Diagnosis and Treatment of Hydrosalpinx

Diagnostic Methods

Transvaginal ultrasound (TVUS) is the initial imaging modality of choice with 86% sensitivity in detecting hydrosalpinx, as recommended by the American College of Radiology 1, 2
MRI is useful for detection of hydrosalpinges with 75.6% accuracy in surgically confirmed cases, and is superior to TVUS in assessment of pelvic inflammatory disease (PID), according to the American College of Radiology 2, 3
Hysterosalpingography (HSG) allows detection of tubal patency, size, irregularity, and peritubal disease with 65% sensitivity and 85% specificity compared to laparoscopy, as stated by the American College of Radiology 1, 4

Hydrosalpinx is most commonly caused by prior pelvic inflammatory disease (PID), as reported by the American College of Radiology 1, 3
Antibiotic prophylaxis should be considered at the discretion of the physician if there is a prior history of PID or if hydrosalpinx is noted at the time of any diagnostic procedure, as suggested by the American College of Radiology 1, 5
When performing surgical procedures for hydrosalpinx, coordination with other indicated surgeries should be considered when appropriate, as recommended by the National Comprehensive Cancer Network 6

Transvaginal ultrasound (TVUS) is the initial imaging modality of choice with 86% sensitivity for detecting hydrosalpinx, and antibiotic prophylaxis should be considered if there is prior history of pelvic inflammatory disease or if hydrosalpinx is identified during any diagnostic procedure, as recommended by the American College of Radiology 7

For women planning IVF, laparoscopic salpingectomy is preferred as a category 1 recommendation when surgical expertise is available, and a gynecologic oncologist should perform the surgery when possible, based on improved outcomes, as recommended by the National Comprehensive Cancer Network 8
Proximal tubal occlusion has the highest relative ranking for improving pregnancy outcomes in women with hydrosalpinx planning IVF, with a relative risk of 3.22 for ongoing pregnancy vs no intervention 7
Laparoscopic salpingectomy increases the odds of ongoing pregnancy and clinical pregnancy compared to no treatment, with an odds ratio of 2.14 and 2.31, respectively, and is the second-highest ranking option for improving pregnancy outcomes in women with hydrosalpinx planning IVF, with a relative risk of 2.24 for ongoing pregnancy vs no intervention 8