as well as destruction of adhesions inside the tube;
• fimbryolysis, or fimbryoplasty - release of fimbriae adhesions and/or their plastic;
• salpingostomy or salpingoneostomy - the release of an anatomical or the formation of a new opening in the ampullary region if it is obstructed.

In most cases, reproductive specialists recommend IVF and, as a preparatory stage, surgical salpingectomy (removal of the pathological fallopian tube), after which the likelihood of pregnancy as a result of in vitro fertilization more than doubles.

Post date: 30.09.2014 14:30

nata. m.

Hello! I am diagnosed with 2-sided hydrosalpinx! the left one is 12mm and the right one is 2mm and one of these days they will have surgery! and I’m worried they’ll leave my tubes or tie them up! Thank you!

Post date: 30.09.2014 18:01

Dostibegyan Gary Zelimkhanovich

Hello, dear Nata. M.
Your feelings are understandable.
But this question should be asked ONLY to one person, the one who will perform the operation. Nobody else knows the answer to this question.

Post date: 29.10.2014 05:54

Guest

Hello, I am 22 years old, a month ago I had a rupture of my left ovary, and yesterday I was told by ultrasound that hydrospinx can be treated without surgery, and so a month ago there was surgery?

Post date: 29.10.2014 06:50

Dostibegyan Gary Zelimkhanovich

Hello.
Yes, of course, in any case, you can and should first try to be treated not surgically, but conservatively; if there is no effect, then you will have to resort to laparoscopy.

Sincerely, Dostibegyan Gary Zelimkhanovich, fertility specialist

Post date: 15.12.2014 09:53

Violet

Hello. I am 58 years old, menopausal, the size of the uterus and ovaries are not enlarged. The diagnosis is a small cyst of the right ovary and left-sided hydrosalpings. severe pain in the lower abdomen and back. but I also have problems with the lumbosacral spine (Schmorl’s nodes and perineural cyst). The gynecologist sends me for laparoscopy. Question: maybe the pain is due to the back and can I do without surgery?

Post date: 15.12.2014 13:09

Dostibegyan Gary Zelimkhanovich

Hello, dear Violetta.
This section is called "Infertility Treatment".
As far as it is clear from your message, you have a different problem.
Pain is pain, but at 58 years old there should not be a cyst in the ovary, so I think that your doctor’s tactics are correct. At this age, doctors are afraid to miss oncology, so surgical treatment is justified.

With best wishes, Gary Zelimkhanovich Dostibegyan, reproductologist

Post date: 15.12.2014 14:18

Julia

Good afternoon Please tell me, I want to get pregnant, but I have a missed period, hydrosalpingx on the left, or a parovarian formation (no one knows what it is). HPV 68 type 10*4.7. Exocirvicitis. Treatment: injections of vitamins B6.1, aloe, metronidazole intravenously and calcium glucanate. (hot injection), suppositories Panavir and Allokin _alfa. 1. Is the treatment correct? 2. And will calcium glucanate harm me in my situation? I also have compensatory hypothyroidism since 2006. 3. Should my husband be treated for HPV if he has it? 4. And if he doesn’t? Maybe he is also going through some kind of inflammatory process, what tests should he take?

Post date: 15.12.2014 14:31

Dostibegyan Gary Zelimkhanovich

Hello, dear Yulia.
Sorry, but it is neither correct nor ethical to comment on treatment prescribed by other doctors.
HPV needs to be treated.
All questions regarding my husband should be addressed to a urologist-andrologist.

With best wishes, Gary Zelimkhanovich Dostibegyan, reproductologist

Post date: 15.12.2014 21:56

Julia

Thank you. Please write whether a hot injection of calcium glucanate would do any harm in my situation.

Post date: 16.12.2014 10:33

Post date: 16.01.2015 19:02

Angela

Hello. I’m 23 years old. My husband and I have been planning children for 2 years now, but it’s not working out. 8 months ago I had a laparoscopy to remove bilateral hydrosalpinx. But the pregnancy never occurred. I had an ultrasound on January 15, 2015. There was a relapse, again the same diagnosis. Please tell me, is it worth going for laparoscopic surgery again or will only IVF help?

Post date: 16.01.2015 21:34

Dostibegyan Gary Zelimkhanovich

It's a pity that everything is exactly like this...
In such situations, laparoscopy is performed and after 2 months (not earlier) IVF.
It is not worth doing IVF for hydrosalpinx, and the chances are much lower and the risk of complications is higher.

Post date: 17.01.2015 07:29

Angela

Please tell me which country is better to do ecology? We are from Kazakhstan. Thanks in advance.

Post date: 18.01.2015 06:26

Dostibegyan Gary Zelimkhanovich

Hello, dear Angela.
Kazakhstan is big, personally, in Samara (Russia), almost every day I see patients from Uralsk (a city in the north-west of Kazakhstan); many do IVF, many very successfully.
You can do IVF in any country in the world, including Kazakhstan.
If you would like to come to Russia, please first call +78002502424.

With best wishes, Gary Zelimkhanovich Dostibegyan, reproductologist

Post date: 18.01.2015 10:09

Angela

Tell me, do you give a certain percentage of success in conducting eco? Or is it all individual? And one more question, approximately how much time in general will we need to spend in Russia if we do eco with you?

Update: October 2018

One of the unpleasant consequences of inflammation of the appendages, in particular the fallopian tubes, is hydrosalpinx. According to statistics, this pathology occurs in 10–30% who are faced with the problem of pregnancy, since hydrosalpinx interferes with successful conception.

But with timely and adequate treatment, the onset of a long-awaited pregnancy is quite possible, so you should not try to get rid of this disease on your own, this only aggravates the pathological process and delays the wait for the joyful moment - the birth of a child.

Hydrosalpinx: what is it?

Hydrosalpinx is a disease of the fallopian tubes that results in disruption of their patency. The name of the pathology comes from Latin words, where “Hydro” is translated as liquid, and “salpinx” means pipe. The phrase often used by women - hydrosalpinx of the tubes - is incorrect, just like oilseed oil. A feature of the disease is the accumulation of fluid (transudate) in the lumen of the fallopian tube due to blockage of the internal and external openings of the oviduct, as a result of which it turns into a saccular formation.

There are:

• right-sided hydrosalpinx;
• hydrosalpinx on the left;
• bilateral hydrosalpinx.

It is incorrect to use such combinations as acute and chronic hydrosalpinx. This pathology is a complication of the inflammatory process of the fallopian tubes - salpingitis, which can be both acute and chronic.

An example of a diagnosis: Acute bilateral salpingoophoritis. Bilateral hydrosalpinx.

A little anatomy and physiology

The fallopian tube (synonyms: fallopian tube or oviduct) is a paired organ and is presented as a hollow tube with two lumens. The length of the oviduct reaches 10–12 cm, with the right tube being slightly longer than the left. One end of the oviduct opens into the uterine cavity, and the other ends with fimbriae (villi) and opens into the abdominal cavity, near the ovary. Through these openings, the abdominal cavity communicates with the woman's internal and external genitalia, which increases the risk of ascending infection, for example, with vaginitis.

The wall of the oviduct consists of three layers:

• external – represented by the peritoneum and protects the pipe from negative influences;
• muscular - formed by muscle fibers and thanks to which the tube makes peristaltic (contractile) movements towards the uterine cavity;
• internal, covered with ciliated epithelium, the cilia of which move in waves (flicker), which facilitates the movement of the fertilized egg towards the uterus; in addition, the glands located in the mucous layer of the tube produce a secretion that maintains the constancy of the internal environment of the oviduct and the viability of the egg, sperm and zygote.

The role of the fallopian tubes

The oviducts are essential for successful conception and implantation of a fertilized egg in the uterus. The functions of the fallopian tubes include:

• with the help of the fimbriae of the funnel of the tube, the matured egg released from the follicle is captured (the moment of ovulation);
• the egg moves to the ampullary section of the tube, where sperm are delivered from the uterine cavity;
• maintaining the viability of germ cells (sperm and eggs), preparing for their union, direct fertilization;
• maintaining the vital activity of the fertilized egg (zygote) in the tube until it moves into the uterine cavity;
• transportation of the zygote into the uterine cavity due to peristalsis of the oviducts and increased activity of the cilia of the ciliated epithelium.

The mechanism of pathology development

Impaired functioning of the fallopian tubes occurs due to inflammation, for example, against the background of salpingitis or salpingoophoritis. As a result, connective tissue begins to grow and scars and adhesions form. The inflammatory process and adhesions affect all layers of the oviducts, with varying degrees of severity.

The villi of the ciliated epithelium die, and the muscle layer stops contracting (peristalsis disappears). Adhesions grow in the lumen of the fallopian tube, which impairs its patency, and the fimbriae of the funnel of the tube stick together. When the adhesions close both openings of the oviduct, mucus begins to accumulate in the resulting closed space, intensely, due to inflammation, produced by the glands of the epithelium of the inner layer of the tube. As a result, the tube expands, forming a hydrosalpinx or sactosalpinx. When the serous-mucosal contents of the tube suppurate, a pyosalpinx is formed.

In some situations (incomplete fusion of the fimbriae), a “ventilated hydrosalpinx” is formed, which periodically breaks through due to the pressure of the accumulated fluid. An increase in pressure occurs with a sudden change in body position, straining, or during hysterosalpingography. In this case, the transudate flows into the pelvis. Emptying of the oviduct with “ventilated hydrosalpinx” occurs systematically. The overflowing inflammatory fluid stimulates the formation of adhesions in the pelvis - a vicious circle is formed that maintains the existence of hydrosalpinx.

Causes of hydrosalpinx

The formation of hydrosalpinx is caused by the closure of the ampullary (middle) part of the fallopian medium, which is facilitated by a local infectious-inflammatory reaction. Infectious agents can penetrate into the cavity of the oviduct both ascendingly, from the underlying organs of the reproductive system (cervix, vagina, uterus), and descendingly through the bloodstream (bladder and kidneys, tonsils and intestines, appendix and others). Inflammation can be aseptic and occur in the presence of other gynecological diseases. The formation of hydrosalpinx occurs due to the following reasons:

• inflammation of the tubes, ovaries or appendages (salpingitis, oophoritis, adnexitis);
• inflammation of the uterus (endometritis);
• frequent and random change of sexual partners (sexually transmitted infections: chlamydia, myco- and ureaplasma, trichomonas, gonococci and others);
• tuberculosis of the female genital organs;
• wearing an intrauterine contraceptive;
• frequent hypothermia (weaken the immune system and activate opportunistic flora);
• abortions and diagnostic curettage of the uterine cavity;
• long-term vaginitis and vaginal dysbiosis;
• inflammation of the cervix and cervical canal;
• external endometriosis (causes aseptic inflammation and the formation of adhesions in the pelvis);
• adenomyosis;
• myomatous node in the area where the fallopian tube enters the uterine cavity;
• sexual infantilism (pipes are thin, long and crooked);
• damage to the oviducts during laparoscopy with the subsequent occurrence of aseptic inflammation.

The following factors predispose to the formation of a saccular formation in the pipe:

• neglect of the rules of intimate hygiene;
• stress, emotional stress;
• endocrine pathology: diabetes mellitus, thyroid diseases (weaken the body’s defenses).

But I would like to note that not always suffered and treated salpingitis or adnexitis ends in the formation of hydrosalpinx. With strong immunity and adequate and timely treatment, the inflammatory process in the tube disappears without consequences.

Symptoms

The clinical picture of the described pathology depends on the disease that caused it. With hydrosalpinx, which developed against the background of acute inflammation of the tubes, the symptoms are more pronounced. The patient is worried about febrile temperature, sharp, bursting pain in the groin (left or right), signs of intoxication: loss of appetite, lethargy and weakness. With the rapid accumulation of transudate in the ampullary section of the tube, the pain is bursting and pulsating.

In the case of chronic salpingitis, accompanied by the formation of hydrosalpinx, patients are often not bothered by anything. Often the only complaint is the inability to get pregnant, and hydrosalpinx is discovered during additional examination. But complaints of discomfort in the iliac regions, sensation of a foreign body in the groin, etc. are also possible. If there is ventral hydrosalpinx, then the woman may notice periodic heavy watery discharge from the genital tract (in the event of a rupture of the formation into the uterine cavity). When transudate spills into the pelvic cavity, adhesions increase in it, which is manifested by chronic pelvic pain syndrome. Sometimes the symptoms of saccular tube formation resemble acute surgical pathology (appendicitis, renal colic or intestinal colic).

Typical signs of chronic salpingitis and formed hydrosalpinx are:

• discomfort or slight aching pain in the iliac region/areas;
• menstrual disorders;
• pathological discharge from the genital tract;
• absence of pregnancies.

Pregnancy due to hydrosalpinx

It is possible to become pregnant due to hydrosalpinx, but only if the tube is damaged on one side. Accordingly, the likelihood of conception is reduced by 50%. However, with this disease, the risk of tubal pregnancy and spontaneous abortion increases. Ectopic pregnancy is caused by damage to the ciliated epithelium in the affected tube and disruption of its peristalsis. As a result, the fertilized egg lingers in the oviduct for 4 or more days, where it implants and continues to develop.

Spontaneous termination of pregnancy due to saccular expansion of the tube is explained by several points:

• mechanical effect: periodically pouring fluid from the ventral hydrosalpinx washes the zygote from the surface of the endometrium, preventing it from implantation;
• the inflammatory transudate of the hydrosalpinx, entering the uterine mucosa, causes its damage and the development of endometritis, which makes implantation of the embryo impossible;
• there may be a toxic effect of the inflammatory fluid on the embryo, which leads to its damage and death;
• the sensitivity of endometrial receptors to female sex hormones decreases, which leads to disruption of the hormonal regulation of the uterine mucosa during the implantation process.

If hydrosalpinx is diagnosed on both sides, then pregnancy cannot occur naturally. In such cases, they resort to assisted reproductive technologies (IVF), although the effectiveness of in vitro fertilization and subsequent gestation is reduced several times (2 – 5).

If pregnancy nevertheless occurs against the background of an existing saccular expansion of the tube, then it can terminate spontaneously in the early and late stages. Therefore, all pregnant women with hydrosalpinx are at high risk for miscarriage. Treatment of the disease is postponed until the postpartum period.

Diagnostics

Diagnosis of this complication begins with a gynecological examination. When performing bimanual palpation, hydrosalpinx can be felt as a tight-elastic and elongated formation on the right/left or on both sides. There may be minor pain on palpation of the appendage area or no pain at all. But with a slight expansion of the oviduct, the doctor may not palpate the formation and prescribe additional research methods:

Ultrasound with transvaginal sensor

The presence of a saccular formation on one or both sides, located between the uterus and the ovary, its size and shape are determined. It is possible to visualize the septa in the formation (follicular hydrosalpinx). The formation is filled with hypoechoic fluid and has its own thick capsule.

Hysterosalpingography

This method consists of introducing a contrast agent (under pressure) into the uterine cavity through the cervical canal. Then x-rays are taken. Hysterosalpingography allows you to determine the patency of the tubes - contrast is visualized in the pelvis and identify hydrosalpinx. If there is a complication, the fallopian tube looks tortuous and thickened, and accumulated contrast is found in the enlarged ampullary section.

Laparoscopy

Carried out for diagnostic and therapeutic purposes. During laparoscopic surgery, thickened fallopian tubes are revealed, the fimbriae at their ends are swollen and hyperemic, and the wall of the tube is thinned and translucent, its cavity is filled with watery contents.

In addition to instrumental examination methods, it is necessary to be tested for sexually transmitted infections (chlamydia, myco- and ureaplasma, cytomegalovirus, HPV and herpes virus).

Treatment

If hydrosalpinx is detected, a woman is strongly recommended to undergo treatment, because the longer this pathology exists, the more intensively adhesions form in the pelvis, which reduces the chances of conception and increases the risk of miscarriage or ectopic pregnancy. Unfortunately, many patients think of this disease as not serious (it doesn’t hurt, so it’s not dangerous) and delay their visit to the gynecologist. Sometimes this leads to irreversible consequences: the absolute impossibility of conceiving naturally and the need to resort to IVF.

But how to treat this pathology? Treatment for hydrosalpinx is carried out in two stages. The first stage of treatment is conservative therapy. If there is an acute inflammatory process of the appendages or an exacerbation of a chronic one. First of all, antibiotic treatment is prescribed. The duration of the course and dosage of antibacterial drugs are selected individually, taking into account the identified pathogens and their sensitivity to drugs.

The main line of conservative therapy is stimulation of the immune system. For this purpose, immunomodulatory drugs are prescribed:

• immunofan;
• lycopid;
• imudon;
• Thymalin;
• taktivin;
• aloe injections;
• immunal;
• autohemotherapy (intramuscular injection of a woman’s own venous blood).

Also, to stimulate the immune system, taking and parenteral administration of vitamins is indicated. Physiotherapeutic procedures are widely used, although it is impossible to achieve complete cure of hydrosalpinx and resorption of adhesions with their help:

• magnetophoresis;
• electrolytes (calcium, magnesium);
• electrical stimulation of the fallopian tubes;
• endovaginal vibration massage.

Hirudotherapists are confident that it is possible to get rid of this disease by resorting to the method of treatment with leeches. Such a statement has no basis in scientific evidence or confirmed statistical data.

Traditional methods

Most patients believe that hydrosalpinx can be treated with folk remedies. Doctors allow the use of traditional methods, but only as an addition to the first (conservative) stage of therapy. Traditional medicine will not help get rid of the disease, but will only eliminate a number of symptoms: they will reduce pain, somewhat slow down the progression of inflammation and adhesions, and more or less normalize the menstrual cycle. Among the recommended folk remedies, it is permissible to use:

• taking pumpkin, potato and nettle juice (separately or in a mixture);
• microenemas with medicinal herbs (chamomile, calendula, oak bark);
• taking a mixture of aloe leaves, butter and honey;
• taking oat infusion;
• taking juniper baths (an infusion of berries and juniper branches is poured into the water; the water in the bath should be warm, but not hot);
• infusion of adonis;
• infusion of a mixture of herbs (chamomile, currant leaf, sage, St. John's wort).

Once again, I would like to remind you that it is impossible to achieve a complete cure of the disease using traditional medicine methods.

Surgery

The second stage of treatment for this complication is surgical intervention. If hydrosalpinx is present, treatment without surgery does not make sense. As long as the focus of inflammation remains in the pelvis, adhesions will continue to form, pain will persist and the chances of fertilization will decrease.

Today, laparoscopy is used as a surgical intervention for hydrosalpinx. Laparoscopic treatment of saccular formation in the tube is the most gentle and effective surgical intervention. During laparoscopy, depending on the condition of the tubes, the age of the patient and her desire to become pregnant, the following types of surgical intervention in the anatomy of the oviduct are performed:

• salpingo-ovariolysis - adhesions around the oviduct and ovary are dissected, their anatomical location is restored, and adhesions in the lumen of the fallopian tube are also separated;
• fimbryolysis and fimbryoplasty – the fimbriae of the final section of the tube, which are adjacent to the ovary, are freed from adhesions, the inflammatory transudate is removed from the tube, and, if necessary, fimbriae plastic surgery is performed;
• salpingostomy and salpingoneostomy - they form a new hole in the ampullary section of the oviduct or are freed from adhesions of the anatomical hole (minus salpingoneostomy - the new hole closes very quickly);
• tubectomy – removal of a tube/tubes (performed in women over 35 years of age or if it is impossible to restore the patency of the oviduct and eliminate hydrosalpinx).

But even in the case of a successful operation, preserving the tube and restoring its patency, the oviduct does not function as before. The villi of the ciliated epithelium either lose mobility, or the epithelium itself atrophies, and the muscle layer is not able to contract as before, that is, the peristalsis of the tube is disrupted, so patients are included in the risk group for ectopic pregnancy, and pregnancy is recommended through IVF.

Question answer

How dangerous is this disease?

The presence of hydrosalpinx increases the likelihood of an ectopic pregnancy several times. In addition, hydrosalpinx almost always leads to infertility. A saccular formation in the pipes that increases in volume may burst or fester (pyovar).

Are there any restrictions necessary for this disease?

Yes, definitely. Firstly, physical activity should be avoided (vibration, straining, sudden changes in body position: somersaults, bending, jumping). Secondly, avoid excessive activity during sexual intercourse, which increases pain. In addition, it is not recommended to sunbathe and visit a solarium, as well as visiting baths, saunas and taking hot baths, which can provoke an exacerbation of the inflammatory process. It is undesirable to swim in the pool and open reservoirs, as local hypothermia will also provoke an exacerbation. It is prohibited to drink alcohol, including low-alcohol drinks, which suppresses the immune system.

What is the prognosis for pregnancy after laparoscopic surgery for this disease?

With the patency of the tube restored and the hydrosalpinx removed, conception naturally and pregnancy occurs in 60–75%, and the probability of an ectopic pregnancy does not exceed 5%. If the tube is removed, the effectiveness of IVF is 30 – 35%.

For 3–4 weeks it is necessary to abstain from physical activity and observe sexual rest. You should also follow a diet that limits the consumption of spicy, pickled and salty foods, fried and fatty foods, fast food and canned food.

Hydrosalpinx is a complication of salpingitis (inflammation of the appendages), leading to infertility. Other reasons can also cause pathology - hormonal imbalances, stress, hypothermia, so the disease is very common.

Appointment with a gynecologist - 1000 rubles. Comprehensive pelvic ultrasound - 1000 rubles. Appointment based on ultrasound or test results - 500 rubles (optional)

What is hydrosalpinx

Hydrosalpinx is an accumulation of fluid in the lumen of the fallopian tube. At the site of inflammation, a sac with serous fluid inside is formed. The capsule blocks the lumen of the fallopian tube and prevents fertilization and conception.

Causes

The main reason for the formation of hydrosalpinx is (salpingitis). Complications are almost guaranteed in the presence of factors such as:

• Hypothermia. It provokes activation of opportunistic microflora and weakening of the body's protective functions. The result is the formation of pus in the appendages.
• , against the background of which it worsens .
• And (during curettage, the appendages are damaged and infection occurs).
• Surgeries on the uterus and ovaries (later scars and adhesions occur).
• Infections of the genitourinary area (provoke an inflammatory process in neighboring organs).
• An unsuccessfully installed intrauterine device.
• Violent sex life without protection ( - provocateurs of many diseases of the female genital area).
• (inflammation of the uterus).
• near the appendages (the formation puts pressure on the fallopian tubes, causing adhesions)
• Adhesions in the pelvic area (the main cause of hydrosalpinx).
• Violation of the vaginal microflora (the infection is transferred to the uterus and spreads through the fallopian tubes).
• The cause of hydrosalpinx on the right is chronic or acute appendicitis.

Factors that cause hydrosalpinx also include (diabetes, thyroid pathology), severe or constant stress, constant hypothermia (exercise on ice, in cold water).

Types of disease and pregnancy prognosis

The disease is classified based on the following factors.

Liquid composition:

• A simple accumulation of serous fluid is a hydrosalpinx.
• The presence of pus impurities - pyosalpinx.
• The presence of blood impurities inside the formation is hematosalpinx.
• A neoplasm in the fallopian tube with contents inside is a sactosalpinx.

By location:

• Left-sided hydrosalpinx of the ovary, in which the patency of the left-sided fallopian tube is disrupted - occurs most often. In this case, fertilization occurs in a healthy right appendage. In the acute course of the disease, the symptoms are pronounced: the temperature rises, the state of health worsens, and pain in the lower abdomen occurs.
• Right-handed. Hydrosalpinx on the right side differs from the left side only in its location.
• Bilateral hydrosalpinx. A consequence of prolonged inflammation and the formation of adhesions. It significantly increases the risk of infertility because it blocks the normal circulation of serous fluid in the appendages.

According to symptoms and duration of treatment:

• Acute, with bright signs.
• Chronic. If the disease is not treated, the severity of the symptoms will subside, and the patient will be diagnosed with chronic hydrosalpinx.

According to the form of the neoplasm:

• tubular;
• bell-shaped;
• oval;
• irregular shapes.

According to morphological features:

• Simple(the formation is a single capsule with liquid inside).
• Follicular hydrosalpinx. INis expressed in multiple formations inside the fallopian tube, filled with fluid and not interconnected (capsules of different sizes and shapes, separated from each other by partitions 1-4 mm thick). Pain on the right side is sometimes perceived as an attack of appendicitis, and the patient does not immediately seek help. Follicular hydrosalpinx requires surgical intervention.
• Valve(with partial release of fluid mixed with mucus, when adhesions periodically break through).

Vent hydrosalpinx of the left tube is a variant of chronic pathology. It also occurs on the right side, but is more often left-sided. It is formed in cases where the adhesive process does not block the lumen of the appendage, and the adhesions themselves remain soft and elastic. Under the pressure of the accumulating serous fluid, the hydrosalpinx cavity stretches and bursts, and the contents pour into the pipes and from there into the vagina. A woman recognizes this by watery discharge and acute pain in the lower abdomen.

If the size of the ruptured capsule is small, then the ventilated form of the disease does not cause discomfort, although the problem must be eliminated.

Symptoms of hydrosalpinx

Statistics show that women are more often diagnosed with hydrosalpinx on the left, the symptoms of which force the patient to seek medical help. Hydrosalpinx on the right may not bother you until the symptoms indicate an acute course of the disease.

The disease is especially dangerous if hydrosalpinx forms in both fallopian tubes. The causes of hydrosalpinx on the right are the same as on the left, but bilateral lesions are more often the result of unsuccessful surgical intervention. With unilateral hydrosalpinx, you can get pregnant safely, but bilateral pathology is almost 100% infertile.

Sometimes the neoplasm develops asymptomatically, and the patient begins to worry when she has problems conceiving. It is easier to notice a disease caused by inflammation of the fallopian tubes. Symptoms of inflammation:

• Intoxication of the body (fever, weakness, nausea, headache).
• When hydrosalpinx occurs in an acute form, the temperature rises to 38-39 C. Also, a constant temperature within 37-37.50 C should be alarmed if there is a failure of menstruation and pain is felt in the lower abdomen. This is how the chronic form of the disease proceeds.

Symptoms of hydrosalpinx on the right and left:

• The patient notes from the vagina (a sign of unilateral or small hydrosalpinx, due to which the serous fluid partially passes through the fallopian tubes and flows out through the vagina).
• (the problem affects the functioning of the ovaries).
• , having a pulsating character. Unpleasant sensations andlower abdominal painafter sexual intercourse.

Feedback from patients indicates that the symptoms of hydrosalpinx in the chronic form are less pronounced or absent.

Symptoms of bilateral hydrosalpinx

The signs of hydrosalpinx on the right are similar to how hydrosalpinx manifests itself on the left, but the symptoms of a bilateral neoplasm are pronounced. In addition to lethargy and fever, the patient feels nagging or aching pain on both sides of the abdomen; they are bursting, “cramping” in nature. The sensations are similar to those that a woman experiences before the onset of menstruation.

Signs of hydrosalpinx rupture

The growing tumor causes anxiety, causing unusual pain in the projection of the ovaries, copious watery discharge and increased temperature. If these symptoms remain unattended, since the patient may attribute them to PMS, constipation, poor diet, change of weather, etc., the formation reaches a large size and the bubble with pus bursts.

Hydrosalpinx will also burst if conservative treatment does not help. This happens with late treatment, weak immunity, and incorrectly selected medications.

Symptoms of a hydrosalpinx rupture are as follows:

• Sharp, unbearable pain below the navel on one or both sides of the abdomen, of a cramping, pulsating nature.
• Severe pain during sexual intercourse.
• Vaginal fluid
• A sharp deterioration in health, short-term loss of consciousness.

The condition is very dangerous, since when serous fluid enters the abdominal cavity, peritonitis begins - purulent inflammation in the abdominal cavity.

In such a situation, the patient develops tachycardia against the background of severe pain, so during the initial examination at the site, a hydrosalpinx rupture can be mistaken for a myocardial infarction. The abdominal muscles tense and relaxation does not occur, even if the patient lies on her back.

Diagnosis of hydrosalpinx rupture is complicated by the syndrome of imaginary well-being, which consists of the following: at first a person feels a sharp pain, then the peritoneal receptors adapt and stop sending alarming signals to the brain. The woman decides that she has a spasm, which has passed. She calms down, but after 1-2 hours the attacks repeat with renewed vigor.

An equally dangerous consequence of hydrosalpinx rupture is sepsis - the entry into the blood of pus and serous fluid from the ruptured sac. The rupture is accompanied by both an increase and a decrease in body temperature. The heartbeat quickens, sweat appears on the forehead. A blood test shows an abnormal increase in white blood cells in the blood. The danger is septic shock, which in every second case leads to death.

Hydrosalpinx and other diseases: ovarian cyst, bacterial vaginosis, endometriosis

Between diseases and hydrosalpinx - direct connection. The fact is that a left ovarian cyst is often caused by an infection coming from the intestines. If a woman is hypothermic, her immune system is weakened, the infection passes from the intestines to the ovary, and from there it can spread to the fallopian tubes.

This also applies to vaginal infections, which freely reach the uterus and from there spread to the appendages, causing hydrosalpinx.

IN Where a woman is diagnosed with bilateral hydrosalpinx, a right ovarian cyst or endometriosis is often discovered. The disease usually develops against the background of an existing infection. This provokes inflammation and loss of peristalsis of the fallopian tubes. Serous fluid accumulates in them, which leads to the death of the ciliated epithelium, which is responsible for the advancement of the fertilized egg to the uterus. The connective tissue begins to grow, a bubble is formed from it, where serous fluid accumulates - the hydrosalpinx itself.

Diagnosis: signs of left-sided and right-sided hydrosalpinx on ultrasound

Ultrasound diagnostics is the primary method of examination for suspected hydrosalpinx and obstruction of the fallopian tubes in general. Ultrasound clearly shows the presence of a tumor. If this is detected, further diagnostics are carried out to determine the nature of the formation and the degree of overlap of the lumen of the appendage. Such details are revealed by laparoscopic examination and a test for tube patency, for example, hydroturbation.

Progress of the examination:

• on the examination chair. The size of the ovaries and uterus is checked by touch. The doctor asks if the patient feels acute pain.
• Microflora smear.
• . The doctor examines the patient using an ultrasound diagnostic device with . An ultrasound detects a neoplasm, but its nature is not established.
• X-ray allows you to see the patency or obstruction of the appendages.
• Laparotomy recognizes the nature of the neoplasm and confirms whether it is hydrosalpinx or another disease.

What can be seen on an ultrasound

Ultrasound diagnostics can reveal the first signs of hydrosalpinx, but does not confirm the diagnosis 100%. Sometimes the neoplasm is confused with a serosocele - an accumulation of serous fluid in the appendages. In this case, ultrasound visualizes free fluid between the ovary and uterus, as well as dilation of the fallopian tubes. This is enough to detect the disease in its early stages.

Also, the ultrasound shows a follicular-shaped hydrosalpinx, the septa and the location of the capsules relative to each other are clearly visualized.

An ultrasound is performed between 5 and 9 days from the beginning of the last menstruation. You can undergo ultrasound diagnostics later, but the results will be preliminary. An accurate diagnosis is made after a comprehensive examination of the patient or after laparoscopy (insertion of a flexible endoscope with a camera and light at the end through a micro-incision).

U Ultrasonic waves can reveal hydrosalpinx or anechoicity, which is characterized by serous fluid inside the capsule. In this case, the doctor writes “sactosalpinx,” meaning the presence of a capsule inside the fallopian tube. X-ray examination is required to confirm the diagnosis.

Confirmatory methods prescribed after ultrasound

• Hysterosalpingography.An effective way to determine the form of the disease is hysterosalpingography. This is an X-ray using oily, water-soluble, contrast-colored substances injected into the fallopian tubes.
• Mmagnetic resonance imaging.MRI detects small areas of inflammation, adhesions or other pathology. The procedure makes it possible to display pathology in a section, including the location of the septa, the outline of the capsule and the parameters of the wall of the fallopian tube.

Treatment of hydrosalpinx

Having learned about the diagnosis, women wonder whether hydrosalpinx can be treated. Yes, it can be treated, and the sooner the patient seeks help, the greater her chances of maintaining reproductive health. Thematic forums are filled with reviews of women who successfully treated the disease and gave birth to healthy babies.

The disease requires complex treatment, including the simultaneous use of different methods. Hydrosalpinx is often treated surgically due to regular relapses during conservative treatment.

What is the most effective treatment for hydrosalpinx?

Treatment of the disease comes down to three complementary methods: conservative, surgical and physiotherapeutic.

Conservative treatment is the primary method.It comes down to eliminating inflammation in acute hydrosalpinx. But treatment with pills does not eliminate scars and adhesions, so drugs are prescribed when the cause of the disease is inflammation of the fallopian tubes and ovaries.

Conservative treatment includes antibiotic treatment and physical therapy. The pathogenic microflora is resistant to antibiotics, so the medicine is selected individually for the patient. If the patient has undergone antibiotic therapy before, autohemotherapeutic methods are prescribed that stimulate local immunity (infusion of her own blood, placenta, aloe vera extract). To reduce and soften adhesions, enzymes and bacterial polysaccharides (Prodigiosan, Pyrogenal) are prescribed.

In the chronic course of the disease, when adhesions and obstruction are pronounced, only surgical intervention will help.

• Salpingectomy. This is a radical way to eliminate the problem; the patient has the fallopian tube removed from one or both sides. Depending on the extent of the lesion, the operation is performed laparoscopically (through small punctures), endoscopically (using an endoscope through the vagina or an opening in the abdomen) or through an incision in the abdominal wall.
• Salpingo-ovariolysis.Adhesions are dissected using an endocoagulator in the lumen of the fallopian tube. Thanks to the temperature of 120 0 The method is gentle and bloodless. The blood vessels are instantly cauterized and stop bleeding.
• Salpingoneostomy.The procedure refers to reconstructive plastic surgery and includes a set of surgical procedures, such as fimbryoplasty (connection of the part of the tube that goes into the ovary), dilatation or diaglutination (unsticking) of the mouth of the tube, salpingostomy (creation of a new mouth of the fallopian tube). Tweezers or a mosquito is inserted into the appendage, which opens, expanding the lumen. Sometimes scars and adhesions are dissected, followed by sutures.
• Fibryolysis.The procedure is aimed at separating the glued fimbriae (villi that line the walls of the pipe from the inside). Through a hole in the wall of the appendage, a liquid dye is injected inside, which helps to identify areas of glued fimbriae. The adhesions are dissected with a coagulator, and the colored liquid passing under pressure using special forceps expands the lumen of the appendage and the fimbriae are unstuck.

How to treat hydrosalpinx if surgery is contraindicated and antibiotics are ineffective?

Physiotherapy will help in the treatment of left-sided and right-sided hydrosalpinx:

• Laser therapy. The site of hydrosalpinx is exposed to a laser light flux with a power of 5 to 100 W of specified energy parameters. As a result, metabolic processes improve and scar tissue softens. Hydrosalpinx on the left is found in gynecology more often than a right-sided neoplasm, the treatment of which is similar to how hydrosalpinx on the right is removed (treatment includes certain types of physiotherapy).
• Medicinal electrophoresis.A dose of electric current is applied to problem areas. Medicines penetrate faster and are better absorbed.
• Paraffin baths.Improves blood circulation, restores blood microcirculation in areas prone to adhesions.
• UHF therapy.Low-intensity ultraviolet rays inhibit bacteria, improve blood circulation, and accelerate recovery.

The procedures are painless for the patient and bring tangible results. After 2-3 procedures, women note a decrease in pain and a general improvement in well-being.

Complications and consequences.

Hydrosalpinx is a capsule in which serous fluid accumulates, resulting from the infiltration of lymph through the blood vessels. Serous fluid contains protein, leukocytes and other substances. When tissues adhere, circulatory disturbance occurs, and fluid accumulates in the cavities, forming transudate, which contains up to 2% protein and does not contain enzymes.

If changes in the tissues of the fallopian tube are caused by infection and inflammation, exudate accumulates instead of transudate. It contains more leukocytes and has a greater density than transudate. If a tube bursts due to hydrosalpinx, the consequences are such that the contents of the capsule will enter the fallopian tube, and from there into the vagina or abdominal cavity.

The danger is that if the capsule with serous contents ruptures, transudate will leak into the abdominal cavity. This threatens with peritonitis - acute inflammation of the peritoneum with the development of edema, poor circulation and toxic poisoning of the body.

If the disease does not make itself felt for a long time, the symptoms are not pronounced, the woman may not pay attention to health problems. As the hydrosalpinx increases in size, it causes inflammation and a subsequent dangerous consequence - an abscess. This is an inflammatory process accompanied by the release of pus and accumulation in the cavity (capsule).

Can a pipe burst with hydrosalpinx?

Hydrosalpinx by itself is not capable of tearing the appendage. However, there is a danger with the follicular form of the disease and some associated factors. These include:

• A new infection of the genitourinary organs, which leads to the revival of pathogenic microorganisms and inflammation of the wall of the appendage.
• . In this case, the gap will occur soon after fertilization.
• When the walls of the fallopian tube become thinner due to purulent inflammation.
• Too intense growth of follicular formation.

If the hydrosalpinx bursts, is this a sign of HIV?

A person infected with HIV has no immunity. The body is unable to resist infection. All life support systems suffer: genitourinary, cardiovascular, endocrine. A chronic disease becomes acute and cannot be treated.

It is not surprising that hydrosalpinx increases in size and worries the woman. It is possible that a weakened immune system will accelerate the growth of the tumor, which can burst and release transudate into the lumen of the appendage. But it is not correct to consider hydrosalpinx a direct sign of HIV, because rupture of the capsule also occurs in a woman without HIV.

Complications and consequences of hydrosalpinx

Like any pathology, hydrosalpinx has negative consequences for the patient’s health. Possible complications include:

• Bend of the uterus or change in the position of the uterus relative to the body (normally it should tilt forward), the cause of the bend is adhesions of the peritoneal organs, caused by infections or viruses.
• Violation of the vaginal microflora. Each neoplasm, even benign, disrupts the immune system, and therefore the natural microflora, increasing the number of opportunistic bacteria.
• Rupture of the fallopian tube (in advanced cases of the disease).
• Development of ectopic pregnancy. A capsule with serous fluid blocks the lumen of the epididymis, but does not cause rejection of the fertilized egg.
• Abscess. The accumulation of pus due to the spread of pathogenic bacteria in the capsule leads to organ dysfunction.
• Problems with the intestines, as the infection spreads to neighboring organs.
• Disruption of ovarian function, cycle failure (under conditions of inflammation, the egg stops producing oocytes).
• Infertility (even after treatment, only half of women are able to get pregnant on their own).

Hydrosalpinx and pregnancy

Hydrosalpinx is not a death sentence, despite the decrease in a woman’s ability to conceive.

Hydrosalpinx at the initial stages is small in size, so it does not interfere with the passage of the egg through the lumen of the tube. In addition, if inflammation is recognized in time and appropriate treatment is carried out, the adhesions soften, become elastic and sometimes resolve. A capsule that does not block the lumen will not be an obstacle to the egg or sperm.

Some patients suffering from follicular hydrosalpinx worry whether it is possible to become pregnant with hydrosalpinx of one tube. The likelihood of a productive outcome is high because one appendage is involved in fertilization, not both. If the egg goes through a healthy fallopian tube, with a favorable combination of factors (healthy sperm, a healthy egg, healthy condition of the uterus and endometrium), pregnancy occurs in 99%.

Those who became pregnant with hydrosalpinx note two factors that threaten pregnancy:

• Serous fluid, secreted by the mucous membrane of the fallopian tube and uterus and having a number of functions, with hydrosalpinx and adhesions accumulates in places where the tube is narrowed. If the adhesions are soft, the pressure of the water stretches the wall, and the serous fluid breaks into the uterus. If a zygote is encountered along the flow path, it will be washed away and the embryo will not attach to the uterine cavity.
• If, during ovulation, the egg is released into an unhealthy fallopian tube, there is a possibility of an ectopic pregnancy. In this case, the woman will have the affected tube removed along with the embryo.

Pregnancy after hydrosalpinx

Pathologies of the fallopian tubes in 25-30% of cases cause infertility. If a woman has undergone surgery to eliminate adhesions and remove hydrosalpinx, restorative procedures are carried out for 2 years to resume peristalsis and revive dormant microvilli (fimbriae).

After surgical removal of a small hydrosalpinx and small adhesions, pregnancy occurs in 77% of cases, and only under the condition that one tube was affected by the disease, and not both appendages. Ectopic pregnancy occurred in 2-3%.

F factors with a favorable prognosis for pregnancy after surgery:

• Unity of adhesions. Follicular adhesions lead to removal of the tube.
• Adhesion density. Filmy, elastic adhesions are easier to remove and have fewer consequences than rough and dense ones.
• The diameter of the hydrosalpinx capsule: sizes less than 15 mm are considered small, from 15 to 25 mm medium and over 25 mm large.
• The condition of the mucous surface of the fallopian tube. Folding leads to the death of fimbriae.
• Wall thickness. Thick fallopian tubes lack peristalsis and, accordingly, are immobile.

Conclusion:With favorable prognosis and a small size of the removed hydrosalpinx, there is a possibility of pregnancy occurring naturally.

Where to get diagnosed and treated for hydrosalpinx in St. Petersburg

Such an examination is carried out in St. Petersburg at the specialized gynecological clinic Diana. There is a new expert Doppler ultrasound machine here. The cost of a comprehensive pelvic ultrasound is only 1000 rubles. The cost of treating pathology depends on the form and stage of the process. With timely treatment, everything may be limited to an appointment with a gynecologist, the cost of which is 1000 rubles. and re-appointment after ultrasound and tests.

One of the consequences of inflammation of the uterine appendages, in particular its tubes, is hydrosalpinx. According to statistics, this pathology is present in 10-30% of women who are planning pregnancy, but it does not occur due to the fact that hydrosalpinx prevents successful conception.

However, with adequate timely treatment, a long-awaited pregnancy is possible, so there is no need to try to get rid of the pathology by resorting to self-medication. This approach will only aggravate the pathological process and delay the onset of the long-awaited conception, and in particularly advanced cases, pregnancy may not occur at all.

The concept of hydrosalpinx

Hydrosalpinx is a disease of the fallopian tubes that leads to disruption of their patency. The very name of the pathology comes from Latin words, where “salpinx” is a pipe, and “hydro” is a liquid. The phrase that can be heard quite often from women - hydrosalpinx of the tubes - is incorrect, since, based on the above, the result is oily oil. A feature of this disease is that transudate (fluid) accumulates in the fallopian tubes due to blockage of the external and internal openings of the oviduct. Thus, the pipe turns into a formation similar to a bag.

There are:

bilateral gyrosalpinx;

hydrosalpinx on the left;

right-sided hydrosalpinx.

It is also incorrect to use combinations such as chronic and acute hydrosalpinx. This pathology refers to complications of the inflammatory process of the uterine tubes - salpingitis, so it can be chronic or acute.

An example of a diagnosis: Chronic bilateral salpingoophoritis. Hydrosalpinx is bilateral.

Anatomy and physiology

The fallopian tube (oviduct, fallopian tube) is a paired organ that is a hollow tube with two lumens. The length of the oviduct is 10-12 centimeters, with the right tube being slightly longer than the left. One end of the fallopian tube opens into the uterine cavity, while the other ends in villi (fimbriae) and opens near the ovary into the abdominal cavity. Through these openings, the abdominal cavity communicates with the external and internal genital organs, which only increases the risk of developing an ascending infection, for example, with vaginitis.

The wall of the oviduct consists of 3 layers:

internal - it is covered with ciliated epithelium, its cilia make wave-like movements that promote the movement of the fertilized egg towards the uterus. In addition, the glands on the mucous tube secrete a substance that maintains the viability of the zygote, sperm and egg, as well as the constancy of the internal environment of the oviduct;

muscular - made of muscle fibers, due to which contractile movements occur directed towards the uterine cavity;

external – represented by the peritoneum, it performs the function of protecting the pipe from negative influences.

The role of the fallopian tubes

Fallopian tubes are required to ensure successful conception as well as implantation of the (fertilized) egg in the uterine cavity. The functions of the oviducts include:

transportation of the zygote to the uterine cavity, through peristaltic movements of the oviduct, as well as increased activity of the ciliated epithelium (its cilia, in particular);

maintaining the vital activity of the zygote (fertilized egg) in the tube before it enters the uterine cavity;

maintaining the viability of sperm and eggs (sex cells), as well as their preparation for union, that is, fertilization;

the egg is delivered to the ampullary section of the fallopian tube, where sperm from the uterine cavity are also sent;

With the help of fimbriae, the mature egg, after its release from the follicle, is captured and brought to the funnel of the tube.

The mechanism of pathology development

The functioning of the fallopian tubes may be impaired due to inflammation, for example, against the background of salpingo-oophoritis or salpingitis. Pathological growth of connective tissue begins, adhesions and scars form. The inflammatory process, as well as adhesions, penetrate into all layers of the fallopian tube; only the degree of severity of the process differs.

The villi of the ciliated epithelium die, and the muscle layer stops contracting. Adhesions grow in the lumen of the fallopian tube, the patency of the oviduct is disrupted, and the fimbriae of the infundibulum stick together. When both lumens of the fallopian tube are closed by adhesions, fluid begins to accumulate in the resulting blocked cavity, resulting from increased secretion of mucus by the epithelial glands in response to inflammation. This leads to expansion of the tube and the formation of sactosalpinx, or hydrosalpinx. If suppuration of the serous-mucosal contents in the tube occurs, pyosalpinx appears.

Sometimes incomplete soldering of the tube fimbriae occurs. In such cases, they speak of “ventilated hydrosalpinx,” which tends to periodically break out under the pressure of fluid accumulated in the cavity of the pipe. An increase in pressure occurs due to a change in body position, during hysterosalpingography, or straining. There is an outpouring of transudate into the pelvis. With “ventilated hydrosalpinx,” the oviduct is emptied systematically. The inflammatory fluid that pours into the pelvis provokes the formation of adhesions - thus forming a kind of vicious circle that maintains hydrosalpinx.

Causes of hydrosalpinx

The formation of hydrosalpinx occurs as a result of the closure of the middle (ampullary) section of the oviduct; this occurs in response to a local infectious and inflammatory reaction. Infectious agents penetrate into the cavity of the fallopian tube both through the ascending route, from the lower organs of the reproductive system (cervix, uterus, vagina), and downward, namely through the bloodstream from the appendix, intestines, tonsils, kidneys, and bladder. Inflammation can be aseptic and occur in the presence of gynecological diseases. Hydrosalpinx is formed due to the following reasons:

diagnostic curettage of the uterine cavity and abortions;

frequent hypothermia (activation of opportunistic microflora against the background of weakened immunity);

wearing an intrauterine contraceptive device;

promiscuous sex life and frequent changes of partners (sexually transmitted infections: gonococci, trichomonas, ureaplasma, chlamydia);

endometritis (inflammation of the uterus);

inflammation of the appendages, ovaries, tubes (andexitis, oophoritis, salpingitis);

damage to the oviducts during laparoscopy with the occurrence of aseptic inflammation;

sexual infantilism (twisted, long, thin pipes);

myomatous node located at the entrance of the oviduct into the uterine cavity;

adenomyosis;

external endometriosis (causes aseptic inflammation and the formation of adhesions in the pelvic area);

inflammation of the cervical canal and cervix;

vaginal dysbiosis and long-term vaginitis.

Predisposing factors that increase the risk of developing hydrosalpinx:

endocrine pathologies: thyroid diseases, diabetes mellitus (weaken the body’s defenses);

emotional stress, stress;

neglect of the rules of personal intimate hygiene.

It is worth noting that treated and transferred andexitis or salpingitis does not always result in the occurrence of hydrosalpinx. In the presence of a strong immune system, as well as adequate timely treatment, inflammatory processes in the fallopian tube disappear without consequences.

Symptoms

The clinical picture of the pathology depends on what disease led to it. If hydrosalpinx occurs against the background of acute inflammation of the fallopian tubes, its symptoms are more pronounced. The patient suffers from signs of intoxication: weakness, lethargy, loss of appetite, bursting pain in the groin (right or left), febrile temperature. If transudate quickly accumulates in the middle section of the fallopian tube, then the pain can be described as pulsating and bursting.

If hydrosalpinx occurs against the background of the presence of a chronic form of salpingitis, quite often patients do not experience any discomfort. Most often, the only complaint is the inability to get pregnant, and the pathology itself is discovered during infertility research. However, complaints of discomfort in the iliac region, pain during sexual intercourse, and a sensation of a foreign body in the groin area are also possible. With ventral hydrosalpinx, a woman notices the appearance of periodic watery discharge from the vagina (provided that the formation has ruptured into the uterine cavity).

When fluid spills into the pelvic cavity, the processes of adhesions intensify, this manifests itself in the form of chronic pelvic pain syndrome. In some cases, a formation with fluid in the fallopian tube can behave like an acute surgical pathology (intestinal or renal colic, appendicitis).

Typical signs of the presence of chronic salpingitis with associated hydrosalpinx are:

absence of pregnancy;

pathological discharge from the genital tract;

menstrual disorders;

slight aching pain or discomfort in the iliac region.

Pregnancy with hydrosalpinx

Pregnancy can occur against the background of hydrosalpinx, but only if the tube is affected on only one side. Thus, it is easy to calculate that the chances of pregnancy are reduced by 50%. At the same time, the risk of tubal pregnancy and subsequent spontaneous abortion increases significantly. Ectopic pregnancy occurs due to damage to the ciliated epithelium and impaired peristalsis of the tube. Thus, the fertilized egg remains in the fallopian tube for up to 4 days or more, then it is implanted and begins to grow and develop.

Spontaneous abortion due to hydrosalpinx can be explained using several points:

decreased sensitivity of endometrial receptors to the effects of female sex hormones. This leads to disruption of the hormonal background of the uterine mucosa and the process of egg implantation;

there may be a toxic effect of the transudate on the embryo, with its damage and subsequent death;

the inflammatory fluid of the hydrosalpinx affects the uterine mucosa, which leads to the development of endometritis, and, accordingly, the impossibility of implantation of the embryo;

mechanical effect: periodic effusions of fluid during ventral hydrosalpinx simply wash away the zygote from the endometrium, preventing its implantation.

If hydrosalpinx of both tubes is diagnosed, then natural pregnancy is impossible. In this situation, assisted reproductive technologies, such as IVF, are required. It is worth noting that the effectiveness of in vitro fertilization and gestation is reduced by 2-5 times.

If pregnancy does occur due to saccular dilatation of the tube, then its spontaneous termination can occur at a late or early stage. Therefore, all pregnant women diagnosed with hydrosalpinx are considered to be at very high risk of miscarriage. Treatment during pregnancy is postponed until the postpartum period.

Diagnostics

Typically, the diagnosis of such a complication begins with a gynecological examination. During bimanual palpation, the hydrosalpinx is felt as an elongated, tightly elastic formation on one or both sides. Minor pain may appear during palpation of the appendages, but at the same time there may be no pain. If the dilation of the fallopian tube is insignificant, then the doctor may not detect complications during palpation; in such cases, additional studies are prescribed:

Ultrasound with a transvaginal sensor.

Allows you to determine the saccular formation on both or only one side, establish its location (between the ovary and the uterus), shape and size. It is also possible to visualize the septa (follicular hydrosalpinx). The formation has its own thick capsule, which is filled with hypoechoic fluid.

Hysterosalpingography.

This method involves introducing a contrast agent into the uterine cavity through the cervical canal (under pressure). After this, a series of x-rays are taken. This method allows you to determine the patency of the fallopian tubes - contrast is determined in the pelvis, visualizing hydrosalpinx. If there is a complication, the fallopian tube appears thickened and tortuous, and accumulated contrast is visible in the expanded middle section.

Laparoscopy.

Carried out for the purpose of diagnosis and treatment. During laparoscopy, thickening of the fallopian tube, hyperemic and edematous fimbriae at the ends are detected, at the same time, the wall of the oviduct itself is translucent and thinned, and its cavity is filled with liquid.

In addition to instrumental diagnostic methods, you also need to be tested for the presence of sexually transmitted infections (herpes virus, HPV, cytomegalovirus, myco- and ureaplasma, chlamydia).

Treatment

When diagnosing hydrosalpinx, a woman must undergo treatment, because the duration of the existence of such a complication depends on the neglect of the process of adhesions in the pelvis, which in turn is a factor that increases the risk of ectopic pregnancy, miscarriage and reduces the possibility of conception.

Unfortunately, some patients do not take this pathology seriously, thinking primitively - it doesn’t hurt, and therefore it’s not dangerous. This attitude leads to delays in visiting a gynecologist, and in some cases, delay leads to irreversible changes: the absolute impossibility of getting pregnant naturally, which can only be solved with the help of IVF.

Treatment of hydrosalpinx is performed in two stages. At the first stage, conservative therapy is carried out. In the presence of an acute inflammatory process in the appendages, or in case of exacerbation of a chronic process, it is necessary to undergo a course of antibiotic therapy. The duration of the course, as well as the dosage of the drug, is selected on a purely individual basis, taking into account sensitivity to drugs and the nature of the pathogen (if the result is positive for STIs).

The main line of the conservative therapy stage is to stimulate the immune system. For this purpose, immunomodulatory drugs are prescribed:

autohemotherapy (intramuscular injections of one’s own venous blood);

"Immunal";

"Aloe injections";

"Tactivin";

"Timalin";

"Imudon";

"Lykopid";

"Immunofan".

Also, in order to stimulate the immune system, it is recommended to take vitamins or their parenteral administration. Physiotherapeutic procedures are widely used, which, although they do not completely cure hydrosalpinx, provide favorable conditions for cure:

endovaginal vibration massage;

electrical stimulation of the fallopian tubes;

electrophoresis of electrolytes (magnesium, calcium);

Magnetic cutter

Hirudotherapists claim that this pathology can be gotten rid of with the help of leeches. However, such a statement has not only no scientific evidence, but also no confirmed statistical data.

Traditional methods

Many patients with hydrosalpinx believe that folk remedies will help them recover. Doctors also allow the use of traditional methods, but only as an additional treatment to the main conservative stage of therapy. Traditional medicine preparations do not eliminate complications, but act as symptom relievers: they slightly normalize the menstrual cycle, inhibit the formation of adhesions in the pelvis, and relieve pain. Among the recommended folk remedies you can use:

infusion of herbs (St. John's wort, sage, currant leaf, chamomile);

infusion of adonis;

taking juniper baths (infusion of juniper branches and berries is poured into the water, the water in the bath should be warm);

taking oat infusion;

taking a mixture of honey, butter and aloe leaves;

microenemas with medicinal herbs (oak bark, calendula, chamomile);

taking nettle, potato and pumpkin juice (mixing or separately).

Surgery

The second stage of treatment consists of surgically eliminating this complication during surgery. Treatment of hydrosalpinx that does not end with surgery is pointless. Until the source of inflammation is eliminated, adhesions will continue to form in the pelvis; accordingly, the pain persists, and the chances of natural fertilization are reduced.

Today, laparoscopy is used as a method of surgical removal of hydrosalpinx. Laparoscopic therapy for formation in the oviduct is an effective and most gentle method of surgical intervention. During the operation, various types of surgical intervention are performed in the structure of the fallopian tube; the technique is determined depending on the patient’s condition, the condition of the tubes and the desire to become pregnant.

Tubectomy – resection of one or both tubes (performed if there is no other way to eliminate the pathology, and also for women who are over 35 years old).

Salpingoneostomy and salpingostomy - the formation of a new hole in the middle section of the oviduct, or the release of the anatomical hole from adhesions (the downside of salpingoneostomy is that the new hole quickly overgrows).

Fimbryoplasty and fimbryolysis - release from adhesions of the fimbriae of the final section of the oviduct at the point of their adjacency to the ovary, and fluid is also removed from the tube. If necessary, fimbriaplasty is performed.

Salpingo-ovariolysis - adhesions around the ovary and oviduct are dissected, their normal position is restored, and adhesions are separated in the lumen of the fallopian tube.

It is worth noting that even if the operation was successful, the tube was preserved and successfully restored its patency, the oviduct will not be able to function normally. The cilia of the ciliated epithelium may lose their mobility, or the epithelium itself atrophies, the muscle layer ceases to contract normally, peristalsis is disrupted, so patients after surgery to eliminate hydrosalpinx are at risk of ectopic pregnancy. In such cases, fertilization using IVF is recommended.

Frequently asked questions regarding hydrosalpinx

What is the danger of this pathology?

The presence of hydrosalpinx in a woman significantly increases the risk of ectopic pregnancy. In addition, the pathology can cause infertility. An increase in saccular formation in the absence of treatment ends in rupture of the pipe and suppuration.

Is it necessary to introduce any restrictions if there is a diagnosis of hydrosalpinx?

Yes. Firstly, you need to avoid heavy physical activity (jumping, bending, somersaults, straining, vibration). Secondly, you should avoid excessive activity during sex, especially if pain is present. In addition, it is necessary to prevent overheating of the body; it is forbidden to take hot baths or visit saunas. Baths, solariums, and sunbathing. The fact is that heating leads to an exacerbation of the inflammatory process. It is also undesirable to swim in open reservoirs and pools, since hypothermia can also cause an exacerbation. It is prohibited to drink alcohol, including low-alcohol drinks, because alcohol suppresses the immune system.

What is the prognosis when planning pregnancy after laparoscopy for such a complication?

If the patency of the tube is restored and the hydrosalpinx is completely removed, then conception naturally followed by pregnancy occurs in 60-75% of cases, and the risk of developing a tubal pregnancy is less than 5%. If the tube has been removed, then the effectiveness of in vitro fertilization is 30-35%.

For 3-4 weeks, you should avoid physical activity and maintain complete sexual rest. You also need to go on a diet that involves limiting canned food, fast food, fatty and fried foods, salty and pickled foods, spicy foods and dishes.