| Hysterosalpingography / Uterosalpingography
What is Hysterosalpingography? Back to Top
Hysterosalpingography,
also called uterosalpingography, is radiography (or x-ray) of the
uterus and fallopian tubes performed after the injection of radiopaque
contrast material (for this examination iodine is used mixed with water
or oil). X-ray images are still pictures of the body’s interior
structures acquired by using small, highly controlled amounts of
radiation that are passed through the body and recorded on film.
Certain anatomic structures allow more radiation to pass through them
than others, creating varying shades of lightness and darkness on an
x-ray image. In hysterosalpingography, a particular type of
radiography, called fluoroscopy, is used. The contrast material used
for this procedure can be water-soluble. It is administered to the
cervix through a small catheter to help the radiologist view the
internal uterine structures.
What are some common uses of the procedure? Back to Top
Hysterosalpingography
is primarily used to examine women who have trouble becoming pregnant.
It is able to show the shape and structure of the uterus, the patency
(openness) of the Fallopian tubes, and any adhesions (scarring inside
the body from prior surgery or infections) that may be present within
the peritoneal cavity. The procedure can be used to investigate
repeated miscarriages that can result from congenital abnormalities of
the uterus. It can also be used to monitor the effects of tubal
surgery—that is, the closure of the fallopian tubes in a sterilization
procedure (tubal ligation), or the re-opening of the fallopian tubes
after a sterilization reversal.
Hysterosalpingography is able to depict congenital abnormalities of
the uterine cavity. It can also be useful to monitor a patient who has
undergone surgery to re-open the fallopian tubes from a disease-related
obstruction. If the uterus is positioned incorrectly as a result of
tumor masses or adhesions, or if uterine fibroids are present in the
uterine cavity, hysterosalpingography can be used to determine the
presence and severity of these abnormalities.
How should I prepare for the procedure? Back to Top
The
hysterosalpingography procedure is best performed one week after
menstruation but before ovulation to make certain that you are not
pregnant during the exam. Also, this procedure should generally not be
performed if you have an active inflammatory condition. If you have a
chronic pelvic infection or an untreated sexually transmitted disease
at the time of the procedure, notify your physician or technologist.
The night before the procedure, it is common for a laxative or an
enema to be given to remove all fecal material from the bowels, so that
the uterus and surrounding structures can be seen clearly. Also, a mild
sedative or over-the-counter medication may be provided prior to the
exam to minimize any potential discomfort. For some patients, the
referring gynecologist or the radiologist may prescribe antibiotics
prior to and/or after the procedure.
What does the equipment look like? Back to Top
The x-ray
machine, or fluoroscopy unit, used to acquire images has a large table
for the patient to lie on, with a moveable x-ray tube positioned above
it with which to acquire the images. The catheter (or tube) used to
administer the contrast material into the cervix is small and
lightweight, and should not cause much discomfort.
How does the procedure work? Back to Top
The contrast
material that is injected into the uterine cavity will fill the uterus
and surrounding structures so that the radiologist is able to see their
shape, size and position in relation to each other. The material should
fill the uterus first, followed by the fallopian tubes and the
peritoneal cavity. If the contrast material does not advance properly,
or if it is seen leaking out of these areas, then the radiologist
should be able to see it and determine the source of the abnormality.
Also, if the shape of the uterus or surrounding structures is abnormal,
the radiologist will be able to see it and determine the cause of the
misshapenness, such as a uterine fibroid.
How is the procedure performed? Back to Top
The patient is
positioned on her back on the screening table, with her knees pulled to
her chest or her feet held up with stirrups. A speculum is inserted
into the vagina, and the catheter is then advanced into the cervix. The
speculum is removed, and the patient is carefully situated underneath
the fluoroscopy device. The contrast material is then injected into the
cervix, and fluoroscopic images are acquired.
In some cases, if certain abnormalities are encountered, the patient
will be asked to rest and wait up to 30 minutes so that a delayed image
can be obtained. This delayed image may provide clues to a patient’s
condition that the original images with contrast material do not. On
occasion, an x-ray will be taken the next day to ensure that there are
no adhesions (or scarring) surrounding the ovaries.
When the procedure is complete, the catheter will be removed, and
the patient will be allowed to sit up. Usually, the patient will be
asked to wait while the images are reviewed to make sure that adequate
images were acquired.
What will I experience during the procedure? Back to Top
The
procedure should cause minimal discomfort. There may be slight
discomfort when the catheter is placed and the contrast material is
injected, but it should not last long. There may also be slight
irritation of the peritoneum, causing generalized lower abdominal pain,
but this should also be minimal and not long lasting. X-ray is a
painless type of imaging that causes no sensation when applied.
Who interprets the results and how do I get them? Back to Top
A
radiologist, a physician experienced in x-ray and other imaging
examinations, will analyze the images and provide a report to your
primary care or referring physician. You will most often receive the
results from your primary care physician or the radiologist may discuss
the results with you.
What are the benefits vs. risks? Back to Top
Benefits
- Hysterosalpingography is a minimally invasive and usually mildly uncomfortable examination with rare complications.
- Hysterosalpingography
is a relatively short procedure that can provide valuable information
on a variety of abnormalities that cause infertility or problems
carrying a fetus to term.
- Minimal low-level radiation is used for this procedure.
Risks
- Women who are or may be pregnant should inform their physician or technologist before the procedure.
- In
the event of a chronic inflammatory condition, pelvic infection or
untreated sexually transmitted disease, be certain to notify the
physician or technologist before the procedure to avoid worsening of
infection.
- Special care is taken during x-ray
examinations to ensure maximum patient safety by using a lead apron to
shield the patient from any more radiation than is necessary for the
anatomic region being imaged.
- Radiation risks are further minimized by:
- the use of high-speed x-ray equipment that requires less radiation to produce an optimal image.
established
technique standards and guidelines designed by and continually reviewed
by national and international radiology protection councils.
- modern,
state-of-the-art x-ray systems that have tightly controlled x-ray beams
with excellent filtration and dose control methods. Thus, scatter (or
stray radiation) is minimized, and other parts of a patient's body not
being imaged receive minimal exposure.
What are the limitations of Hysterosalpingography? Back to Top
Reasons
not to perform hysterosalpingography include pregnancy, menstruation,
pelvic infection or untreated sexually transmitted disease, severe
renal or cardiac disease, sensitivity to contrast material, recent
dilation and curettage, and vaginal bleeding of unknown cause. Back to Top |
