A SYSTEM FOR SIMULTANEOUS BILATERAL TUBAL CANNULATION

Objective - The efficacy of a new system for simultaneous bilateral tu bal cannulation under tactile impression was evaluted. Methods - Two r adiologically detectable selective salpingography catheters (Bard Gyne cology and Urology, Covington, GA) were glued back to back in a ''T'' configuration similar to an intrauterine device. A sliding plastic sle eve contained the straightened catheters and the uterus was cannulated under tactile impression. The sleeve was then withdrawn and the cathe ters opened within the uterine cavity and wedged into the right and le ft tubal ostia simultaneously. Selective injection of water-soluble ra diologic contrast material into the tubes resulted in selective salpin gography and determined successful tubal cannulation. Withdrawal of th e catheters back into the sleeve allowed injection of contrast materia l into the uterine cavity. Patients - The system was evaluated in 14 c onsenting patients scheduled for hysterosalpingogram during infertilit y evaluation. Results - Bilateral selective salpingography was achieve d successfully under tactile impression in 12/14 (86%) patients. In tw o patients with either distorted or very small uterine cavity, the cat heter tips embedded into the lateral uterine walls and did not selecti vely cannulate the tubal ostia Reapplication of the system under fluor oscopy allowed bilateral selective salpingography of these two patient s. Conclusion-Simultaneous bilateral selective salpingography eliminat ed the need for cervical cannula, significantly reduced fluoroscopy ti me to seconds, and demonstrated that tactile cannulation is successful in normal uteri. Application of this system for simultaneous tribal c annulation is identical to intratubal uterine device insertion, a proc edure familiar to all gynecologists. Therefore, this catheter system m ay further contribute to simplification of transcervical access into t he fallopian tubes for diagnosis and treatment.