Hydrosalpinx of the fallopian tubes on the left and right side

When a woman goes to a gynecologist with a problem, such as infertility, she is often diagnosed with a pathology called hydrosalpinx. This is a disease in which tubal obstruction is observed due to localized accumulation of fluid effusion.

What is the danger of hydrosalpinx?

The health of the reproductive system directly affects the condition of the body as a whole. This also applies to the problem of hydrosalpinx: the disease, first of all, prevents pregnancy, and in case of successful conception, it creates the risk of miscarriage, ectopic pregnancy, and fetal fading. If a woman no longer plans to have children, then the pathology is not so harmless for her either: complications such as rupture or torsion of the tube, spread of infection, etc. are possible. It is believed that hydrosalpinx is a "time bomb": a woman can live with this diagnosis without suspecting anything. However, at one point - for example, against the background of a sharp weakening of the immune system, the process can be complicated by suppuration or another reaction, which will require urgent surgery - this time to save the patient's life.

Doctors are unanimous in their opinion: if there is such a diagnosis, then it is necessary to do everything to get rid of the pathology. The only exception may be a small pathological focus that does not create problems for the patient and is not accompanied by any painful symptoms. But even such an insignificant formation should be treated with conservative therapeutic measures.

Epidemiology

The most common consequence of hydrosalpinx is infertility, so a significant proportion of patients with this pathology subsequently resort to the procedure of in vitro fertilization. Among all women who are prepared for assisted reproductive procedures, hydrosalpinx is registered in 10-30% of cases.

If a woman has this pathology within one tube, her chances of independent conception are reduced by 50%, and in the case of a bilateral process, they become impossible altogether. When conducting IVF, such women should take into account that the embryo is implanted approximately 4 times less often. In addition, they have an increased risk of miscarriage at different stages of the process, or the development of an ectopic pregnancy.

Causes hydrosalpinx

The underlying cause of hydrosalpinx formation is an inflammatory process called salpingitis (or adnexitis). In turn, the inflammation itself develops under the influence of other activating factors. Let us list the most common risk factors for the development of pathology:

• exposure to low temperatures with a simultaneous drop in immunity;
• endometriosis;
• spontaneous and medical abortions;
• any surgical interventions on the pelvic organs;
• infectious and inflammatory processes in the urinary system;
• use of an intrauterine device;
• ignoring the use of condoms, promiscuous sex life;
• inflammatory process in the uterus;
• myoma;
• presence of adhesions in the pelvis;
• imbalance of vaginal flora.

Pathogenesis

The disorder in the fallopian tubes according to the variant with the development of sactosalpinx occurs as a result of the adhesive process, which, in turn, becomes the result of inflammatory and other pathologies in the small pelvis. In the tubal cavity, there is an overgrowth of connective tissue, with the formation of peculiar partitions and pseudocystic formations. The internal tubal lumen gradually decreases, until absolute obstruction is achieved in a separate section.

There is a disorder of lymph flow and blood flow in the affected areas of tissue, and a mass gradually accumulates in the newly formed cavity, the composition of which is liquid mucous secretions, blood serum and intercellular fluid.

As the cavity fills with pathological fluid, the tube in this area stretches, and the tissues lose their shape and become significantly thinner.

The liquid contents may occasionally flow out of the tube or be sucked in. But the presence of adhesions and the ongoing inflammatory process leads to a relapse of hydrosalpinx.

In most patients, hydrosalpinx occurs as a result of an inflammatory reaction in the uterus or appendages, as well as sexually transmitted diseases. The risk group also includes women who have ever undergone any surgical interventions in the pelvic area - for example, for appendicitis, endometriosis, etc.

Symptoms hydrosalpinx

With small volumes of pathology, the first signs may be weakly expressed or absent altogether. Such formations are found by chance - for example, during routine diagnostics. If the tube is stretched under the pressure of a large amount of effusion, then symptoms of discomfort arise. They manifest themselves in the form of pulling and pressing sensations in the lower-outer quadrant of the abdomen, as well as in the form of constant pain in the pelvic area. The temperature with hydrosalpinx can be subfebrile, or does not exceed the normal range. If there is a drainage process, then the woman notes episodic discharge with hydrosalpinx: the liquid is watery, released from the genital tract in a fairly large volume.

In the acute course of the disease, there is an increase in temperature indicators to approximately 38.5°C. The pain in hydrosalpinx is pulsating, pronounced, spreading to the groin area. The sudden onset often causes the disease to be mistaken for an attack of appendicitis or colic.

In chronic cases, obstruction causes reproductive disorders. The lumen of one or two tubes closes, preventing the egg from entering them. If both tubes are affected, pregnancy is considered impossible.

Pulling sensations in the lower abdomen with bilateral hydrosalpinx often become the reason for the patient to see a doctor. However, more often women seek help precisely because of the impossibility of conception: even if the tubal lumen is not completely blocked, the pathology affects the ciliated epithelium, mucous tissues, and leads to atrophic changes in the muscles. Impaired tubal motility often becomes the main factor in the development of an ectopic pregnancy.

Menstruation with hydrosalpinx usually does not change, since the disease does not affect the functional abilities of the ovaries. Some women experience severe nagging pain a week before the onset of menstrual bleeding, as well as in the first three or four days from the beginning of the monthly cycle.

Psychosomatics in hydrosalpinx

In case of idiopathic etiology of the disease, doctors do not exclude the psychosomatic scheme of its development. Not so long ago, fear, stress, and depression began to be considered the main factors of psychosomatic pathology. For example, a situation often occurs when a woman is afraid of getting sick and - in fact, gets sick. Psychologists point out the presence of sometimes unconscious, and therefore even more effective fears. "Will I be able to get pregnant? Will I be able to bear a baby? Will any unforeseen diseases become an obstacle?" Such thoughts can play a decisive role in the mechanism of disease development.

Having a pronounced and unconscious phobia about one's health and well-being, a person subconsciously "programs" oneself for illness, and even for its consequences. As a result, illness occurs, and the fear becomes even greater, inflated by constant attempts to get pregnant, etc.

The stressful situation becomes dominant, and the painful condition gradually worsens. Over time, the fear of not being able to get pregnant and bear a child is added, and the woman's emotional state becomes increasingly depressed.

What to do? It is almost impossible to overcome a psychosomatic disease on your own. Therefore, you should consult a qualified psychologist - preferably one who inspires confidence from the first word. If there really is a so-called psychological block, then the specialist will be able to detect internal factors that contribute to the development of the disease and hinder healing.

Stages

It is customary to distinguish between acute and chronic stages of the disease.

Acute hydrosalpinx is manifested by the following symptoms:

• intense secretion of serous fluid into the tube;
• increase in temperature indicators;
• general weakness, increased sweating;
• pain in the lower abdomen, possibly radiating to the groin;
• rapid heartbeat.

Chronic hydrosalpinx in most cases proceeds unnoticed, with a slow increase in symptoms. Sometimes a woman may complain of pulling pains in the area of the external genitalia.

Forms

According to the nature of morphological signs, hydrosalpinx of the fallopian tubes is:

• single-chambered, with the formation of a spindle-shaped, round or S-shaped neoplasm, in which the length is 2-3 times greater than the width;
• multi-chambered, with 2-8 closed cavities arranged in the form of chain links.

With weak activity of the adhesion process and incomplete closure of the tube, fluid may leak from the neoplasm into the uterus or small pelvis. In such a case, the diagnosis is "valve hydrosalpinx", which is also called "draining". Draining hydrosalpinx is often accompanied by the appearance of massive liquid discharge from the genital slit.

Depending on the degree of fallopian tube involvement, there is unilateral hydrosalpinx, in which only one of the tubes is affected, and bilateral hydrosalpinx, which is the most complex lesion of both tubes simultaneously. The latter variant, fortunately, is much less common.

The fallopian tubes are a paired organ. Each tube is a hollow, double-lumen tube that emerges from the uterine cavity and ends in fimbriae that envelop the egg. These tubes are located to the right and left of the uterus, so both right-sided and left-sided hydrosalpinx can occur. According to some statistics, it is believed that hydrosalpinx on the right is somewhat more common.

Complications and consequences

The disease can entail a lot of negative consequences for the patient - especially if it is detected at a late stage of development. The doctor's task is to prevent the possibility of the following complications:

• deformation of the uterine organ, its backward deviation, bending due to adhesion formation;
• imbalance of vaginal flora associated with weakened immune defense;
• violation of the integrity of the affected pipe;
• ectopic pregnancy;
• abscess formation;
• simultaneous intestinal damage;
• infertility.

Let us consider other possible consequences of the disease using the example of frequently asked questions from patients:

• Inflammation of hydrosalpinx - how to recognize it?

If the pathology exists for a long time and does not manifest itself with any symptoms, then the woman may not even know about the problem. However, with the growth of the formation, an inflammatory reaction begins with the further development of an abscess. This complication is accompanied by the accumulation of purulent discharge in the encapsulated cavity. In this case, the woman complains of high temperature and severe pain in the pelvic area, with possible spread to the area of the external genitalia.

• Is it possible that hydrosalpinx will resolve on its own?

The capsule size can be several centimeters. At the same time, the larger these sizes, the less likely it is that the formation will resolve. Small lesions are indeed prone to spontaneous resorption - but only if their diameter does not exceed 10 mm. By the way, "missing" capsules can reappear - that is, relapse.

• How likely is it that hydrosalpinx will recur?

To avoid relapse, first of all, it is necessary to eliminate the cause of the fluid formation. Most often, this cause is inflammation, which can be eliminated with medication. However, adhesions that formed as a result of an inflammatory reaction can only be removed surgically, so conservative treatment will not protect against the recurrence of the pathology.

After surgical excision of adhesions, the probability of relapse is reduced to a minimum, but there is a risk of other complications - for example, ectopic pregnancy. Therefore, the decision on what treatment to carry out is made by the doctor on an individual basis.

• The hydrosalpinx and the tube burst, how is this possible?

1. The formation itself is unlikely to be able to break through the appendage. But with the follicular variant, in combination with a number of accompanying factors, such a complication is indeed possible:
2. with simultaneous inflammation of the appendage wall;
3. in case of tubal pregnancy;
4. in case of purulent inflammatory process in the tubular walls;
5. with rapid increase in follicular formation.

• Torsion of hydrosalpinx – what is it?

Torsion is possible both with and without pathology in the tubes. However, in patients with hydrosalpinx, such a complication occurs in 10-20%. The provoking factor is sudden movements, intense sports, abdominal injuries, sudden lifting of weights, etc. The pathology most often manifests itself as an acute abdomen: sudden or gradually increasing pain radiating to the groin and back. Many experience nausea, bloating, and menstrual cycle irregularities. As a rule, pronounced symptoms are present for 2-7 days. Torsion treatment is surgical.

• Can hydrosalpinx develop into cancer?

The capsule itself, as a rule, cannot cause a cancerous process. However, the chronic inflammatory process, against which the pathology is formed, is considered a predisposing factor for the development of a tumor. Thus, the long-term course of adnexitis and salpingitis in patients over 45-50 years old significantly increases the risk of developing oncological complications.

• Is hydrosalpinx dangerous during menopause and postmenopause?

The disease is dangerous at all ages, as complications can develop in any patient and at any time. The idea that the pathology should be treated only in women of fertile age is a misconception.

Hydrosalpinx and pregnancy

If the patient plans to become pregnant in the future, she should definitely decide on laparoscopic surgery. Laparoscopy can restore tubal patency, but unfortunately, natural tubal function often suffers. After the intervention, tubal motility worsens, the number of receptors that provide sensitivity to basic sex hormones, such as estradiol and progesterone, decreases. All of these processes together can cause tubal pregnancy.

With unilateral hydrosalpinx, conception can occur through a healthy tube. But an untreated inflammatory process can negatively affect the course of pregnancy - for example, fetal development may freeze. Given this, doctors do not recommend planning conception against the background of existing hydrosalpinx.

In a bilateral process, a woman will definitely not be able to get pregnant on her own. In such a situation, after laparoscopic removal of the tubes, the patient is prepared for the in vitro fertilization procedure.

Diagnostics hydrosalpinx

Suspecting the presence of hydrosalpinx, the doctor will conduct a more thorough diagnosis, which will allow determining the true state of the reproductive organs. Usually, already during a bimanual examination, the gynecologist can palpate a dense, tight neoplasm - more often on one side. During palpation, the patient may feel discomfort.

Blood and urine tests do not provide comprehensive information about the presence of hydrosalpinx, but they can indicate that there is an inflammatory process in the body or disorders of the blood coagulation system. Such studies are only an addition to other diagnostic procedures.

Instrumental diagnostics is the most important stage for determining pathology. It usually includes the following procedures:

• Ultrasound with a transvaginal sensor – helps in detecting hydrosalpinx, clarifying its location, shape and size;
• Hysterosalpingography – allows you to determine the presence of patency in the tubes.

The most reliable diagnostic method is considered to be laparoscopic surgery, which can also be a treatment procedure.

• Hydrosalpinx on ultrasound is best examined on a specific day of the cycle - preferably from day 5-6 to day 7-9. The pathology manifests itself as a fluid accumulation in the tubal cavity: a neoplasm with liquid contents becomes visible, localized in the space between the appendage and the uterus. The neoplasm can be present in one tube, or in both at once.
• Hydrosalpinx can be examined in more detail on MRI, so the procedure of magnetic resonance imaging in gynecology is considered more informative than ultrasound. The disadvantage of the procedure is its cost, but ultimately the costs are justified, since the doctor gets the opportunity to carefully examine the pathology. The only more informative method than MRI can be considered laparoscopy.

Differential diagnosis

Differential diagnostics are necessary for adequate diagnosis, primarily because the initial signs of malignant tumors often resemble the picture of hydrosalpinx. Therefore, before starting treatment, it is necessary to perform diagnostic laparoscopy with biopsy.

During ultrasound examination, there may be a problem in recognizing pathologies such as a cyst or hydrosalpinx with one chamber. A single-chamber capsule of a regular oval shape does indeed resemble an ovarian cyst in appearance. However, this rarely happens: the capsule configuration is often still irregular, with a predominance of the longitudinal size. In other situations, hydrosalpinx or paraovarian cyst are differentiated only during surgery.

• What is the difference between hydrosalpinx and sactosalpinx?

When talking about sactosalpinx, they mean a general term applied to all tubal pathologies associated with the formation of a cavity with liquid effusion inside. Hydrosalpinx is just a type of sactosalpinx, which suggests that the accumulated fluid is serous in nature. In addition to this variant, there is also pyosalpinx, which is distinguished by the presence of pus inside the cavity.

Many diseases often coexist, and this significantly complicates the diagnostic process. Hysterosalpingography is successfully used for differentiation. This method is based on the introduction of a contrast fluid into the tubal lumen, which, under the influence of radio waves, begins to emit light at a certain wavelength. With the help of hysterosalpingography, it is possible to differentiate the adhesive process, salpingo-oophoritis or hydrosalpinx.

Treatment hydrosalpinx

Treatment procedures are used immediately after diagnosis. Conservative therapy can be used in women who already have children and do not plan to have more in the future, as well as in cases of mild hydrosalpinx. First of all, such treatment is aimed at stopping the inflammatory process, so the first prescribed drugs are antibiotics. When choosing a drug, it is necessary to rely on the resistance of bacteria and the type of pathogen.

For more information on hydrosalpinx treatment methods, read this article.

Prevention

Hydrosalpinx has no specific methods of prevention. However, the use of general rules recommended by gynecologists will help to avoid many diseases, including the one in question.

Let's list these important rules:

• It is necessary to visit a doctor in a timely manner if any negative symptoms from the reproductive system appear.
• We must not forget to observe the rules of personal hygiene, especially during menstrual bleeding.
• It is necessary to abstain from promiscuous sex and also remember to use condoms.
• An important preventive criterion is maintaining a healthy lifestyle, with the exclusion of bad habits.

Forecast

If the treatment for hydrosalpinx was successful, patency was restored, and the adhesion process was eliminated, the functionality of the tubes will still remain impaired - the villous mucosal cover loses the necessary motility, and movement through the tubes becomes intermittent.

If women have undergone fimbriolysis and salpingo-ovariolysis as part of their treatment, they are at risk of developing an ectopic pregnancy.

If the patency of the affected tube has been restored and the acute hydrosalpinx has been successfully removed, then natural conception with further gestation becomes possible in 70-80% of cases. At the same time, the risk of ectopic pregnancy is estimated at approximately 5%.

Is it possible to play sports with hydrosalpinx?

Sports with a diagnosis of hydrosalpinx are possible, but it is necessary to carefully weigh the load. Light exercises, stretching, limb movements are allowed. The restriction concerns loads on the abdominal muscles. It is also undesirable to lift weights, perform high-intensity exercises (jumps, vibration).

It is better to discuss the possibility of doing fitness, athletics, and cycling with your doctor.