[Selective and ambulatory salpingography]

A new technique is here proposed to enhance, in a selective or direct way, the fallopian tubes. This new approach is suggested because hysterosalpingography (with the filling of the uterine cavity) is an indirect procedure, and therefore not completely reliable. Since intrauterine pressure cannot exceed 200 mmHg, and more pressure is needed to reach the tube ostia, false negatives are produced; up to 50% of the fallopian tubes not enhanced during hysterosalpingography are normal. Thurmond et al. were the first to introduce selective salpingography. They used a blind procedure with fluoroscopy passing through the uterine cavity, catheterized, with probes, and performed repeated fluoroscopic examinations of the uterine cavity. We suggest a different technique consisting in the use of hysteroscopy to visualize the ostium, and of a direct image to place the probe into the fallopian tube. The intubation is then repeated, if needed, in the other tube, which is then enhanced with the conventional means. X-ray pictures of both tubes will then be made. The technique is thus a simple and quick one, which can be carried out on an out-patient basis at the Radiology Department, without premedication, and with no need for previous preparation. Neither is it necessary to dilate the cervix nor to anesthesize the patient if the Karl-Storz chorionscope is used, which has proved the most useful instrument for this purpose. No complications were observed and the contraindications were similar to those of hysterosalpingography and hysteroscopy. To optimize the method, 16 direct fallopian tube intubations were carried out on a selected group of patients suffering from different kinds of infertility. The procedure lasted no longer than 20 minutes, was well tolerated, and allowed the patients to immediately resume their usual activities. We believe this practical technique to be the procedure of choice when one/both fallopian tubes are not enhanced during conventional hysterosalpingography.