• Mon. Jan 30th, 2023

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Applications of Fallopian Tube Recanalization

Fallopian Tube Recanalization

Tubal disease is the cause of infertility in about 30 per cent of women, with proximal tubal obstruction (PTO) accounting for 10–25 per cent  of these cases. Since its discovery more than a century ago, PTO has posed a diagnostic and therapeutic conundrum. In up to 40 per cent of women, it occurs in the intramural segment or at the uterotubal junction as a result of tubal spasm or transitory occlusion by mucus plugs. 

PTO has been linked to the presence of pathogenic microflora in the oviducts of about 33%  per cent of women, as shown by tubal fluid bacteriology. Isthmic tubal blockage appears to have an inflammatory aetiology, and chlamydial infection may be the chronic irritant in many cases, causing muscle hypertrophy and salpingitis isthmica nodosa. PTO infertility can be influenced by induced abortion, uterine curettage, pelvic inflammatory disease, and intrauterine devices.

The expert explains, “The proximal tube’s small size, thick muscular wall, and low proportion of ciliated cells in the epithelium make it prone to occlusion. During the estrogen-dominant phase of the cycle, increased muscular tone, reduced ciliary activity, and increased tubal secretions at the uterotubal junction (UTJ) and isthmus can result in tubal luminal contents’ stagnation and functional occlusion of the proximal tube. This occurrence could biologically delay the zygote’s arrival in the ampulla for nutritional and developmental reasons.”

Now, during the progesterone-dominant phase of the menstrual cycle, this functional proximal tube obstruction should be completely reversed with relaxation of the UTJ muscle, greater ciliary activity, and a reduction in tubal secretions. Failure to do so may result in uterine material stasis and, as a result, partial (tubal spasm) and then complete morphological occlusion of the limited intramural tubal lumen over time. Calcification of the obstructive material may occur as a result. Fibrosis may be a generic last response to persistent injury to the oviduct’s transmural and isthmic segments, after which tubal damage is irreversible.

Coaxial catheter systems are presently being employed with hysteroscopy, fluoroscopy, ultrasonography, and tactile sensation with consistent success, despite the fact that Fallopian tube cannulation with coaxial catheters began under fluoroscopy and was adaptable to cornual cannulation. Under sonographic, fluoroscopic, or hysteroscopic guidance, FTR can be conducted with catheters, guidewires, or balloon systems.

Furthermore, tubal catheterization methods for tubal disease diagnosis and recanalization, are minimally invasive procedures that enable for transcervical treatment of PTO and can help us better understand and diagnose tubal disease. True occlusion by amorphous material and filmy adhesions can only be treated successfully with various uterotubal cannulation methods, and guide-wiring the Fallopian tubes can restore tubal patency and fertility.

Tubal cannulation can be utilised efficiently in the management of female subfertility related to isolated PTO by restoring tubal patency, avoiding the requirement for costly assisted reproductive technology.  Tubal cannulation is preferable to invasive laparotomic and laparoscopic microsurgical interventions because it is less invasive, has lower peri- and post-operative morbidity, takes less time, requires less anaesthesia, and has fewer risks (e.g., bowel injury or bleeding after vessel perforation), resulting in a shorter convalescence.

Despite significant advancements in the treatment of PTO, the restoration of distal and peritubal damage typically fails to meet expectations. Patients with distally blocked tubes are not suitable candidates for this treatment. Fallopian tube catheterization is diagnostically valuable and technically extremely successful for treating occluded tubes. Distal isthmic, ampullary, or fimbrial occlusions, which are most usually caused by a prior pelvic infection or endometriosis, are difficult to recanalize and result in low pregnancy rates.

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