How is the fallopian tube hydrosalpin treated? Indications for operation

One of the serious consequences of inflammation of the appendages is the disease of the fallopian tubes - hydrosalpinx. According to statistics, it is detected in 30% of women of reproductive age. Pathology interferes with the successful conception of the child. However, with adequate treatment, pregnancy is possible. In today's article, we will talk about how to timely recognize the ailment, what methods of its treatment is offered by modern medicine.

Structure and function of the fallopian tubes

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

The walls of the fallopian tube consist of three layers: external, muscular and internal. The first is represented by the peritoneum and performs a protective function. The muscle layer promotes the appearance of contractile movements directed toward the uterine cavity. From the inside, the fallopian tube is lined by the ciliated epithelium. Its main function is to perform wave-like movements, thanks to which a fertilized egg easily enters the uterus. Between the elements of the ciliated epithelium are located glandular cells. They are responsible for developing a special secret. This substance supports the viability of spermatozoa, eggs and embryos at the initial stages of its development.

What is the tubal hydrosalpinx?

This is a gynecological disease, which eventually leads to a violation of the patency of the fallopian tubes. It is characterized by a gradual accumulation of the transudate in the lumen of the canals. As a result, the pipe turns into an education that looks like a pouch. At the initial stage of development, the pathological process does not manifest itself. Usually, the disease is diagnosed when a woman turns to a gynecologist in search of reasons for infertility.

Doctors distinguish the following forms of hydrosalpinx:

• Left-sided;
• Right-sided;
• Two-sided.

One-sided form of the disease is characterized by the appearance of inflammation on only one tube. At the same time, a woman can become pregnant on her own, but the probability of successful conception is halved. With a two-way hydrosalpine, both tubes are blocked. You can not get pregnant with such a diagnosis if you do not consult a doctor in a timely manner. Subsequently, complete infertility can occur, in which the probability of independently taking and giving birth to a healthy child is zero.

Separately, it is necessary to consider the chronic form of pathology. It develops gradually and does not show any deviations. The woman is fine. It is found that the tubal gallows hydrosalpinx is accidental, when examined by a gynecologist. Therefore, it is so important to periodically undergo a preventive examination with this doctor.

Mechanism of disease development

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

Inflammation of the ciliated epithelium dies, and the muscle layer ceases to fully decrease. In the lumen of the pipe spikes grow, violating its patency. The secret begins to accumulate in the formed cavity. It is produced by the glands of the epithelium in response to the existing inflammation. Thus, the disease of the fallopian tubes - hydrosalpinx - develops.

Main reasons

The onset of the disease is due to the closure of the middle part of the fallopian tubes. Usually such a problem is the response of the body to the local inflammatory process. Infectious agents penetrate both upward and downward paths. In the first case, the organs of the reproductive system are meant (cervix, uterus, vagina). In the second, it is about the inflow 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.

Physicians identify the following causes of the hydrosalpinx of the fallopian tubes:

• Frequent abortions, diagnostic curettage of the uterine cavity;
• Use of an intrauterine device;
• Hypothermia (the pathogenic flora is activated against the background of weakening of immunity);
• Frequent change of sexual partners;
• Inflammatory processes affecting the area of the appendages and ovaries (oophoritis, adnexitis);
• Sexual infantilism ;
• Adenomyosis;
• Endometritis;
• Dysbacteriosis of the vagina.

A one-sided process (hydrosalpinx of the left uterine tube or just the right one) often occurs due to anatomical disturbances or due to pyosalpinx. At the same time purulent content completely resolves, there is only a serous secret. A bilateral pathological process affecting both fallopian tubes is formed against a background of chronic inflammation caused by various infectious agents.

Clinical picture

What has hydrosalpin tubal symptoms? At the initial stage of the development of the disease, characteristic signs are absent, since the inflammatory processes do not show activity. He is identified, as we have already said, by accident, during an examination with a gynecologist.

As the disease progresses, an expanded clinical picture appears. The 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, a woman has a feeling of heaviness in the lower abdomen. If the pathology is two-sided, this symptom is seen on both sides. Periodically, it is possible to raise the temperature to subfebrile indicators. In some cases, women report increased secretions from the vagina.

With the diagnosis of "obstruction of the fallopian tubes," hydrosalpinx affects the reproductive capacity of the body. When the lumens are completely closed, the egg can not get inside, so fertilization does not occur. Such a violation is called tubal infertility. If the lumen is not completely blocked, the folds of the mucosa are smoothed out, and the muscle tissues are atrophied. As a result of these changes, a woman has an increased risk of ectopic pregnancy.

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

Hydrosalpinx and pregnancy

Women with hydrosalpinx planning pregnancy are recommended to perform laparoscopy. This procedure allows to restore patency of pipes, but often their natural function is violated. In addition, the number of receptors to the main hormones, estradiol and progesterone, is sharply reduced. These factors can lead to an ectopic pregnancy.

If the pathological process extends only to one tube, conception is possible. However, the presence of a foci of inflammation in the small 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 menstrual cycle. In the bilateral form of the disease, pregnancy by natural means is impossible. In this case, an IVF procedure is recommended for a woman.

Resection of the fallopian tubes before extracorporeal fertilization entails an increase in the probability of successful conception by about 30%. The prognosis is significantly improved if we immediately perform an operation to remove, rather than try to restore the patency of the oviducts with the help of various versions of laparoscopy.

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

Methods of diagnosis

If you suspect a hydrosalpin of the fallopian tubes, you should immediately contact a gynecologist. Diagnosis of this disease begins with the examination of the patient. When performing bimanual palpation, the pathology is probed as an elongated, tight formation with only one or both sides. This procedure can cause pain discomfort. After passing to the instrumental methods of diagnosis. Among them, the most informative are the following procedures:

1. Transvaginal ultrasound. It allows to determine the hydrosalpinx, to establish localization, shape and approximate size.
2. Hysterosalpingography. Helps assess the patency of the fallopian tubes. During the diagnosis, a contrast agent is injected into the uterine cavity under pressure. After this, a series of X-ray photographs are taken, on which the internal genitalia can be clearly seen.

In medical practice, cases are known when after such a survey, women become pregnant themselves. On the other hand, it increases the likelihood of exacerbation of chronic inflammation.

A more reliable method of diagnosis is laparoscopy of the tubal hydrosalpinx. The application of this method allows us to evaluate 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 interference can increase the development of the adhesion process.

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

Conservative treatment

Therapy should be started immediately after the doctor confirms the diagnosis of "tubal hydrosalpinx". Treatment without surgery is recommended for women who do not already plan a pregnancy, or with a slight severity of the pathological process. To combat inflammation, antibacterial drugs are prescribed. The duration of the course of therapy and the dosage of medications is 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. To this end, patients are prescribed immunomodulating drugs (Tactivin, 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 we can distinguish:

• UHF;
• UFO;
• The magnetographer;
• Electrophoresis;
• Endovaginal vibromassage.

If doctors diagnosed the started hydrosalpin of the fallopian tubes, treatment is possible only through surgical intervention.

Operative treatment

Surgical intervention is recommended for all women who still dream of trying on the role of mother. In addition, it is impossible to do without surgery in the case of a rapidly progressing adhesive process, as well as a complicated course of the disease.

How to treat tubal hydrosalpinx? Today, laparoscopy is used as the basic method of operative elimination of pathology. This is the most effective and at the same time sparing way of treatment. There are several varieties of this procedure. The doctor chooses the specific variant of therapy taking into account the patient's health, the condition of the fallopian tubes.

1. Tubectomy. During this operation, the doctor performs a resection of one or both tubes. To her help resorted to when there are no other options for treating the disease.
2. Salpingonemostomy. The procedure involves the formation of a new opening in the fallopian tube.
3. Fimbriolysis. Surgical manipulations are aimed at releasing the villi of the final section of the tube from the adhesions, removing the fluid.
4. Salpingoovariolysis. 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 prolonged course of which necessarily affects the health of a woman. Successful operation is not a guarantee of rapid conception of the baby. If the doctor managed to keep the pipes and restore their patency, the oviduct will not function fully. Cilia of ciliated epithelium may lose mobility, and the muscle layer often ceases to contract. As a result, normal peristalsis is disrupted. Therefore, women after the operation fall into the group at risk of an ectopic pregnancy. Such patients are recommended for fertilization by IVF.

Preventive actions

Gidrosalpinks fallopian tubes, the treatment of which is described a little higher, 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. When you have pain, uncharacteristic discharge or other unpleasant symptoms, you should immediately go to a gynecologist.
2. It is important to observe basic rules of personal hygiene. Doctors advise to take a shower twice a day. During menstruation, hygiene products should be changed as often as possible.
3. It is better to give up promiscuous sexual relations and always use barrier means of contraception.
4. It is necessary to adhere to a healthy lifestyle, eliminate all harmful habits.

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