Hydrosalpinx: Definition and Treatment
Definition
Hydrosalpinx is a distension or dilatation of the fallopian tube caused by distal tubal occlusion, most commonly resulting from prior pelvic inflammatory disease (PID). 1, 2 The blocked tube fills with fluid, creating a characteristic tubular, fluid-filled structure visible on imaging. 1
Diagnosis
Transvaginal ultrasound (TVUS) is the initial imaging modality of choice, with 86% sensitivity for detecting hydrosalpinx. 1, 3
Additional diagnostic considerations:
- MRI provides 75.6% accuracy in surgically confirmed cases and is superior to TVUS for assessing PID complications. 3
- Hysterosalpingography (HSG) detects tubal patency, size, irregularity, and peritubal disease with 65% sensitivity and 85% specificity compared to laparoscopy. 1, 3
- Antibiotic prophylaxis should be considered if there is prior history of PID or if hydrosalpinx is identified during any diagnostic procedure. 1, 3
Treatment
For Women Planning In Vitro Fertilization (IVF)
Laparoscopic salpingectomy is the preferred treatment when surgical expertise is available, as it significantly improves IVF outcomes. 3 This recommendation is based on:
- Salpingectomy increases odds of ongoing pregnancy (OR 2.14) and clinical pregnancy (OR 2.31) compared to no treatment. 3
- The relative risk for ongoing pregnancy is 2.24 versus no intervention. 3, 4
Proximal tubal occlusion is the highest-ranking alternative intervention, with a relative risk of 3.22 for ongoing pregnancy versus no intervention. 3, 4 This approach is particularly valuable when:
- Distorted pelvic anatomy or dense pelvic adhesions make abdominal surgery complex. 2, 5
- Laparoscopy is contraindicated. 5
Ultrasound-guided aspiration of hydrosalpinx fluid is the least effective option and shows inconsistent results in improving IVF outcomes. 6, 4
For Women Desiring Natural Conception
Salpingostomy (distal tubal plastic surgery) can be considered only in highly selected cases: 2
- Small, thin-walled hydrosalpinx with healthy mucosa. 6
- Performed by an experienced surgeon via laparoscopy or open microsurgery. 6
Critical caveat: Ectopic pregnancy rates as high as 10% have been reported after salpingostomy. 2 The overall prognosis for surgical repair is poor, with good results achievable only in carefully selected patients. 6
Key Clinical Pitfalls
- Hydrosalpinx reduces implantation and pregnancy rates in IVF through mechanical and chemical disruption of the endometrial environment. 2, 6
- Incomplete salpingectomy at the time of hysterectomy can lead to painful hydrosalpinx requiring repeat surgery—complete removal of the entire fallopian tube including fimbriae is essential. 7
- When performing salpingectomy, coordination with other indicated surgeries should be considered when appropriate. 3