Phalloscopy

The state of the epithelium of the fallopian tubes is important for determining their functionality. Phalloscopy - a direct visual inspection of the inner tube epithelium allows to evaluate its condition, to reveal a possible pathology, and also to estimate the probability of pregnancy after microsurgical operation with in vitro fertilization (GIFT, ZIFT).

An attempt of direct visual inspection of the lumen of the fallopian tube was undertaken in 1970 by Mohri et al., Who used a fiber optic endoscope with a diameter of 2.4 mm. But in view of the technical imperfection of the endoscope, the attempt was unsuccessful.

The improvement of fiber optics, the creation of powerful light sources and video monitors contributed to the development of endoscopy. Kerin et al. In 1990, invented the technique and described the technique of transcervical direct visual inspection of the lumen of the uterine tube - phalloposcopy.

The phalloposcope is a microendoscope with a diameter of 0.5 mm. Falloposcopy should be distinguished from salpingoscopy, in which a rigid endoscope is inserted into the uterine tube through the fimbrial part (usually with laparoscopy).

In the first stages, the technique of phalloposcopy consisted in the following: first hysteroscopically the tube was cannulated with a flexible conductor having an external diameter of 0.3-0.8 mm, under the control of a laparoscope. A Teflon cannula with an outer diameter of 1.3 mm was inserted from this conductor from the outside. After that, the flexible conductor was removed, and a phallosposcope was inserted through the Teflon conductor. A washing system using saline facilitated the movement of the endoscope inside the cannula and improved visibility, constantly washing and deflecting the epithelium from the lens of the endoscope.

Subsequently, Bauer et al. In 1992, invented for phalloposcopy a system consisting of a catheter with a polyethylene balloon, which was based on the principle of the hydraulic pressure of the deployable balloon for atraumatic cannulation of the tube and the insertion of an endoscope into the cavity of the tube (The Linear Eversion Catheter - LEC). This system, manufactured by Imagin Medical Inc. (Irvine, CA, USA) can be used without a hysteroscopic conductor. The catheter is made of plastic, the diameter of its base is 2.8 mm, inside it is a steel conductor 0.8 mm in diameter. A soft, non-stretchable polyethylene cylinder is attached to the catheters, which serves as an elastic gasket between the endoscope and the pipe wall, protecting both the endoscope itself and the pipe wall from damage. Inside this system is introduced a phallosposcope. The fluid installation increases the pressure inside the balloon, and when the steel inner conductor moves, the balloon turns from the tip of the catheter so that the double layer of the balloon and the endoscope are inserted into the tube lumen. The balloon raises (stretches) the tissue in front of the endoscope, making it easier to inspect the lumen of the tube and protect it from damage. One of the advantages of LEC technology in phalloscopy is its ability to conduct without anesthesia on an outpatient basis.

Kerin et al. (1989, 1992) described, according to the phallosposcopy, the state of the uterine tube cavity both in norm and in pathology: inflammatory diseases of the fallopian tubes, tubal pregnancy, intra-tubular polyps and synechia, zones of nonspecific devascularization, atrophy and fibrosis.

Normal condition. The proximal part of the pipe looks like a tunnel with a straight, straight wall. The isthmic department of the fallopian tube has 4-5 longitudinal folds of the epithelium. Usually the lumen of these two segments is fully visible. Further, the distal part of the tube becomes wider, its lumen can not be inspected completely during phalloscopy. There are also longitudinal folds of the epithelium moving under the current of the injected fluid.

Pathology. Significant narrowing of the lumen of the proximal part of the tube is detected with stenosis; when phalloscopy it can be eliminated with balloon tuboplasty. Complete infection of the proximal part looks like a blindly terminating tunnel, with its considerable damage, uneven outlines of the tube lumen with well-defined lobes are visualized. When the distal part of the fallopian tube is occluded (phimosis, small hydrosalpinx), the epithelium still retains folds, but their movements are less pronounced. With considerable stretching, the folds disappear, the wall relief is almost smoothed, the tube clearance looks like a dark cavity. The worst in the forecasting plan is the in-tube synechia (spikes).

With visual inspection of the lumen of the fallopian tube under the pressure of the liquid, the mucus plugs can be washed out of the proximal part and the delicate synechia can be destroyed. Occlusion of the proximal part of the fallopian tube can be caused by several reasons: spasm, mucous plugs, congestion of mucous membrane scrapes, adhesions, stenosis, true fibrosis. Transcervical balloon tuboplasty, tube catheterization under X-ray control, hysteroscopic catheterization of the fallopian tubes and lavage under pressure do not reveal the cause. Only with phallosposcopy can you determine the cause of the occlusion of the proximal part of the uterine tube and decide the method of its elimination.

In 1992, Kerin et al. Proposed the classification of the intragranular pathology using a point system, taking into account the changes in the folds of the tubal epithelium, the nature of the vascularization, the size of the lumen, the presence and nature of adhesions and zones of nonspecific devascularization. Depending on the degree of damage to the proximal part of the fallopian tubes, the probability of pregnancy (in percent) and the tactics of the patient's management are determined.

Similar classifications were also proposed for predicting the results of treatment of the pathology of the distal part of the fallopian tube.

Hysterosalpingography remains the main screening method for infertility examination, which allows one to suspect the pathology of the fallopian tubes. But only with phallosposcopy can you accurately determine the nature of the changes. But even with the normal results of hysterosalpingography (permeable fallopian tubes), phalloposcopy can diagnose the intrabrain pathology in women with infertility of infertility.

There are also cases when hysterosalpingography revealed occlusion of the proximal part of the fallopian tubes, and by results of phallosposcopy they turned out to be passable. The discrepancy between the data of hysterosalpingography and phallosposcopy was revealed in 40%.

Risquez et al. In 1992 showed the possibility of diagnosing ectopic pregnancy through transcervical phalluscopy and suggested treatment by introducing methotrexate directly into the fetal egg under visual control.

Thus, phalloposcopy supplements the generally accepted methods of infertility research, such as hysterosalpingography, laparoscopy, and salpingoscopy. This endoscopic method allows you to examine and evaluate the lumen and the epithelium inside the fallopian tubes, and also choose the method of further treatment (tuboplasty, laparoscopic operation on the fallopian tubes or methods of in vitro fertilization).

[1]