Ovarian canal is an organ where the ovulated egg and sperm meet and the whole physiological environment is provided for fertilization. Here is the accumulation of fluid in the bulbous region of the ovarian canal where this environment is provided. hydrosalpenx is named. Hydrosalpenx is an indicator of previous pelvic infection (PID). In women who have had this type of infection, scar tissue (pelvic adhesions) can be seen between the tube and the ovary, including the intestines. This often causes infertility problems.
In women, due to various infections, the ovarian canal swells like a sausage as a result of the occlusion of its ends. hydrosalpenx” is named. In Greek, “hydro” means water, “salpinx” means pipe. Hydrosalpinx, on the other hand, is used in the sense of “water-filled channel”. While there is initially inflammation in the occluded ovarian canal, “ pyosalpenks” is named. At this stage, it is possible to develop hydrosalpenx after appropriate antibiotic therapy. With ectopic pregnancy, channels filled with blood are seen. ”hematosalpenx”is named.
Causes of Hydrosalpenx
In general, sexually transmitted diseases such as gonorrhea, chlamydia, and sometimes tuberculosis can cause adhesions and hydrosalpenx formation in the ovary. In addition, events such as adhesions due to endometriosis, ovarian and colon cancer may also cause hydrosalpenx. Normally, the fluids in the ovarian canal are constantly cleaned from the open end of the tubes to the abdominal cavity by the wobbly hair cells in the canal wall.
If there is an obstruction at the fimbrial end of the tubes, this fluid flow stops and begins to accumulate in the walls and channels. In addition, this accumulated liquid disrupts the wall structure and function of the tube channel. Hydrosalpenx can cause infertility by preventing the passage of egg and sperm.
While hydrosalpenx does not cause any symptoms in some women, it may cause complaints such as persistent or intermittent abdominal and groin pain and burning in some women. Hydrosalpenx may cause unusual pinkish watery vaginal discharge in some women.
Women with hydrosalpinx are either unable to conceive, or they often end in miscarriage even if pregnancy does occur. In this case, the fluid accumulated in the tube flows in the opposite direction, into the uterus instead of the abdominal cavity, with the effect of pressure, since the fimbrial end of the tubes is blocked. The flow of hydrosalpinx fluid into the uterus has a “washing effect” on the embryo and prevents the embryo from attaching to the uterus wall. In addition, the microorganisms in this liquid and their toxins cause harmful effects on the embryo. However, in women who have a clogged tubal ostium at the point entering the uterus on the hydrosalpenx side, and who conceive because the other tubule is intact, this effect does not occur, since fluid cannot flow from the hydrosalpenx tube to the uterus.
Hydrosalpenx can often remain undetected in most patients who do not want to become pregnant and do not have pain in the groin. It should not be forgotten how important is the diagnosis of hydrosalpenx in infertile patients, especially since the rate of infertility due to tubal factors is 35%. While a normal tube is not noticed on vaginal ultrasonic examination, In the case of hydrosalpenx, the tubas can be observed on ultrasound as fluid-filled. However, sometimes this condition can be confused with fluid-filled cysts, so a medicated uterine film (HSG) is required to make a definitive diagnosis.
If the hydrosalpenx has not enlarged the ovarian canal too much, X-ray images are obtained after the radio-opaque substance is given with the medicated uterine film, and the enlarged channels are observed and it is observed that there is no peritoneal spread of the radiopaque substance. If the ovarian canals are blocked from the point where they enter the uterus, it is not possible to watch the tubes on this film. HSG film may give false-positive results with a rate of 15% in the diagnosis of hydrosalpenx. In this case, either hydrosalpenx can be suspected with careful ultrasonic examination, or more precisely, enlarged tubas can be observed when laparoscopy is performed under anesthesia. In patients with elongated and enlarged ovarian canal, the diagnosis of hydrosalpenx can be easily made by ultrasonography.
Previously, in the treatment of hydrosalpenx, the treatment was performed in such a way that the fluid inside was drained without removing the tubes and the tubes were protected, but after this treatment, the tuba was occluded again and the hydrosalpenx re-formed and the possibility of ectopic pregnancy increased because the tubal function was impaired, this preventive treatment was abandoned. Today, laparoscopic removal of the tubal in the hydrosalpenx state (salpingectomy) is recommended. For patients who will try in vitro fertilization, if there is a hydrosalpenx condition, the tubas should be removed first. Surgical treatment should also be planned for women who do not have infertility problems but whose pain due to hydrosalpenx does not go away with current painkillers.
If hydrosalpenx treatment is performed for patients who want IVF, not because of pelvic pain, when there is too much adhesion around the tube due to many factors such as endometriosis, previous pelvic surgery, in order not to reduce egg reserves, it is necessary to block only the cornual part of the tube (the point where it enters the uterus) and insert the tube. You may need to leave it in place. Or, in such cases, the tubal ostium, which is a hydrosalpenx, can be occluded using a microinsert by entering the uterus hysteroscopically.
Prevention of Hydrosalpenx
Precautions should be taken, early diagnosis and treatment should be taken, especially for sexually transmitted diseases such as gonorrhea and chlamydia, in order to prevent the formation of hydrosalpinx. If pyosalpenx occurs after such diseases, the tubas may revert to hydrosalpenx after appropriate antibiotic therapy.
Kiss. Dr. Kutlugul Yuksel
Gynecology and Obstetrics Specialist