Hydrotuhation. Separate Examination of the Patency of Each Tube with Isotonic Saline Solution. Hideo Yagi, M.D.

Transcription

1 Hydrotuhation Separate Examination of the Patency of Each Tube with sotonic Saline Solution Hideo Yagi M.D. HYDROTUBATON is a tenn which introduced in 1929 to describe a new technic for diagnosing patency of the fallopian tubes by means of isotonic saline solution instead of air or carbon dioxide. 2 The idea came from the experience of performing hysterosalpingographies in the diagnosis of sterility. With hysterosalpingography was struck with the following observation: f more than cc. of iodized oil can be injected easily under low manometric pressure it is almost a positive indication that one or both of the tubes are patent as may be verified by roentgenography. On the other hand if there is tubal closure or stenosis resistance is encountered and when added pressure is applied oil will leak from the uterus into the vagina. This led me to conclude that tubal patency could be tested with the use of a nonradiopaque medium such as isotonic salt solution without the aid of x-ray pictures. sotonic salt solution at body temperature is an ideal nonirritating medium. ts use is free from the potentially dangerous after effects notably embolism that are sometimes associated with the use of radiopaque oils.. METHOD n applying the test salt solution at a pressure of 2 m. is used instead of air or carbon dioxide. By noting the quantity and speed of flow we can From the Department of Obstetrics and Gynecology Okayama University Medical School Okayama Japan. 0

2 Vol. 6. No HYDROTUBATON 1 estimate the degree of tubal patency. The resulting data can be plotted as a hysterosalpingogram and may be kept as a permanent record. My original paper describing this method was published in and simplified in The English translation 4 brought forth immediate response in other countries 6. 7 as exemplified by Slamova's citation of my technic in n 1944 worked out a new technic for the separate hydrotubation of the individual tubes. 9 The principle of the new method lies in -. Fig. 1. The principle of separate hydrotubation lies in blocking one of the tubes with the tip of the cannula while injecting the salt solution into the other. blocking one of the fallopian tubes at its uterine cornu with the tip of the special cannula which resembles the end of a uterine sound and then injecting the salt solution into the other tube through openings below the tip of the cannula (Fig. 1). The cannula is 22 cm. long. The tip measuring 7 cm. is made of malleable silver and resembles the common uterine sound. Two openings are situated 1 and 2 cm. respectively from the tip on the side of greater curvature of the cannula. An adjustable rubber cone or olive surrounds the cannula. Mter measuring the uterine depth-the distance between the external cervical os and the tubal ostium-the cone is properly set with a metal screw and applied closely against the cervix with a M useux forceps which

3 2 VAG Fertility & Sterility is attached to the cannula. After testing one tube the cannula is partially withdrawn rotated through an arc of 180 degrees and then directed against the other side. By this method separate hysterosalpingograms can be prepared for each tube. The test is performed with patients having either primary or secondary sterility. Prior to the test pelvic examination is performed to exclude uterine Fig. 2. Apparatus for hydrotubation. Note openings near end of cannula tip. bleeding and acute and subacute infectious conditions which are contraindications for the test. Additional tests should include bacteriologic examination of cervical secretions and the usual tubal insufflation and x-ray salpingography. Hydrotubation may be performed at any time except during the premenstrual and menstrual periods. However the optimal period is between one and two weeks following the cessation of menstruation.

4 "1 Vol. 6 No.6 19 HYDROTUBATON 3 Equipment The special cannula devised for the purpose of separate hydrotubation is used. A graduated glass cylinder of 0 cc. capacity is employed as a reservoir for the sterile salt solution and is connected with the cannula with a sterilized narrow rubber or nylon tube. The upper surface of the salt solution is initially raised to a level of 2 m. above the uterus. This gives a Fig. 3. Schematic representation of apparatus in use. pressure approximately equal to that of mm. of mercury. The solution is permitted to flow by gravity (Figs. 2 and 3). TECHNC The patient is placed in the lithotomy position. By pelvic examination the position and approximate size of the uterus is determined. A graduated uterine sound is introduced to ascertain the distance between the cervical os and the uterine cornu. The upper malleable portion of the cannula is

5 4 YAG Fertility & Sterility bent to fit the internal uterine contour. The cannula is then gently inserted into the uterine cavity the tip being pressed so as to occlude the right tube at the uterine cornu. The rubber cone is moved into position to close by pressure the cervical os and is held by a screw. A Museux forceps is applied to the cervix and is then clamped to the cannula. While the operator watches for leakage of solution at the cervix an assistant regulates the height of the cylinder and notes the saline How minute by minute. f there is no leakage from the os and the amount of solution escaping is more than lo cc. the tube tested is presumed to be patent. n such case the hysterosalpingogram reveals an ascending curve. 1 O~ ~ ~ min. Fig. 4. Flow of the salt solution is plotted against time. Note that the curves are of the ascending type denoting that both tubes are open. The cannula is now freed and turned 180 degrees so that its tip fits the opposite uterine cornu and the second test is carried out. A second curve is then made for the right tube (Fig. 4)....' ANALYSS The curve varies according to the tonicity and patency of the tubes. f tonicity is weak or low the curve may be very steep (Fig. ). f on the other hand the tonicity is strong a slowly ascending curve is obtained. Thus when the tube is patent the hysterosalpingogram is always of the ascending type. When tubal occlusion exists the curve becomes horizontal and runs parallel to the base line. When the curve is horizontal and very

6 Vol. 6 No.6 19 HYDROTUBATON close to the base line this indicates that the inflow of solution is very small and that the occlusion is at the cornu itseh (Fig. 6). An ascending curve which is followed by a horizontal curve extending further from the base cc 20 1 /1 '-d { ~ P.. p 0 Fig min. The steeply ascending curves denote low tonicity of the patent tubes. ec ~ min. Fig. 6. Hysterosalpingograms of two tubes occluded at or near the uterine cornua. Note flat or horizontal character of the curves denoting retention of the fluid. line indicates occlusion nearer the abdominal end of the tube (Fig. 7). When the fall of the column of water stops as it may in some cases we ''hold'' the pressure for a maximum of five minutes to rule out obstruction due to temporary spasm in the uterine cornu or in the tube. By this method then it is possible to diagnose the side and site of occlu-

7 6 VAG Fertility & Sterility sion without recourse to x-ray pictures. The principle may also be applied to the use of air or gas. The equipment is cheap and can be assembled by practitioners. The test can be repeated as necessary without danger of irritation of the pelvic peritoneum. Therapeutically this procedure may be employed to open some occluded tubes so that pregnancy may ensue. cc cr.-----Q J:> o tnin. Fig. 7. The initially ascending character of the curve shows that fluid is entering the tubes. The curves on becoming "horizontal" indicate that the tubes on filling take on no more fluid and are therefore presumed to be closed at their distal portions. During the past 20 years have performed 3000 hydrotubations with accurate diagnoses in 9 per cent of the cases as determined by follow-up with laparotomy or by hysterosalpingograms. REFERENCES 1. Sd.MOVA B. Hydrotubation statt Pertubation. Zentralbl. f. Gyniik. 61 : YAG H. Hydrotubation. Jap.]. Obst. & Gynec. 12 No YAG H. Hydrotubation. Jap. J. Obst. & Gynec. 13 No YAG H. Hydrotubation. Jap. ]. Obst. & Gynec. 13 No YAG H. Hydrotubation. Ber. Gyniik. 19 S YAG H. Hydrotubation. Jahreok. f. Arztl. Fortbild. July YAG H. L'hydrotubation. Gynec. etobst. 23 No YAG H. The theory and application of hydrotubation. Diagnosis & Treatment 23 No YAG H. Jap. Kink Gyn. ]. 27 No YAG H. On hydrotubation. Clinical Medical Report 2 No