Microlaparoscopy and a GnRH agonist: a combined minimally invasive approach for the diagnosis and treatment of occlusive salpingitis isthmica nodosa associated with endometriosis.
OBJECTIVE
To evaluate whether occlusive salpingitis isthmica nodosa associated with endometriosis can be diagnosed by microlaparoscopy and managed with medical therapy using leuprolide acetate.


METHODS
This was a prospective, nonrandomized study conducted at a university hospital and a private community hospital. It included women with occlusive salpingitis isthmica nodosa associated with endometriosis. Diagnosis of salpingitis isthmica nodosa was made via microlaparoscopy with chromotubation. Patients with occlusive salpingitis isthmica nodosa were treated with leuprolide acetate 3.75 mg administered monthly for 6 months.


RESULTS
Tubal patency in occlusive salpingitis isthmica nodosa following medical therapy with leuprolide acetate was evaluated. Thirteen of 16 (81.3%) women with bilateral salpingitis isthmica nodosa achieved patency of both fallopian tubes following treatment with leuprolide acetate; 3 of 16 (18.8%) developed patency in one of the fallopian tubes. All 5 women with unilateral SIN demonstrated bilateral patency following medical therapy.


CONCLUSIONS
Diagnosis of occlusive salpingitis isthmica nodosa can be made by microlaparoscopy. These preliminary results suggest that medical therapy with leuprolide acetate may be the first-line treatment modality for women with occlusive salpingitis isthmica nodosa associated with endometriosis, possibly avoiding a more invasive surgical procedure.
Almeida
Oscar D
OD
Department of Obstetrics and Gynecology, University of South Alabama College of Medicine, Mobile, USA. odalmeida@aol.com
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000494:pharmacology / Q000627:therapeutic use*; D015897:Comorbidity; D004715:Endometriosis / Q000175:diagnosis* / Q000453:epidemiology; D005187:Fallopian Tubes / Q000187:drug effects; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016729:Leuprolide / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D012488:Salpingitis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*
D018931:Antineoplastic Agents, Hormonal; D016729:Leuprolide