Hydrosalpinx
What’s that?
Hydrosalpinx is an accumulation of secretion in the lumen of the fallopian tube associated with obstruction of its fimbrialsection. The disease has inflammatory causes.
About the disease
The fallopian tube is a cylindrical formation connected to the uterine cavity on one side and opens freely into the abdominal cavity with its fimbrial end on the other. The fallopian tube is lined with mucous membrane from the inside, which contains epithelial cells that produce mucus. In the case of an unobliterated tube, the secretion produced flows freely into the uterus due to the directed movements of cilia (outgrowths of epithelial cells that line the mucosa).
In the case of an inflammatory process, conditions are created for the accumulation of fluid in the lumen of the tube.
The uterus in hydrosalpinx can also be involved in the pathological process. Thus, often in combination with inflammation of the tube, chronic sluggish endometritis is diagnosed.
The pathogenetic factors of hydrosalpinx are:
- impaired blocking of ciliary transport (functional inactivity of cilia);
- increased fluid formation, which consists not only of mucus but also of inflammatory exudate formed by the passage of plasma through the vascular wall;
- impaired emptying of the fallopian tube into the abdominal cavity with the formation of adhesions in the fimbrialsection, which causes its obliteration.
The accumulated fluid exerts mechanical pressure on the walls of the tube, which leads to their thinning and even greater violation of the functional state. In the normal tube is the place of fertilization of the egg, from where it, thanks to the movements of cilia, descends into the uterine cavity and is implanted in the decidually altered endometrium. With hydrosalpinx, this process is disturbed – a woman often develops a tubal-peritoneal form of infertility. The severity of its course is determined not only by the intraluminal state of the tube but also by the possibility of compression from the outside (formed adhesions of the peritoneum).
Types
Hydrosalpinx disease can be classified into the following classes:
- simple, when the entire tube is dilated and is a single cavity;
- follicular – the dilated tube is divided by connective tissue ties into several sections;
- ventilated – there is periodic emptying of the tube either towards the abdominal cavity or into the uterine cavity.
Depending on the prevalence of the pathological process, unilateral or bilateral hydrosalpinx is distinguished.
Symptoms of hydrosalpinx
Clinical signs of hydrosalpinx may be absent for a long time, as the developing salpingitis is primarily chronic and sluggish. However, some women may note the following symptoms:
- minor pain or discomfort in the lower abdomen;
- menstrual irregularities;
- intermenstrual bleeding;
- odorless discharge from the genital tract;
- soreness and discomfort in the vagina during intercourse.
If hydrosalpinx suppuration occurs, the general condition of the woman worsens significantly. Body temperature rises, pain appears, or increases, and vaginal discharge is often purulent. In the general blood test, an increased level of leukocytes and acceleration of erythrocyte sedimentation are determined. Vaginal examination reveals sharp soreness on the side of the lesion.
Causes of hydrosalpinx
The direct cause of hydrosalpinx is infection. In the role of specific pathogens can be chlamydia, trichomonas, viruses, mycoplasmas, and others. In some cases, the development of hydrosalpinx can lead to the development of conditionally pathogenic nonspecific microorganisms that constantly inhabit the vagina, but with a decrease in the body’s defenses can cause inflammation.
Risk factors that may increase the likelihood of hydrosalpinx formation are:
- frequent changes of sexual partners;
- early initiation of sexual activity without condom use;
- comorbidities that disrupt the microbial landscape of the vagina;
- vaginal sprays;
- taking antibacterial drugs without a doctor’s prescription;
- taking corticosteroids and other drugs that depress immunity.
Diagnosis of hydrosalpinx
During vaginal bimanual examination, hydrosalpinx can be suspected if a soft-elastic mass sensitive or painful to pressure is detected in the area of the appendages. With a prolonged inflammatory process, the contours of the mass may become indistinct because peritubular adhesions develop.
After the diagnosis of hydrosalpinx is established, the gynecologist prescribes an examination to identify the most probable cause of the development of this pathology. The program of laboratory diagnostics can be carried out in the following areas:
- bacteriologic examination of uterine aspirate and posterior vaginal vault secretions;
- PCR testing to identify specific pathogens.
The most accurate results can be obtained if the study is performed with material obtained during diagnostic laparoscopy. However, in practice, this is a difficult task to realize.
Treatment of hydrosalpinx
Treatment of hydrosalpinx begins with conservative measures. If they are ineffective, the issue of laparoscopic intervention is decided.
Conservative treatment
Conservative treatment is selected based on the results of laboratory examination, which allows to establish the most probable cause of the inflammatory process. The treatment program may include the following drugs:
- antimicrobial agents directed against causative bacteria, viruses, or protozoa;
- immunomodulatory drugs that improve the activity of the immune defense;
- anti-inflammatory medications that prevent secondary damage;
- vitamin and mineral complexes that improve the course of metabolic processes.
After the inflammatory process subsides, a complex of individually selected physical procedures is functional.
Surgical treatment
If a woman is planning a pregnancy and conservative treatment of hydrosalpinx has not been successful, the question of surgical intervention is decided. Taking into account the clinical situation, the following types of surgery may be proposed:
- Organ-preserving – fallopian tube repair. The surgeon disconnects adhesions, removes fluid, and restores the patency of the organ.
- Organ-killing – tubectomy. If the tube is severely altered, its complete removal is performed. In preparation for IVF, this allows you to avoid ectopic pregnancy and remove the focus of chronic infection.
Fallopian tube repair and tubectomy in modern gynecology are performed by laparoscopic access. The gynecologist makes three small punctures in the anterior abdominal wall, through which instruments are inserted. All manipulations are performed gently, which avoids trauma to nearby tissues. Postoperative recovery after laparoscopic intervention is faster and more comfortable than after traditional cavity surgery.
All these treatment options are available in more than 700 hospitals worldwide (https://doctor.global/results/diseases/hydrosalpinx). For example, salpingectomy can be performed in 25 clinics across Turkey for an approximate price of $2.9 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/salpingectomy).
Prevention
The following interventions can help reduce the risk of hydrosalpinx formation:
- protection from sexual infections – using a condom in the absence of a regular partner, regular microbiological tests;
- maintaining the health of the vaginal microflora – compliance with the rules of intimate hygiene, the use of detergents with a slightly acidic pH level for washing, refusal of vaginal sprays, which contribute to the washout of microflora;
- regular visits to the gynecologist for the timely detection of possible adversity in the reproductive system.
Rehabilitation
After conservative treatment or fallopian tube repair, a course of physiotherapeutic procedures is recommended to reduce the risk of adhesions. They will improve the functional state of the organ.
