title: Comparative Study of Laparoscopic Abdominopelvic and Fallopian Tube Findings Before and After Antitubercular Therapy in Female Genital Tuberculosis With Infertility.
abstract: OBJECTIVE
  To study the effect of antitubercular treatment (ATT) on the laparoscopic abdominopelvic and fallopian tube findings in female genital tuberculosis (FGBT).
  
  
  METHODS
  Prospective cohort (Canadian Task Force classification II2).
  
  
  METHODS
  Tertiary referral center in northern India.
  
  
  METHODS
  Fifty women with infertility and diagnosed with FGTB on laparoscopy, histopathology findings, or endometrial sampling (acid-fast bacilli culture, granuloma on histopathology, positive polymerase chain reaction).
  
  
  METHODS
  Diagnostic laparoscopy in all women diagnosed with FGTB before and after a 6-month course of ATT (2 months of rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by 4 months of rifampicin and isoniazid). All procedures were performed by the same surgeon between June 2012 and May 2014.
  
  
  RESULTS
  The mean patient age was 28.7 years, mean parity was 0.9, and mean body mass index was 23.6 kg/m(2). Infertility was seen in all 50 women (66% primary infertility, 34% secondary infertility), with a mean duration of 6.06 years. Abnormal laparoscopic findings of FGTB included tubercles in the pelvic peritoneum, fallopian tube, and ovary in 27 women (54%) before ATT and in only 1 (2.04%) woman after ATT (p < .001). Caseous nodules and encysted ascites were seen in 4 women (8%) before ATT, and in no women after ATT (p < .001); however, there was no change from before ATT to after ATT in the rate of pelvic adhesions (42% vs 42.5%) and perihepatic adhesions (56% vs 58%). Laparoscopic findings in fallopian tubes included hydrosalpinx (32%), pyosalpinx (4%), beaded tubes (12%), nonvisualization of tube (20%), and tubal blockage on the right side (56%), left side (50%), and both sides (38%) before ATT. Hydrosalpinx, beaded tubes, and nonvisualized tube were seen in 33.4%, 4.1%, and 20.8% cases, respectively, after ATT; however, free spill increased to 52% on the right side and 50% on left side after ATT.
  
  
  CONCLUSIONS
  ATT improves laparoscopic findings in FGTB with infertility. However, advanced fibrotic lesions (eg, pelvic and perihepatic adhesions, bilateral blocked tubes) do not improve with ATT.
authors.affiliation: Department of Obstetrics and Gynaecology, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: jbsharma2000@gmail.com.
authors.forename: Jai Bhagwan
authors.initials: JB
authors.lastname: Sharma
authors.affiliation: Department of Obstetrics and Gynaecology, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Jayaramaiah
authors.initials: J
authors.lastname: Sneha
authors.affiliation: Department of Obstetrics and Gynaecology, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Urvashi B
authors.initials: UB
authors.lastname: Singh
authors.affiliation: Department of Obstetrics and Gynaecology, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sunesh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Obstetrics and Gynaecology, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Kallol Kumar
authors.initials: KK
authors.lastname: Roy
authors.affiliation: Department of Obstetrics and Gynaecology, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Neeta
authors.initials: N
authors.lastname: Singh
authors.affiliation: Department of Obstetrics and Gynaecology, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sona
authors.initials: S
authors.lastname: Dharmendra
authors.affiliation: Department of Obstetrics and Gynaecology, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India; Department of Biostatistics, All India institute of Medical Sciences, New Delhi, India.
authors.forename: Perumal
authors.initials: P
authors.lastname: Vanamail
mesh_terms: D000328:Adult; D000818:Animals; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005184:Fallopian Tube Diseases / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D005187:Fallopian Tubes / Q000473:pathology* / Q000821:virology; D005260:Female; D006801:Humans; D007194:India; D007247:Infertility, Female / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D010535:Laparoscopy; D011247:Pregnancy; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D016896:Treatment Outcome; D014384:Tuberculosis, Female Genital / Q000150:complications / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000995:Antitubercular Agents
keywords: Antitubercular therapy; Female genital tuberculosis; Infertility; Laparoscopy findings; Polymerase chain reaction