Hydrosalpinx: what it is, symptoms, treatment without surgery, reviews. How is tubal hydrosalpinx treated? Indications for surgery

– pathology of the fallopian tubes, caused by one- or two-sided accumulation of transudate in their lumen. It can be asymptomatic and first detected in connection with infertility. Clinically pronounced forms of hydrosalpinx are accompanied by pain in the lower abdomen (pulling, bursting, pulsating), profuse watery leucorrhoea, febrility and general weakness. To diagnose hydrosalpinx, a gynecological examination, OMT ultrasound, USGSS and hysterosalpingography, collection and evaluation of smears, and diagnostic laparoscopy are performed. Treatment of hydrosalpinx is most often surgical - salpingostomy, tubectomy.

Classification of hydrosalpinx

A serious complication of hydrosalpinx can be a rupture of the fallopian tube, the occurrence of which is indicated by a sudden sharp pain in the corresponding half of the abdomen, tachycardia, arterial hypotension, pale skin, cold sweat. In case of rupture of the pyosalpinx, there is a high probability of developing peritonitis, pelvioperitonitis, and abscess of the pouch of Douglas. In some cases, the breakthrough of pus does not occur in the abdominal cavity, but in the bladder, vagina or rectum.

Hydrosalpinx and IVF

Research in the field of reproductology convincingly proves the negative impact of hydrosalpinx on the prognosis of IVF. At the same time, not only do the chances of successful embryo transfer decrease significantly, but the risks of developing ectopic pregnancy and spontaneous abortion in the early stages also increase. This cause-and-effect relationship is explained by a number of pathological effects that the contents of hydrosalpinx can cause:

Mechanical action. It is assumed that the draining hydrosalpinx, emptying into the uterine cavity, can “wash out” early embryos.
Embryotoxic effect. In addition to the direct mechanical removal of embryos from the uterine cavity, the contents of the hydrosalpinx have a destructive effect on them. Liquid from hydrosalpinx contains large quantities of microorganisms and their toxins, lymphocytes, prostaglandins, proinflammatory cytokines, etc., which have a pronounced cytotoxic and embryotoxic effect. This effect persists even with a 50% dilution of the hydrosalpinx contents.
Endometrial damage. Using morphological and immunohistochemical methods, pathomorphological changes in the endometrium in conditions of the existence of hydroalpinx were identified. A decrease in local immunity, the expression of receptors for progesterone and estradiol, a decrease in subendometrial blood flow, structural disorders of the glandular and stromal components of the endometrium - any of these factors can cause a violation of embryo implantation.

Diagnosis of hydrosalpinx

Clinical, laboratory and instrumental diagnostics aimed at identifying hydrosalpinx include examination on a chair with collection of smears from the genital tract, examination of the patency of the fallopian tubes, sonography, and laparoscopy. During vaginal examination, a formation of a round or ovoid shape of a tight-elastic consistency, usually moderately painful, may be palpated between the uterus and the ovary.

The most reliable data for the presence of hydrosalpinx can be obtained during diagnostic laparoscopy. At the same time, the monitor shows thickened fallopian tubes with edematous fimbriae, thinned walls of the tube, through which the watery contents are visible. Laparoscopy is also the main component of conservative-surgical management of patients with hydrosalpinx.

Treatment of hydrosalpinx

It is not possible to cure hydrosalpinx only by conservative means. The preservation of pathomorphological prerequisites for the accumulation of transudate determines the recurrent course of the pathology. In addition, the presence of hydrosalpinx casts doubt on the successful implementation of reproductive plans. Currently, all patients with this problem undergo two-stage treatment. First, adequate anti-inflammatory therapy is prescribed, aimed at stopping the activity of the infectious process in the fallopian tubes. Antibacterial drugs, vitamin therapy, physical therapy are prescribed (electrophoresis of artificial insemination, reproductive specialists recommend laparoscopic tubectomy (salpingectomy). Removal of the fallopian tube increases the effectiveness of the IVF program three or more times.

Forecast and prevention of hydrosalpinx

Hydrosalpinx is associated with low chances of pregnancy, both when trying to conceive independently and as part of IVF protocols. Functional reconstructive surgery does not always allow achieving the desired pregnancy naturally, so the method of choice for a significant proportion of patients is tubectomy followed by an IVF cycle (.

Prevention of hydrosalpinx is the prevention and adequate treatment of PID (salpingoophoritis, endometritis) and STDs, exclusion of casual sexual contacts, refusal of abortions, regular observation by a gynecologist.

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 moment of the long-awaited conception, and in particularly advanced cases, pregnancy may not occur at all.

What is it?

Hydrosalpinx (from the ancient Greek ǔδωρ - “water” and σάλπιγξ - “pipe”) is a one- or two-sided saccular expansion of the fallopian tube, filled with a clear serous non-infected fluid (transudate), formed against the background of inflammation due to soldering of the ampullary part of the fallopian tube.

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:

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

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 supports the existence of 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, bladder. Inflammation can be aseptic and occur in the presence of gynecological diseases.

Hydrosalpinx is formed due to the following reasons:

wearing an intrauterine contraceptive device;
diagnostic curettage of the uterine cavity and abortions;
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 changes of partners (sexually transmitted infections: gonococci, trichomonas, ureaplasma, chlamydia);
endometritis (inflammation of the uterus);
myomatous node located at the entrance of the oviduct into the uterine cavity;
adenomyosis;
damage to the oviducts during laparoscopy with the occurrence of aseptic inflammation;
sexual infantilism (twisted, long, thin pipes);
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:

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 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.

Classification

There are hydrosalpinx:

Right-handed	the pathological process affects only the right fallopian tube.
Left-handed	the pathological process affects only the left fallopian tube.
Bilateral	Both tubes are affected. Most often, with this form of pathology, complete infertility develops (the inability to get pregnant on your own).
Simple	a process limited to one cavity of the fallopian tube.
Follicular	a process in which cavities are formed, formed by the growth of adhesions that divide the lumen of the fallopian tube into several chambers.
Ventilated	The fluid accumulated inside the tube, due to its pressure and elasticity of the internal adhesions, breaks into the uterine cavity, and then out through the vagina.

Symptoms

Very often, hydrosalpinx is completely asymptomatic at the very beginning. The woman is mainly concerned about the symptoms of the primary disease against which it arose. As the disease develops, signs that differ from the main pathology gradually begin to appear, the intensity of which increases. They make you wary and run to the doctor to find out the causes of concern.

But it often happens that a woman tries not to pay attention to the 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?

Persistent nagging pain in the lumbar region of varying intensity.
Nagging pain in the lower abdomen, which subsides from time to time and returns again (the greatest intensity is on the affected side).
Menstrual irregularities.
Rise in body temperature to subfebrile levels (no more than 37.5°C).
General malaise (weakness, dizziness, etc.).
A feeling of fullness in the lower abdomen, which is more intense on the side of the affected tube.
Unsuccessful attempts to conceive a child.
Discharge from the genital tract. With any type of hydrosalpinx, there is an increase in the secretion of leucorrhoea (which is very typical in the presence of an inflammatory process). Periodic watery discharge from the vagina may also be observed (characteristic of the ventral type of pathology), as a result of which all symptoms temporarily subside until the fallopian tube is filled with fluid again.

Diagnostics

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

Ultrasound. An ultrasound examination determines the presence of a fluid formation between the ovaries and the uterus.
Gynecological examination. In this case, it is possible to identify between the ovary and the uterus a tightly elastic formation of an ovoid or round shape, which, as a rule, is painless or slightly painful.
Laparoscopy. As in a number of other gynecological diseases, this method is not only diagnostic, but also therapeutic.
Hysterosalpingography. The nature of the x-ray picture may be similar to the nature of fallopian tube obstruction. 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 include:

ectopic (tubal pregnancy);
miscarriage;
suppuration of hydrosalpinx (pyosalpinx);
adhesions in the pelvic cavity;
infertility;
in the case of IVF – 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 you need:

determine the nature of structural damage in the affected pipe (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 treatment for hydrosalpinx includes antibacterial, anti-inflammatory therapy and physical therapy. Most often, the first stage of treatment is preparatory, and after it an operation is performed to remove the hydrosalpinx using the laparoscopic method.

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

The next stage of treatment involves not only removing the hydrosalpinx itself, but also restoring the patency of the fallopian tube. Laparoscopy successfully copes with both tasks.

Laparoscopic surgery to remove hydrosalpinx is the most effective method of treating infertility, and also represents the most reliable diagnostic method, allowing the doctor to see the changes occurring in a natural form. Before starting the operation, carefully examine the area of the pipe, assess the degree of inflammation and the level of damage. Based on what he sees, the doctor determines further surgical tactics.

As a rule, the essence of the operation is to remove 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?

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

Are there any restrictions necessary for this disease?

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.

Hydrosalpinx, or sactosalpinx, is a pathological phenomenon in the fallopian tubes, characterized by a local accumulation of serous fluid in them and causing their obstruction. The diagnosis of “left hydrosalpinx” means that only the left tube is affected; if the ultrasound identified hydrosalpinx on the right, the right fallopian tube was affected. Bilateral hydrosalpinx also occurs, in which case the disease can have an even more significant impact on your reproductive function. Unfortunately, hydrosalpinx occurs in many women of childbearing age, and the causes of its occurrence are varied.

The provoking factor in the development of pathology is often salpingitis, salpingo-oophoritis or adnexitis - inflammatory processes of the uterine appendages. If you dream of having healthy offspring, you literally need to protect yourself from these phenomena so as not to encounter difficulties in conceiving in the future.

Causality: where does the pathological process in the pipes originate?

Your fallopian tubes are paired, hollow, elongated organs connected at an open end to the uterine body. The lateral ends are covered with fimbriae and connected to the abdominal cavity. Pipe sizes may vary in each individual case. Standard parameters for a healthy woman are 10-12 cm in length and 0.4-0.7 cm in diameter. The inside of the tube is covered with a serous membrane, replete with villi of prismatic and ciliated epithelium, as well as cells that produce viscous mucus. On top of the loose connective tissue system is a three-layer muscle part. It is she who ensures healthy peristalsis and transports the fertilized egg (zygote) to the body of the uterus.

Hydrosalpinx is a hollow, round-shaped neoplasm with an elastic structure that deposits transudate and prevents the normal movement of the egg through the tube. Sactosalpinx is a stage of the disease in which autosecretion exudate begins to accumulate in the “bag”. If we are talking about acute inflammation, when pus is concentrated in the cavity, this is the final stage of the disease, called pyosalpinx. The symptoms of pyosalpinx are extremely pronounced, and the course of the disease requires immediate medical intervention. Sactosalpinx can be functional (valve), when the sac bursts and the contents pour into the uterine cavity.

The causes of the disease lie in the following circumstances:

sexually transmitted infections (chlamydia, syphilis, ureaplasmosis, gonorrhea);
previous adnexitis, salpingitis, salpingo-oophoritis;
chronic inflammation of the appendages;
adhesions of the pelvic organs resulting from surgical manipulations;
endometriosis of the ovaries and uterus.

Left-sided hydrosalpinx and right-sided hydrosalpinx have no fundamental differences in terms of provoking factors and clinical manifestations. Bilateral hydrosalpinx has more acute specific manifestations in the clinical picture.

The size of hydrosalpinx can vary between 1-4 centimeters. Like any cyst-like neoplasm, the cavity can grow in size. The larger it becomes, the harder it is to dissolve. In this case, the disease often progresses to a purulent form and requires surgical removal by gentle surgery - laparoscopy.

How to identify an insidious disease yourself

Regardless of the cause, the disease manifests itself in the same way in all cases. Sactosalpinx on the left and right has quite specific manifestations, but a woman may not pay attention to them for a long time, confusing them with PMS, ovulation or banal hypothermia. This is the insidiousness of the disease: while you ignore the warning signs, the cavity grows, the serous fluid transforms into exudate or pus, and a number of various complications arise, the treatment of which is often unsuccessful.

It’s worth sounding the alarm for any abnormal phenomenon related to women’s health. If you are planning a pregnancy, treat this with particular care and caution, because even the mildest treatment does not guarantee renewal of reproductive function.

It should be emphasized that unilateral and bilateral sactosalpinx in the vast majority of cases occurs in a latent, asymptomatic form. Therefore, it is important to attend routine gynecological examinations in a timely manner.

Symptoms of hydrosalpinx are identified in the following phenomena:

excruciating pain of a pulling or cramping nature in the lower abdominal part (often on one side);
copious watery discharge from the genital tract, often yellowish in color with an unpleasant odor;
recurrent miscarriage, inability to fertilize, ectopic pregnancy;
general malaise, fever, myalgia, apathy (mainly with the development of pyosalpinx).

Voice alarming signs to your doctor, and he will refute or confirm your fears by conducting a classic gynecological examination and ultrasound. Sactosalpinx is easily detected by transabdominal and transvaginal ultrasound.

Medical diagnostic tests

Professional diagnosis of hydrosalpinx occurs in several main stages. The disease cannot always be detected immediately, especially if the tubes are not visualized on an ultrasound machine. This may occur due to adhesions, an abundance of clear fluid behind the uterus, or some inflammatory syndromes that make it difficult to assess the picture. In this case, the doctor will tell you what measures to take to eliminate the interference and how to prepare for the next ultrasound. Treatment of sactosalpinx is selected on a private basis, depending on the reasons that provoked the appearance of the pathology.

Diagnostic procedures include:

collection and thorough examination of the medical history, including current signs of the disease, complaints and symptoms;
detailed analysis of obstetric and gynecological history (past illnesses and infections, routes of delivery, abortions, surgical interventions);
classic gynecological examination with a speculum;
bimanual palpation of the genital organs;
Ultrasound of the pelvic organs (most often combined);
taking a smear for laboratory evaluation of vaginal and cervical mucus;
PCR (polymerase chain reaction) - analysis for the detection of fungi and pathogenic microorganisms;
laparoscopy for diagnostic purposes.

Most often, the presence of sactosalpinx is identified using an ultrasound machine, and further studies are required only to confirm the diagnosis. If the smear confirms the presence of pathogenic bacteria, you will be prescribed appropriate treatment for STDs and STIs. If the ultrasound shows an adhesive process, surgery will be required. Treatment of hydrosalpinx is absolutely necessary for those planning a pregnancy.

Therapeutic measures to eliminate pathology

If you find signs of sactosalpinx, do not hesitate to select effective therapy. Your doctor will help you with this. Treatment is mandatory and does not require delay, especially for those planning a pregnancy. Therapeutic methods largely depend on the intensity of the symptoms and your desire to maintain the ability to fertilize. If you already have children and pregnancy is absolutely irrelevant for you, the fallopian tube is most often amputated.

We also want to emphasize that untreated sactosalpinx almost always evolves into a chronic form, and then the cavity ruptures along with the fallopian tube. As a result of this process, the possibility of spontaneous conception is reduced by 70%. In vitro fertilization may also not be successful. Not only the preservation, but also the course of gestation is called into question.

What options does effective treatment of the disease involve?

Conservative treatment involves stopping the inflammatory process with physiotherapy and taking antibiotic drugs. This option is advisable only with the primary development of sactosalpinx, or with inflammation of the appendages, when there is a risk of its subsequent formation. In other cases, drug treatment plays only a stabilizing role.
Surgical treatment is performed using laparoscopy and is necessary in almost all cases of acute, chronic and recurrent disease. Reconstructive surgery is aimed at emptying the hydrosalpinx with subsequent expansion of the lumen of the fallopian tube, which increases its patency. If you are an adult woman with children, your best choice will be a complete resection of the affected organ area. Full amputation of the fallopian tube with preservation of the ovary is also practiced. Pregnancy with cured hydrosalpinx will be possible only with the help of assisted reproductive technologies (IVF). After laparoscopy with artificial dilatation of the tube, the patient is automatically included in the risk group for ectopic pregnancy.
Traditional treatment is unlikely to be effective, but some women prefer to use it as maintenance therapy. Treatment of the disease with folk remedies involves taking special phytotherapeutic complexes. The most common practice is douching with herbal infusions and taking baths with juniper, clay or cabbage decoction. Therapy with folk remedies may consist of oral administration of an infusion of boron uterus. It is diluted with distilled water in the amount of 30-40 drops per standard glass, and taken several times a day.

Treatment with folk remedies should never be prescribed independently! At best, it will not yield any results, at worst, it will harm you even more. Follow your doctor's advice and ask about supportive natural recipes. Use folk remedies therapy only with the permission of the gynecologist, in the process of full treatment!

Pregnancy and illness

Hydrosalpinx and a healthy pregnancy are relatively compatible concepts. When planning a pregnancy after hydrosalpinx, it is important to constantly see a doctor. It is important to remove cysts first, as their contents are toxic and dangerous to the fetus. Preserving the tubes is only advisable for women under 35 years of age; however, when planning a pregnancy, you must make sure that your husband’s genital organs are healthy. If you are planning a pregnancy through IVF, amputation is inevitable, because the inflammatory process in the tube prevents even artificial implantation and can lead to ectopic. Conception during the disease is likely if the lesion is one-sided. In this case, you can use folk remedies to speed it up. Traditional treatment often helps even desperate women get pregnant.

What dangers does pathology pose?

fatal infertility;
fusion of the fallopian tubes;
ectopic pregnancy;
decreased effectiveness of IVF;
progression to a purulent process;
related diseases of the pelvic organs.

Timely detection of the disease and its professional therapy will help you avoid all known complications and preserve your main natural function - the ability to bear children. Don’t forget to regularly visit your gynecologist, adjust your own lifestyle, treat “provoking diseases,” and hydrosalpinx is guaranteed to bypass your family.

Treatment of this disease can be carried out either surgically or conservatively. Conservative methods of treatment include localization of inflammatory processes, using physiotherapy and medications, as well as blowing out the fallopian tubes mechanically.

A hydrosalpinx is an accumulation of fluid in the fallopian tubes due to injury or infection. This fluid has a pale yellow tint and is called transudate. In this article we will look at the causes of hydrosalpinx, as well as possible treatment methods.

The classic causes of hydrosalpinx are chlamydia or gonorrhea. These infections can go unnoticed for many years, slowly destroying the thin lobular fimbriae. As a response to injury, the body rushes inflammatory cells to the area of inflammation. The inflammatory process can lead to loss of fimbriae and “blockage” of the fallopian tube. These infections usually affect both fallopian tubes.

Not only is hydrosalpinx a cause of infertility, but the condition can also reduce the success rate of infertility treatments, even those procedures that do not involve the fallopian tubes.

Diagnosis of hydrosalpinx

There are several ways to diagnose this disease:

1. Ultrasound. During the procedure, a narrow probe is inserted into the vagina. Healthy fallopian tubes are usually not visible on an ultrasound, but a tube filled with fluid will appear larger, thus standing out from the rest. Ultrasound is a brief, non-invasive and painless test and is often used in the initial assessment of the ovaries, uterus and fallopian tubes.

2. Hysterosalpingogram. This is an x-ray method in which a small amount of dye is injected into the uterine cavity and fallopian tubes. The dye seeps through the uterus, making any changes easy to visualize. If the fallopian tubes are open, fluid passes through them into the surrounding areas of the abdomen. In the case of a blockage, such as a hydrosalpinx, the dye will not be able to exit the fallopian tubes and the tubes will appear stretched. A hysterosalpingogram is performed in the second week of the menstrual cycle (that is, after menstrual bleeding has stopped, but before ovulation). The whole procedure takes about 10 minutes. Side effects are possible - in the form of pain in the pelvic area or cramps. Ibuprofen taken before the procedure will help manage these side effects. Most women can begin work or household chores immediately after the procedure.

3. Laparoscopy is a surgical procedure performed using a laparoscope. It is a thin instrument equipped with a tiny surveillance camera. The laparoscope is inserted into the pelvis through a microscopic incision in the navel, allowing the surgeon to directly see the fallopian tubes on a screen. In some cases, laparoscopy may be used to confirm a previous diagnosis of hydrosalpinx or for other conditions. Because this surgical procedure requires general anesthesia, it is usually not used for initial diagnosis.

Hydrosalpinx: causes of occurrence

The causes of the disease are different, we list the main ones:

endometriosis;
ovulation induction;
inflammatory diseases of the pelvic organs (for example, chlamydial or gonococcal infections). Hydrosalpinx occurs most often when adhesions occur from inflammatory diseases of the pelvic organs;
unilateral or bilateral hydrosalpinx can occur in women after hysterectomy, when only the fallopian tubes are involved in the blood supply to the ovary;
with the accumulation of uterine secretions caused by surgery;
after a tubal ligation procedure;
for malignant primary or secondary tumors of the fallopian tubes.

Most often, hydrosalpinx is asymptomatic. During the acute stage of the disease, body temperature can rise to 39ºC. The patient experiences weakness, severe fatigue, throbbing and bursting pain in the pelvic area. Tachycardia and increased heart rate are possible. The size of the inflamed area can reach several centimeters.

Treatment of hydrosalpinx without surgery

Treatment methods for this disease can be either conservative or surgical. Conservative treatment is carried out using medications - immunocorrective drugs. A treatment method such as autohemotherapy will also be effective. During the procedure, blood is taken from a vein from the patient and this blood is injected intramuscularly or subcutaneously.

Treatment of hydrosalpinx without surgery is carried out using physiotherapeutic methods of treatment, such as UV irradiation, electrophoresis with magnesium or potassium iodide, UHF therapy. But, as practice shows, treatment of hydrosalpinx without surgery is not particularly effective, since this disease is a mechanical obstacle, so surgical intervention is necessary.

Surgery to remove hydrosalpinx

For small hydrosalpinx, surgical treatment methods are often prescribed. During the procedure, the transudate accumulated in the tube is mechanically removed, after which there is a high probability of becoming pregnant naturally. During the operation, the surgeon makes a small incision in the abdomen and removes fluid that has accumulated in the fallopian tubes. Recovery from this procedure is relatively quick, and the patient can return to normal life within a few days.

Due to the fact that after 35 years the reproductive qualities of the ovaries decrease, this operation is recommended for younger patients. After surgery, the risk of ectopic pregnancy increases. Therefore, girls who want to get pregnant naturally should regularly visit a doctor who will monitor the fertilization process and be able to identify pathology in time.

Due to the fact that after surgical reconstruction of the fallopian tubes, the rate of natural pregnancy is not that high (studies have shown about 10%), and also due to the increased risk of developing an ectopic pregnancy, most women prefer IVF fertilization.

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

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 it is possible to treat hydrosalpinx 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.

Surgical treatment

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 in the pelvis remains, 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 their 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?

For 3 to 4 weeks it is necessary to refrain 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.