Salpingographic demonstration of "cobblestone" mucosa of the distal tubes is indicative of irreversible mucosal damage.

OBJECTIVE

To establish the predictive value of the observation of a "cobblestone" pattern of the distal tube mucosa shown on the selective salpingogram as an indicator of significant and probably irreparable damage to the ciliated epithelium.

DESIGN

Clinical study.

SETTING

Fertility and Laser Center and Academic Radiology Department.

PATIENT(S): Patients with primary or secondary infertility and obstruction of the fallopian tubes documented on hysterosalpingogram.

INTERVENTION(S): Transcervical recanalization of obstructed tubes followed by reassessment by selective salpingogram.

MAIN OUTCOME MEASURE(S): Progression of mucosal disease with resultant low likelihood of intrauterine pregnancies and high probability of ectopic pregnancy.

RESULT(S): In 32 asymptomatic patients, there was progression to coalescence and agglutination of mucosal folds in 13, to a thick wall pyosalpinx in 4. Five thin wall and 8 thick wall hydrosalpinges in asymptomatic patients showed no significant progression of mucosal disease but increasing peritubular fibrosis. In 12 symptomatic patients, progressive fusion of mucosal folds with polypoid hyperplasia was observed in 11, a thin wall hydrosalpinx in 2.

CONCLUSION(S): Cobblestone appearance of the distal tubes heralds significant mucosal damage, prone to progressive disease and hence, a poor chance for conception.