Etiology of Proximal Tubal Obstruction.
Fallopian Tube Recanalization Techniques.
Summary of Results Following Various Endoscopic Fallopian Tube Recanalization Techniques.
This activity is intended for primary care clinicians, infertility specialists, gynecologists, and other specialists who care for women with fallopian tube obstruction.
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The diverse applications, safety, efficacy, credibility, noninvasiveness, reduced risks, costs and morbidity and encouraging results with endoscopic FTR in the evaluation and treatment of tubal obstructions make this procedure an excellent alternative to surgical invasive procedures (e.g., microsurgical tubal anastomosis and assisted reproduction), and should be offered as the initial method to treat proximally obstructed Fallopian tubes in well-selected patients. Falloposcopy is a diagnostically accurate procedure for evaluating and grading tubal disease with a good predictive value for future fertility, and falloposcopically-guided interventions under hystero–laparoscopic control have been therapeutically used to breakdown intraluminal adhesions or dilate a stenosis in normal or minimally diseased tubes with high patency and pregnancy rates. However, severe tubal disease with poor mucosal health, obliterative fibrosis, distal tubal obstruction and bipolar tubal damage are not amenable to recanalization techniques, and following an accurate diagnosis of the tubal mucosa and tubo-peritoneal environment, such cases must directly be referred for IVF. Moreover, technical shortcomings associated with falloposcopy limit the routine application of this procedure. The latest improvements in sonographic equipment and catheter technology may help eliminate radiation and replace fluoroscopy during the performance of transcervical balloon tuboplasty, making sonographic transcervical tubal catheterization a simple and cost-effective procedure for the diagnosis and treatment of patients with PTO.[76]