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Dan C. Martin, MD
UT Medical Group, Inc.

University of Tennessee Health Science Center (UTHSC)

UTHSC Academic Office

Daniel Clyde Martin, M.D.
UT Medical Group, Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733

(901) 347-8331
(901) 347-8188 fax
Directions to Office

Updated information is at
UTMG 2006

Click for information on:
Glenn Ann Martin, Ph.D.
Clinical Psychologist

 

THERAPEUTIC IMPLICATIONS
OF DIAGNOSTIC HYSTEROSCOPY
FOR CORNUAL OCCLUSION

Presented at the
Third World Conference on the Falloppian Tube in Health and Disease
Kiel, West Germany 4 July 1990
by
Dan C. Martin, M.D, University of Tennessee, Memphis, USA
and
PD Dr. Wolfgang Zieger, Klinikum Mannheim, Germany

Tubal Hydrosalpinx Stages of Damage Cornual Occlusion Cornual Paper

Other Reproductive Surgery Pages:     Tubal Reversal         Adhesions         Endometriosis   

 

[PDF of Current Evaluation and Treatment Protocol for Cornual Occlusion]

 

Hysteroscopic cannulation is an excellent technique in selected patients.  However, we must be concerned that unnecessary surgery may result in perforation, trauma, bleeding and postsurgical scarring.

Since initial reports of transvaginal cannulation for proximally occluded tubes about 1985, there has been significant increase in reports of tubal cannulation for cornual occlusion.  However, this is more commonly discussed as a therapeutic rather than a diagnostic procedure.  Some of these procedures are being performed without cervical culture or preoperative medication.  It would appear that some of the patients being reported as successful therapeutic cannulation might have been more properly reported as successful diagnostic cannulation or alternately may represent overuse of the equipment.

All patients had chlamydia cultures and standard cultures prior to surgery.  These were treated until the cultures were negative.  Danocrine and GnRH analogs were used to suppress hormonal production on the basis of statements by Brian Cohen regarding the association of endometriosis with cornual occlusion.  Doxycycline was used in all patients due to a high incidence of positive Chlamydia IGG titers and the inability to perform cornual Chlamydia cultures.  These had been used together since 1980 and were analyzed in 1985.

Ovarian suppression and antibiotics were used for eight weeks prior to hysterosalpingogram and/or hysteroscopy for 26 patients.

In this study, 62% of patients with cornual occlusions responded to a combination of hormonal suppression, antibiotics and repeat tubal studies.  Radiologic tubal cannulation as a diagnostic or therapeutic procedure may be successful in certain patients but may not demonstrate coexistent salpingitis isthmica nodosa and is ineffective against hydrosalpinges and endometriosis.

Combined hysterosalpingogram, laparoscopy with hysteroscopic cannulation following a combination of Danazol or GnRH analogs in association with Doxycycline or other antibiotic therapy appears to be the most comprehensive approach in the evaluation and therapy of these patients.

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Additional possibilities such as dried secretions in the tube, mucus in the tube or spasm as a reaction to X-ray dye are covered at Cornual Occlusion.  These may be corrected by the pressure of the X-ray, by antibiotics or by medicine to relieve the spasm.

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Updated protocol is on the pdf  "Therapeutic Implications of Diagnostic Hysteroscopy for Cornual Occlusion."

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