Transvaginal four‐dimensional hysterosalpingo‐contrast sonography: Pain perception and factors influencing pain severity

Zhang, Ning; Liu, Yu; He, Yanni; Shi, Jiayao; Zhou, Meijun; Li, Hongmei

doi:10.1111/jog.14538

Cited by 9 publications

(8 citation statements)

References 27 publications

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“…This technique is safe due to its noninvasive and nonradiative nature and can be easily performed in outpatient settings ( 14 , 15 ). Transvaginal four-dimensional HyCoSy (4D-HyCoSy) is a diagnostic technique that can dynamically demonstrate the entire contrast flow from the uterine cavity through the bilateral uterine horns to the fallopian tubes and ultimately into the pelvic cavity ( 16 , 17 ). Furthermore, postcontrast imaging allows for frame-by-frame dynamic playback and segmental analysis of the area of interest, which further improves diagnostic accuracy.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study

Wang,

Chen,

et al. 2024

Quant Imaging Med Surg

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Background Although the application of four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) has relatively good diagnostic accuracy for assessing the patency of the fallopian tubes, the evaluation process mainly relies on morphological findings of the fallopian tubes and pelvic cavity. The purpose of this study was to explore the relationship of peak injection pressure during 4D-HyCoSy and tubal patency to provide a quantitative indicator for the evaluation of fallopian tube patency. Methods This study included infertile patients who underwent 4D-HyCoSy and laparoscopic chromopertubation (LC) between 2020 and 2022, with LC serving as the reference test for assessing tubal patency. For the HyCoSy procedure, the ultrasound contrast agent was injected automatically using a liquid injection machine, and real-time pressure values were recorded. Patients were classified based on tubal patency status in LC as bilaterally patent, unilaterally patent, or bilaterally nonpatent. The average peak injection pressure and contrast agent volume of different groups were compared. Receiver operating characteristic (ROC) curve analysis was employed to determine the cutoff value. Results A total of 268 infertile patients were enrolled in the study. With LC as the standard examination, the sensitivity and specificity of 4D-HyCoSy in diagnosing nonpatent fallopian tubes were 91.1% and 95.1%, respectively. In general, peak injection pressure was observed to gradually increase as tubal patency decreased (P<0.001), with average peak injection pressures of 233.5±66.3, 338.8±99.8, and 469.6±63.1 mmHg in the bilaterally patent, unilaterally patent, and bilaterally nonpatent groups, respectively. The volume of contrast agent used in patients in the bilaterally nonpatent group was significantly lower than that in the other two groups (P<0.01), with average volumes of 22.7±6.3, 24.3±9.3, and 18.9±9.2 mL, respectively. When one fallopian tube was patent, the area under the curve (AUC) for distinguishing obstruction from patency of the other fallopian tube was 0.827, with a sensitivity of 79.8% and a specificity of 74.3% (cutoff value: 254.3 mmHg). Similarly, when one fallopian tube was nonpatent, the AUC was 0.866, with a sensitivity of 90.6% and a specificity of 78.3% (cutoff value: 401.3 mmHg). Conclusions Peak injection pressure during 4D-HyCoSy demonstrates promising diagnostic performance in evaluating fallopian tube patency in infertile patients.

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Section: Introductionmentioning

confidence: 99%

Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study

Wang,

Chen,

et al. 2024

Quant Imaging Med Surg

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“…If the contrast agent was injected too quickly, the intrauterine pressure would too quickly, causing the patient’s uterine tubal spasm and discomfort. 15 , 16 Therefore, a slow low-pressure bolus injection of contrast agent could avoid excessive accumulation of the contrast agent in the uterine cavity, which helped reduced reducing the possibility of intravasation.…”

Section: Discussionmentioning

confidence: 99%

Operator’s Influence on Contrast Agent Intravasation During Hysterosalpingo-Contrast Sonography: Explanation Based on a Physics Model

Jin¹,

Ma²,

Zhao³

et al. 2022

IJGM

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Objective To analyze the risk factors of the operators on contrast agent intravasation during hysterosalpingo-contrast sonography (HyCoSy). Methods We retrospectively collected 399 infertile women who underwent HyCoSy by the same sonographer. These patients were divided into two groups according to the way how the assistants connected the syringe to the uterus radiography catheter to inject the contrast agent. We analyzed whether the use of different contrast bolus injection methods had any influence on the incidence of intravasation during HyCoSy. Results There was no significant difference between the two groups with different cross-sectional areas of the syringe outflow tract in the risk variables for intravasation, but the intravasation rates of the two groups were different, 26.4% in group A and 17.1% in group B, P <0.05. The primary manifestation was that when both fallopian tubes were unobstructed, the intravasation rate of group B with smaller cross-sectional area of the outflow tract of the syringe was lower, and the difference was statistically significant. The inferences drawn from our physics model were also in line with the clinical results. Conclusion The influence of different operators on the contrast agent intravasation rate of HyCoSy cannot be ignored. The assistants of HyCoSy examination should inject the contrast agent slowly and steady, and a needle can be used as a flow restrictor to control the flow into the uterine cavity per unit time, slow down the rising speed of intrauterine pressure, and avoid the accumulation of contrast agent in the uterine cavity, so as to reduce the intravasation caused by operator factors.

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“…The first lies in cervical cannulation; in HSG it represents a very painful step and implies a high failure rate (7.31%, 6/82); a possible explanation for this could be that in HyFoSy the professional who performs cervical cannulation is a gynaecologist who is acquainted with the procedure. On the other hand, we ruled out the use of an anti-reflux balloon in HyFoSy, because the patients studied are mostly nulliparous and cases of contrast media reflux are exceptional (0.9%, 1/107); therefore, higher pain on the VAS scale in the HSG group could be associated with the filling of the anti-reflux balloon in the cervix or uterine cavity, which has been associated with more pain and vagal reactions [ 43 ]. Finally, differences in the VAS score could be explained by a higher contrast volume instilled in HSG patients (8.8 ± 4.1 ml/pat vs. 4.5 ± 2 ml/pat in HyFoSy, p < 0.001), as a lesser distension of the uterine cavity is associated with lower perceived pain [ 43 ]; for this reason, we recommend using the lowest volume possible for fallopian tubes and uterine cavity assessment.…”

Section: Discussionmentioning

confidence: 99%

Is hysterosalpingo-foam sonography (HyFoSy) more tolerable in terms of pain and anxiety than hysterosalpingography (HSG)? A prospective real-world setting multicentre study

et al. 2022

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Background In 60% of sterile couples a female factor is present, with these being tubal factors in 30–50% of cases. A tubal patency test is also required in women without a male partner undergoing fertility treatment. Thus, an accurate, safe and tolerable technique should be available. The aim of this study is to determine and to compare hysterosalpingo-foam sonography (HyFoSy) and hysterosalpingography (HSG) tolerability in terms of pain and anxiety. Methods This is a prospective real-world setting multicentre study conducted in two tertiary hospitals in Madrid. 210 infertile women/women without a male partner looking to get pregnant were recruited; 111 for the HyFoSy group and 99 for the HSG group. Tolerability was measured in terms of anxiety by the State Trait Anxiety Inventory (STAI) and pain by the Visual Analogue Scale (VAS). Results Median VAS score in HyFoSy group was 2 (P25; P75: 1; 3) versus 5 (4; 8) in HSG group, p < 0.001. The median State-STAI score in the HSG group was 18 points (10; 26) versus 10 (7; 16) in the HyFoSy group (p < 0.001); the median Trait-STAI score in the HSG group was 15 (11; 21) versus 13 (9; 17) in the HyFoSy group (p = 0.044). Conclusions HyFoSy shows higher tolerability to both: pain and anxiety. It is related to less pain and less post-test anxiety than HSG.

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Transvaginal four‐dimensional hysterosalpingo‐contrast sonography: Pain perception and factors influencing pain severity

Cited by 9 publications

References 27 publications

Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study

Evaluation of tubal patency based on peak injection pressure in four-dimensional hysterosalpingo-contrast sonography among infertile females: a preliminary study

Operator’s Influence on Contrast Agent Intravasation During Hysterosalpingo-Contrast Sonography: Explanation Based on a Physics Model

Is hysterosalpingo-foam sonography (HyFoSy) more tolerable in terms of pain and anxiety than hysterosalpingography (HSG)? A prospective real-world setting multicentre study

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