Hydrosalpinx symptoms. Hydrosalpinx - is it possible to do without surgery? Conservative therapy: antibiotics, vitamins, tampons with Vishnevsky ointment and other means

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 reproductologists ranges from 10 to 30%.

The 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, a paired anatomical formation about 10-12 cm long, connecting the bottom of the uterus with the pelvic cavity. With one opening, the fallopian tube opens into the uterine cavity. Its distal end ends at 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 oviduct from the outside, the muscular one consists of two multidirectional layers of smooth muscle fibers that provide peristalsis (contractions) to the oviduct in the direction from the ovaries to the uterus. The mucous membrane forms longitudinal folds and is a layer of cells of a cylindrical ciliated epithelium 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 to maintain the activity of spermatozoa, the viability of the egg and 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, it 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. The capture of the egg through the fimbriae at the time of its release from the follicle into the abdominal cavity (ovulation).
2. Ensuring the movement of the egg and the 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. Transfer of the embryo to the uterus through peristalsis and increased activity of the cilia of the epithelium.
5. Ensuring the development of the embryo before the implantation of a fertilized egg in the uterus.

What is hydrosalpinx

The wording "chronic hydrosalpinx" that is sometimes encountered 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 infectious pathogens, sexually transmitted. The most common cause is considered, less often - gonococcus, Trichomonas and other PPIs or opportunistic microflora (mycobacterium tuberculosis).
2. Transferred and cured in the past salpingitis.
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, which reduces its diameter.
6. Tubal pregnancy.
7. Injuries 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. Anomalies of development.

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 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, to a violation of the innervation of the walls and blood circulation in them, to damage to the ciliated epithelium, an increase in 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 circulatory disorders in the walls lead 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 a violation of its outflow, a change in the structure of the muscle layer and a deterioration in peristalsis lead to overstretching of the walls and the formation of a "bag" with liquid contents. Sometimes, with incomplete closure of the holes, it can be emptied (draining hydrosalpinx). In these cases, the liquid content enters the uterine cavity or the pelvic cavity. Pathological formation can also be simple or multi-chamber (follicular), when adhesions separate the cavity, forming several chambers.

Symptoms

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

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

Pain is more often observed during an exacerbation of chronic inflammation. Accession of a secondary infection can cause purulent salpingo-oophoritis and pelvioperitonitis, requiring surgical treatment.

Hydrosalpinx and pregnancy

In accordance with statistical data, the probability of pregnancy in this pathology is reduced by at least two times, and the number of cases of spontaneous abortion (miscarriage) increases by the same amount.

In connection with the widespread use of in vitro fertilization (IVF), there have been many reports indicating a significant number of cases of ineffectiveness of the procedure in women with this disease. The frequency of implantation of a fertilized egg, development of the embryo and pregnancy in them is 2-5 times lower than in women with other causes of infertility. Moreover, the degree of negative results of IVF 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 ectopic pregnancy. However, the frequency of this complication after IVF associated with hydrosalpinges is the same as in other tubal pathologies. Fundamental in these cases is precisely 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

Unsuccessful attempts at natural conception and pregnancy, as well as pregnancy through methods of treatment that are close to the natural process, in conditions of a preserved menstrual cycle, are explained by several reasons already described above:

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

However, these 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 the removal of diseased appendages contributes to an increase (by an average of 3 times) in the pregnancy rate as a result of IVF.

This dependence on the disease is mainly due to the following reasons:

1. Mechanical effect: periodic outflow of accumulated fluid into the uterine cavity during emptying of the hydrosalpinx mechanically washes 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 also affects.
2. The damaging effect of fluid on the uterine endometrium. The process of implantation occurs with the participation of various biochemical reactions between the fertilized egg and the endometrium. They are hampered by the influence of a fluid that is a transudate (plasma effusion through the walls of blood vessels), intercellular fluid and the secret of the glands of the mucous membrane (mucus). The composition of the liquid also includes microorganisms and their toxins, destroyed cells of the mucous membrane, cytokines, prostaglandins, etc., causing damage and normal functioning of the surface layer of the endometrium and cells of the integumentary epithelium, somewhat similar to chronic endometritis.
3. Toxic (in some cases) influence of the elements of the flowing 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 introduction of the egg is also disrupted.

Diagnosis and treatment of hydrosalpinx

Basic diagnostic methods

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

In these cases, it is possible to suspect the disease and check the patency of the lumen of the fallopian tubes with a radiopaque substance injected into the uterine cavity. The hydrosonography method is considered more accurate, that is, checking the patency through ultrasound with the simultaneous introduction of a sterile solution.

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

• insufficient reliability of the results, which makes it 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 you to assess the condition of the pipes and take their contents for sowing in order to establish the presence of an infectious agent 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 carrying out this procedure, due to its invasiveness and the possibility of developing an adhesive process to an even greater extent, and also because of the financial cost.

The results of instrumental research, including endoscopic, allow us to establish a number of prognostic factors that affect the choice of treatment tactics:

1. The volume 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. Wall thickening.
4. The degree of preservation of the folding 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 - tender membranous or coarse 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 physiotherapy and balneological procedures, mud therapy.

Conservative therapy can be recommended for mild 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 uterine pregnancy. The risk of ectopic pregnancy is less than 5%. Surgical treatment, depending on the nature of pathological changes, is carried out by various endoscopic methods:

• salpingo-ovariolysis - dissection of adhesions around the tube and ovary and restoration of their anatomical location, as well as the destruction of adhesions inside the tube;
• fimbriolysis, or fimbrioplasty - release from adhesions of fimbriae and / or their plastic;
• salpingostomy or salpingoneostomy - the release of the anatomical or the formation of a new hole in the ampullar region when it is obstructed.

In most cases, reproductive specialists advise IVF and, as a preparatory stage, surgical salpingectomy (removal of the pathological fallopian tube), after which the probability of pregnancy as a result of in vitro fertilization increases by more than 2 times.

- hydrosalpinx. According to statistics, it is detected in 30% of women of reproductive age. Pathology interferes with the successful conception of a child. However, with adequate treatment, pregnancy is possible. In today's article, we will talk about how to recognize the disease in a timely manner, what methods of its treatment modern medicine offers.

The structure and functions of the fallopian tubes

To understand the mechanism of the development of the disease and its possible causes, it is necessary to delve into the anatomy. The uterine or fallopian tube is a paired organ with two lumens. Its length is 10-12 cm. One of the ends of the tube opens into the uterus, and the other ends with villi and exits near the ovary. Through these holes, the abdominal cavity communicates with the genitals.

The walls of the fallopian tube consist of three layers: outer, muscular and inner. The first is represented by the peritoneum and performs a protective function. The muscular layer contributes to the emergence of contractile movements directed towards the uterine cavity. The inside of the fallopian tube is lined with ciliated epithelium. Its main function is to make wave-like movements, thanks to which the fertilized egg freely enters the uterus. Between the elements of the ciliated epithelium are located They are responsible for the development of a special secret. This substance maintains the viability of sperm, egg and embryo at the initial stages of its development.

What is tubal hydrosalpinx?

This is a gynecological disease that eventually leads to a violation. It is characterized by a gradual accumulation of transudate in the lumen of the canals. As a result, the pipe turns into a formation that looks like a bag. At the initial stage of development, the pathological process practically does not manifest itself. Usually, the disease is diagnosed when a woman turns to a gynecologist in search of the causes of infertility.

Doctors distinguish the following forms of hydrosalpinx:

• left-sided;
• right hand;
• bilateral.

The unilateral form of the disease is characterized by the appearance of inflammation on only one tube. In this case, a woman can become pregnant on her own, but the probability of successful conception is halved. With bilateral hydrosalpinx, both tubes are blocked. It is impossible to get pregnant with such a diagnosis if you do not consult a doctor in a timely manner. Subsequently, complete infertility can form, in which the probability of independently enduring and giving birth to a healthy child is zero.

Separately, it is necessary to consider the chronic form of pathology. It develops gradually and is not manifested by any deviations. The woman feels great. Hydrosalpinx of the fallopian tubes is found by chance, during examination by a gynecologist. Therefore, it is so important to periodically undergo a preventive examination by this doctor.

The mechanism of the development of the disease

Violation of the fallopian tubes begins against the background of inflammation, for example, with salpingitis or salpingoophoritis. There is a pathological proliferation of connective tissue, numerous adhesions and scars are formed. Inflammation gradually spreads to all layers of the fallopian tubes.

The villi of the ciliated epithelium die, and the muscle layer ceases to fully contract. Adhesions grow in the lumen of the tube, disrupting its patency. A secret begins to accumulate in the formed cavity. It is produced by the glands of the epithelium in response to the existing inflammation. Thus, a disease of the fallopian tubes develops - hydrosalpinx.

Main reasons

The onset of the disease is due to the closure of the middle section of the fallopian tubes. Usually such a problem is the body's response to a local inflammatory process. Infectious agents penetrate both ascending and descending pathways. In the first case, they mean the organs of the reproductive system (cervix, uterus, vagina). In the second, we are talking about the intake of infectious agents along with the blood flow from the appendix, kidneys or bladder. Sometimes inflammation has an aseptic nature, when its development is preceded by various gynecological ailments.

Doctors distinguish the following causes of hydrosalpinx of the fallopian tubes:

• frequent abortions, diagnostic curettage of the uterine cavity;
• use of an intrauterine device;
• hypothermia (activation of pathogenic flora occurs against the background of weakened immunity);
• frequent change of sexual partners;
• inflammatory processes affecting the area of ​​​​the appendages and ovaries (oophoritis, adnexitis);
• adenomyosis;
• endometritis;
• vaginal dysbiosis.

A unilateral process (hydrosalpinx of the left fallopian tube or only the right one) often occurs due to anatomical disorders or due to pyosalpinx. In this case, the purulent contents are completely absorbed, only a serous secret remains. A bilateral pathological process affecting both fallopian tubes is formed against the background of chronic inflammation caused by various infectious agents.

Clinical picture

What are the symptoms of tubal hydrosalpinx? At the initial stage of the development of the disease, there are no characteristic signs, since inflammatory processes are not active. It is revealed, as we have already said, by chance, during an examination by a gynecologist.

As the disease progresses, an expanded clinical picture appears. Increased secretion of mucus by the glands of the epithelium leads to overfilling of the tubes, as a result of which they increase in size. Because of this, the woman has a feeling of heaviness in the lower abdomen. If the pathology is bilateral in nature, such a symptom manifests itself on both sides. Periodically, it is possible to increase the temperature to subfebrile indicators. In some cases, women note increased secretion from the vagina.

With the diagnosis of "obstruction of the fallopian tubes" hydrosalpinx is reflected in the reproductive abilities of the organism. When the lumens are completely closed, the egg cannot get inside, so fertilization does not occur. Such a violation is called If the lumen is not completely blocked, the mucosal folds are smoothed out, and the muscle tissue atrophies. As a result of these changes, a woman has an increased risk of ectopic pregnancy.

An unpleasant complication of hydrosalpinx is the rupture of the fallopian tube. This disorder is characterized by the appearance of severe pain in the lower abdomen and tachycardia, a decrease in blood pressure. The skin gradually turns pale, distinct sweat bubbles appear on it. If these symptoms occur, you should immediately call a team of medical workers.

Hydrosalpinx and pregnancy

Laparoscopy is recommended for women with hydrosalpinx planning a pregnancy. This procedure allows you to restore the patency of the pipes, but their natural function is often disrupted. In addition, the number of receptors for the main hormones - estradiol and progesterone - is sharply reduced. These factors can lead to an ectopic pregnancy.

If the pathological process extends to only one tube, conception is possible. However, the presence of a focus of inflammation in the pelvis is detrimental to the developing embryo. The liquid contained in it consists of lymphocytes and other toxic agents. Therefore, without surgical treatment, pregnancy is not recommended. Removal of the fallopian tubes with hydrosalpinx does not reduce a woman's sexual desire, does not affect her hormonal background or the menstrual cycle. With a bilateral form of the disease, pregnancy in a natural way is impossible. In this case, the IVF procedure is recommended for the woman.

Resection of the fallopian tubes before in vitro fertilization entails an increase in the likelihood of successful conception by about 30%. The prognosis is significantly improved if an immediate removal operation is performed, rather than trying to restore the patency of the oviducts using various laparoscopy options.

Previously, it was suggested that the removal of the fallopian tubes entails a violation of the blood supply and nervous regulation of the ovaries. The conducted studies did not confirm this information. Removal of the affected tubes before IVF does not affect the condition of the ovaries, their response to the stimulation process, the fertilization rate.

Diagnostic methods

If you suspect hydrosalpinx of the fallopian tubes, you should immediately contact a gynecologist. Diagnosis of this disease begins with an examination of the patient. When performing bimanual palpation, the pathology is palpated in the form of an oblong, tight formation only on one side or simultaneously on both sides. This procedure may cause pain discomfort. Then they move on to instrumental diagnostic methods. Among them, the most informative are the following procedures:

1. Transvaginal ultrasound. Allows you to determine the hydrosalpinx, to establish the localization, shape and approximate size.
2. Hysterosalpingography. Helps to assess the patency of the fallopian tubes. During the diagnosis, a contrast agent is injected into the uterine cavity under pressure. After that, a series of radiographic images are taken, on which the internal genital organs are clearly visible.

In medical practice, there are cases when, after such an examination, women became pregnant on their own. On the other hand, it increases the likelihood of exacerbation of chronic inflammation.

A more reliable diagnostic method is laparoscopy of hydrosalpinx of the fallopian tubes. The use of this method allows you to assess their condition and take the contents to determine the infectious agent, its sensitivity to antibiotics. Sometimes doctors refrain from laparoscopy because of its invasiveness. Such an intervention can enhance the development of the adhesive process.

Based on the results of the examination, the doctor confirms or refutes the preliminary diagnosis, gives recommendations for treatment. Therapy for this pathology can be conservative or surgical. Let's consider each of the options in more detail.

Conservative treatment

Therapy should be started immediately after the doctor confirms the diagnosis of hydrosalpinx of the fallopian tubes. Treatment without surgery is recommended for women who no longer plan pregnancy, or with a slight severity of the pathological process. To combat inflammation, antibiotics are prescribed. The duration of the course of therapy and the dosage of medications are determined by the doctor. In this case, the specialist must take into account the sensitivity of the pathogenic flora to the drugs used and the nature of the pathogen.

Conservative treatment includes measures to stimulate immunity. For this purpose, patients are prescribed immunomodulatory drugs (Taktivin, Timalin, Imudon) and vitamin complexes. Physiotherapy procedures are widely used. They do not completely cure the disease, but have a beneficial effect on the body. Among them are:

• UHF;
• UFO;
• magnetorez;
• electrophoresis;
• endovaginal vibromassage.

If doctors have diagnosed a running hydrosalpinx of the fallopian tubes, treatment is possible only through surgical intervention.

Surgical treatment

How to treat hydrosalpinx of the fallopian tubes? Today, laparoscopy is used as a fundamental method of surgical elimination of pathology. This is the most effective and at the same time sparing method of treatment. There are several variations of this procedure. The specific treatment option is chosen by the doctor, taking into account the health of the patient, the condition of the fallopian tubes.

1. Tubectomy. During this operation, the doctor performs a resection of one or both tubes. They resort to her help when there are no other options for treating the disease.
2. Salpingoneostomy. The procedure involves the formation of a new hole in the fallopian tube.
3. Fimbriolisis. Surgical manipulations are aimed at releasing the villi of the end section of the tube from adhesions, removing fluid.
4. Salpingo-ovariolysis. During the procedure, the doctor dissects the adhesions in the lumen of the tube.

Is pregnancy possible after laparoscopy of the fallopian tubes? Hydrosalpinx is a very serious pathology, the long course of which necessarily affects the health of a woman. A successful operation is not a guarantee of a quick conception of a baby. If the doctor managed to save the tubes and restore their patency, the oviduct will not fully function. The cilia of the ciliated epithelium may lose their mobility, and the muscle layer often stops contracting. As a result, normal peristalsis is disturbed. Therefore, women after the operation are at risk of ectopic pregnancy. Such patients are recommended to be fertilized through IVF.

Preventive actions

Hydrosalpinx of the fallopian tubes, the treatment of which is described just above, is a serious disease. However, its occurrence can be prevented if the following recommendations are observed:

1. It is necessary to treat gynecological ailments in a timely manner. If you experience pain, uncharacteristic discharge or other unpleasant symptoms, you should immediately contact a gynecologist.
2. It is important to follow the basic rules of personal hygiene. Shower doctors advise to take twice a day. During menstruation, hygiene products should be changed as often as possible.
3. It is better to give up promiscuity and always use barrier contraceptives.
4. It is necessary to adhere to a healthy lifestyle, eliminate all addictions.

Hydrosalpinx of the fallopian tubes, if left untreated, can provoke the development of serious complications. These include not only infertility. Even with the successful conception of a baby, there is a possibility of miscarriage or spontaneous miscarriage.

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 a 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. Such an approach will only aggravate the pathological process and delay the onset of the long-awaited conception, and in especially advanced cases, pregnancy may not occur at all.

What it is?

Hydrosalpinx (from other Greek ǔδωρ - “water” and σάλπιγξ - “pipe”) is a unilateral or bilateral saccular extension of the fallopian tube filled with a clear serous uninfected fluid (transudate), which is formed against the background of inflammation due to soldering of the ampullar section of the fallopian tube.

The 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, a paired anatomical formation about 10-12 cm long, connecting the bottom of the uterus with the pelvic cavity. With one opening, the fallopian tube opens into the uterine cavity. Its distal end ends at 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 oviduct from the outside, the muscular one consists of two multidirectional layers of smooth muscle fibers that provide peristalsis (contractions) to the oviduct in the direction from the ovaries to the uterus. The mucous membrane forms longitudinal folds and is a layer of cells of a cylindrical ciliated epithelium 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 to maintain the activity of spermatozoa, the viability of the egg and 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, it 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. The capture of the egg through the fimbriae at the time of its release from the follicle into the abdominal cavity (ovulation).
2. Ensuring the movement of the egg and the 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. Transfer of the embryo to the uterus through peristalsis and increased activity of the cilia of the epithelium.
5. Ensuring the development of the embryo before the implantation of a fertilized egg in the uterus.

The mechanism of development of pathology

Violation of the 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 adhesion formation capture 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 fimbria of the funnel of the tube stick together. When adhesions close both openings of the oviduct, mucus begins to accumulate in the resulting closed space, intensively, 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. With suppuration of the serous-mucous contents of the tube, a pyosalpinx is formed.

In some situations (incomplete soldering of the fimbriae), a “valve hydrosalpinx” is formed, which periodically breaks through due to the pressure of the accumulated fluid. An increase in pressure occurs with a sharp change in body position, straining, in the process of hysterosalpingography. In this case, the transudate is poured into the small pelvis. Emptying the oviduct with "valve hydrosalpinx" occurs systematically. The poured out inflammatory fluid stimulates the formation of adhesions in the pelvis - a vicious circle is formed that supports the existence of hydrosalpinx.

Causes of hydrosalpinx

The formation of hydrosalpinx occurs due to the closure of the middle (ampullar) section of the oviduct, this occurs in response to a local infectious-inflammatory reaction. Infectious agents penetrate into the cavity of the fallopian tube both along the ascending path, from the lower organs of the reproductive system (cervix, uterus, vagina), and downward, namely with the blood flow from the appendix, intestines, tonsils, kidneys, bladder. Inflammation can be aseptic, occur in the presence of gynecological diseases.

Hydrosalpinx is formed due to such reasons:

• wearing an intrauterine contraceptive;
• diagnostic curettage of the uterine cavity and abortion;
• frequent hypothermia (activation of opportunistic microflora against the background of weakened immunity);
• inflammation of the appendages, ovaries, tubes (andexitis, oophoritis, salpingitis);
• promiscuous sex life and frequent change of partners (sexual infections: gonococci, trichomonas, ureaplasma, chlamydia);
• endometritis (inflammation of the uterus);
• myomatous node located in the area of ​​​​the entrance of the oviduct into the uterine cavity;
• adenomyosis;
• damage to the oviducts during laparoscopy with the occurrence of aseptic inflammation;
• sexual infantilism (coiled, long, thin tubes);
• external endometriosis (causes aseptic inflammation and the formation of adhesions in the pelvic area);
• inflammation of the cervical canal and cervix;
• vaginal dysbacteriosis and prolonged vaginitis.

Predisposing factors that increase the risk of developing hydrosalpinx:

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

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

Classification

There are hydrosalpinx:

Symptoms

Very often, hydrosalpinx at the very beginning is completely asymptomatic. The woman is mainly concerned about the symptoms of the primary disease, against which it arose. In the process of the development of the disease, signs gradually begin to appear that are different from the main pathology, the intensity of which increases. They make you alert and run to the doctor to find out the causes of anxiety.

But it often happens that a woman tries not to pay attention to discomfort for a long time, attributing everything to premenstrual syndrome, physical overload, ovulation, and so on, thereby aggravating the condition. What are the symptoms of pathology?

1. Persistent pulling pains in the lumbar region of varying intensity.
2. Drawing pains in the lower abdomen, which subside from time to time and resume again (they have the greatest intensity on the side of the lesion).
3. Menstrual disorders.
4. The rise in body temperature to subfebrile figures (no more than 37.5 ° C).
5. General malaise (weakness, dizziness, etc.).
6. Feeling of fullness in the lower part of the abdomen, which is more intense on the side of the affected tube.
7. Unsuccessful attempts to conceive a child.
8. Discharge from the genital tract. With any type of hydrosalpinx, there is an increase in the release of whites (which is very typical in the presence of an inflammatory process). There may also be periodic watery discharge from the vagina (characteristic of the valve type of pathology), as a result of which all symptoms temporarily subside until the next filling of the fallopian tube with fluid.

Diagnostics

Diagnosis of the disease we are considering is carried out in several stages. Among them are the following:

1. ultrasound. Ultrasound examination determines the presence of a liquid formation between the ovaries and uterus.
2. Gynecological examination. In this case, it is possible to determine between the ovary and the uterus a tight-elastic formation of an ovoid or rounded shape, which, as a rule, is painless or slightly painful.
3. Laparoscopy. As in a number of other gynecological diseases, this method is not only diagnostic, but also therapeutic.
4. Hysterosalpingography. The nature of the x-ray picture may be similar to the nature of the obstruction of the fallopian tubes. In the case of valve sactosalpinx, filling the tube with a contrast agent determines its external resemblance to a twisted "sausage".

Possible Complications

Complications of hydrosalpinx can be:

• ectopic (tubal pregnancy);
• miscarriage;
• suppuration of hydrosalpinx (pyosalpinx);
• adhesions in the pelvic cavity;
• infertility;
• in the case of IVF - the ineffectiveness of the procedure, spontaneous termination of the resulting pregnancy;
• rupture of the fallopian tube.

Treatment of hydrosalpinx

It is almost impossible to treat hydrosalpinx without surgery. The treatment program includes two stages.

At the first stage it is necessary:

• determine the nature of structural disorders in the affected tube (one or both);
• establish the source of infection and determine the appropriate antibacterial drug to eliminate it.
• identify concomitant infectious and inflammatory changes in the vagina, uterus and cervical canal;
• find out how far the inflammatory process has spread, whether there are signs of inflammation in the ovaries or in the pelvic cavity;
• diagnose existing dyshormonal disorders.

The complex of therapeutic measures at the first stage of hydrosalpinx therapy includes antibacterial, anti-inflammatory therapy and physiotherapy. Most often, the first stage of treatment is preparatory, and after it, an operation is performed to remove the hydrosalpinx by the laparoscopic method.

Sometimes patients try to treat hydrosalpinx without surgery on their own, using randomly selected antibacterial agents or using traditional medicine recipes. Such a practice does not bring proper benefits or leads to an imaginary recovery when the symptoms of the disease pass, and the chronic process continues to progress and can lead to a rupture of the fallopian tube.

The next stage of treatment involves not only the removal of the hydrosalpinx itself, but also the restoration of the patency of the fallopian tube. Both tasks are successfully handled by laparoscopy.

Laparoscopic hydrosalpinx surgery is the most effective method of infertility treatment, and also represents the most reliable diagnostic method that allows the doctor to see the changes in their natural form. Before starting the operation, they carefully examine the area of ​​\u200b\u200bthe pipe, assess the degree of development of inflammation and the level of damage. Based on what he saw, the doctor determines further surgical tactics.

As a rule, the essence of the operation is to remove the hydrosalpinx, dissect adhesions and restore the lumen of the fallopian tubes. If the pipe cannot be restored, it must be removed.

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

With restored tube patency and removal of hydrosalpinx, conception in a natural way and gestation occurs in 60-75%, and the likelihood of an ectopic pregnancy does not exceed 5%. If the tube is removed, IVF efficiency is 30-35%.

Do I need to observe any restrictions for this disease?

Yes, definitely. Firstly, physical activity should be avoided (vibration, straining, a sharp change in body position: somersaults, bends, jumps). Secondly, avoid excessive activity during intercourse, which increases pain. In addition, it is not recommended to sunbathe and visit the solarium, as well as visiting baths, saunas and taking hot baths, which can provoke an aggravation of the inflammatory process.

It is undesirable to swim in the pool and open water, as local hypothermia will also provoke an aggravation. It is forbidden to drink alcohol, including low-alcohol drinks, which suppresses the immune system.

Hydrosalpinx or, as it is also called, dropsy of the fallopian tube is a fairly common gynecological disease.

It is based on the process of formation of transudate in the lumen of the tube, leading to obstruction of the organ, as a result of which it loses its functionality. Currently, this disease is a common cause of infertility in women of reproductive age. Therefore, the first signs of hydrosalpinx should be the reason for immediately seeking qualified help.

Causes of hydrosalpinx development

The main reasons for the development of dropsy of the fallopian tubes include:

• diseases of the pelvic organs of an infectious and inflammatory nature;
• the formation of adhesions in the pelvic cavity;
• undesirable consequences of the surgical elimination of an ectopic pregnancy, which occurred with the saving of an organ (in this case, the fallopian tube).

According to statistical studies, hydrosalpinx is most often diagnosed in women of childbearing age who are sexually active and prone to the development of infectious processes in the genital organs. A very common cause of the formation of fluid in the cavity of the fallopian tubes is an infection: chlamydia, trichomoniasis, gonorrhea, certain types of viruses, and the like. Rarely, non-compliance with the rules of personal hygiene and a weakening of the immune system of a woman against the background of bad habits can lead to a disease.

The main symptoms of the disease

Symptoms of dropsy of the fallopian tube depends on the form of the disease and the nature of its course. In the case of the development of an acute pathological process with the rapid formation of serous exudate, a woman complains of the appearance of sharp arching pains in the inguinal region, the intensity of which increases as the amount of fluid increases.

Soreness is accompanied by an increase in the overall temperature to 39 degrees, the development of symptoms of intoxication, loss of strength, apathy, dizziness, tachycardia, and the like. An experienced gynecologist may suspect acute hydrosalpinx by the characteristic pathological red blush on the woman's cheeks.

Chronic hydrosalpinx is characterized by a very long and almost asymptomatic development, especially in the initial stages of the disease. The chronic process leads to gradual gluing of the fallopian tube fimbriae under the influence of the exudate secreted by the mucous membrane of the organ and, as a result, the development of a tubal type of infertility.

In most cases, there are no complaints in women with a chronic form, so the disease, unfortunately, is diagnosed too late, when even surgery is not able to restore the patency of the fallopian tubes.

In chronic hydrosalpinx, the fallopian tube loses not only its functionality, but also its usual dimensions. A new formation can reach a diameter of one to five centimeters threatening to rupture an organ. Painful sensations in a chronic process, as a rule, are absent in women.

In rare cases, patients note the periodic appearance of a feeling of the presence of a foreign body in the groin or discomfort in the small pelvis. Sometimes, with dropsy of the fallopian tube, it is possible for the organ to self-liberate itself from the liquid by pouring it out. Such a phenomenon in medical practice is called a "valve" hydrosalpinx.

Modern diagnostic methods

With the development of modern medicine, it has become possible to diagnose pathology even at the earliest stages of the formation of the pathological process, when a woman is still unaware of the onset of the disease.

To date, the diagnosis of hydrosalpinx includes several stages:

1. Gynecological examination of the patient.
2. Ultrasound diagnostics of liquid formation in the pelvic cavity.
3. Hysterosalpingography, which makes it possible to assess the patency of the fallopian tubes.
4. Laparoscopic examination, which allows you to confirm the presence of a pathological process in the fallopian tube and carry out elementary surgical procedures aimed at eliminating its consequences.

Additionally, a woman is examined for the presence of sexually transmitted infections, viruses, pathogens of fungal diseases, and the like.

Medical therapy and surgical treatment

Unfortunately, drug treatment of hydrosalpinx, which is reduced to the elimination of the inflammatory process, is in most cases ineffective and unable to prevent the formation of adhesions in the fallopian tube. Therefore, almost all therapeutic measures for the accumulation of fluid in the fallopian tube occur using the achievements of laparoscopic surgery.

Laparoscopic surgery allows you to restore the patency of the fallopian tubes, as well as remove parts of organs that are irrevocably affected by bacterial agents. With advanced bilateral hydrosalpinx, when saving the fallopian tube becomes impossible, experts recommend the patient to resect these organs while saving the ovaries. Pregnancy planning in such cases becomes possible only with the use of in vitro fertilization methods, which are carried out in specialized clinics for female insemination.

Hydrosalpinx is an obstruction of one or both fallopian tubes as a result of the accumulation of liquid contents in them in the presence of an inflammatory process.

In the absence of the effect of conservative therapy or female infertility, an operation is performed to remove the hydrosalpinx.

Indications for appointment

Hydrosalpinx occurs in most cases asymptomatically and is detected during a gynecological examination or ultrasound of the pelvic organs.

If symptoms are absent, conservative therapy is prescribed, consisting of a broad-spectrum antibiotic and anti-inflammatory drugs. After that, an ultrasound control is assigned and the question of the need for surgical treatment is decided.

Among the indications for the removal of hydrosalpinx are:

• lack of effect from conservative therapy;
• symptomatic course;
• infertility;
• ectopic pregnancy;
• rupture of the fallopian tube;
• fistulas.

Surgery is indicated for the following symptoms of gynecological pathology:

• constant pain of a pulling, aching or menstrual-like nature in the lower abdomen or from the side of the pathological process;
• large sizes of hydrosalpinx;
• accession of an infection and the transformation of a hydrosalpinx into a pyosalpinx, accompanied by a rise in body temperature to + 38 ° C or more, severe pain in the lower abdomen, general malaise.

Preparation for the procedure

Before surgery, a woman undergoes a series of diagnostic examinations necessary to study the state of health.

The surveys include:

Immediately before the operation, the woman is given a referral to the hospital and recommendations are given:

Immediately before the operation, the woman consults an anesthesiologist, who selects the optimal method of pain relief and calculates medicines individually for each patient. This takes into account age, weight, history, individual intolerance to drugs.

The woman is escorted to the treatment room, where a nurse installs her venous and urinary catheters.

After preoperative preparation, the woman goes to remove the hydrosalpinx.

How is the operation

The course of the operation depends on:

According to the type of access to the abdominal cavity, 2 operations are distinguished:

1. Laparoscopy.
2. Laparotomy.

The type of anesthesia is determined by the anesthetist individually:

• endotracheal anesthesia;
• epidural anesthesia.

Preference for hydrosalpinx is given to laparoscopic removal of the pathological formation under general anesthesia.

The type of surgical intervention depends on the prevalence of the process, the condition of the fallopian tube, the woman's reproductive function and the capabilities of the operating team.

There are 4 main types of hydrosalpinx removal:

After the woman enters the operating room, the anesthesiologist puts her under general anesthesia. Depending on the operative access, surgical intervention begins.

During laparoscopy, special instruments are inserted into the abdominal cavity through 3 punctures on the anterior wall of the abdomen. With the help of a video camera, doctors monitor the progress of the operation on the monitor.

With laparotomy on the anterior abdominal wall, layer-by-layer access to the abdominal cavity is performed. The advantage is the possibility of a more detailed revision of the internal organs.

After a visual assessment of the condition of the fallopian tube, the question of how to eliminate the pathology is decided. The gynecologist performs the removal of the tube or restores the patency of the fallopian tubes.

After the elimination of the pathological formation, layer-by-layer suturing of the wound is performed.

If the operation was completed without complications through laparotomy access, it is possible to apply a cosmetic suture.

Rehabilitation

How long the rehabilitation period lasts depends on the type of surgical access:

• after laparoscopy, discharge is made for 5-7 days, and the disability certificate is extended for 14-17 days;
• after laparotomy, a woman is discharged on the 7-9th day, and temporary disability lasts from 21 to 24 days.

Possible consequences

Among the possible complications of hydrosalpinx are:

Removal of hydrosalpinx rarely leads to surgical complications. However, the possible consequences include:

• bleeding;
• inflammatory process;
• infection.

After the removal of the pathological formation with the preservation of the fallopian tube, according to doctors, infertility is eliminated in 40-70% of women.

For further treatment of infertility, it is necessary to establish the patency and normal functioning of the fallopian tubes. In some cases, a woman is recommended to undergo IVF to reduce the risk of developing an ectopic pregnancy.