Hysteroscopic Darwishscope Test Versus Bubble Flow Patency Test for Normal and Hydrosalpingeal Fallopian Tubes

Objectives: Currently available hysteroscopic tubal patency testing relies only on anatomical passage of air bubbles or flow of irrigating fluid and debris via tubal ostia. The aim of this study was to assess the reliability of a hysteroscopic proximal tubal bubble flow test and a peristalsis test separately or in combination (Darwishscope test) for detection of tubal patency in apparently normal fallopian tubes and hydrosalpinges as confirmed by laparoscopy. Materials and Methods: A prospective comparative cohort study was conducted at an endoscopy unit of a tertiary university hospital. The subjects were infertile women undergoing concurrent laparoscopy and hysteroscopy for infertility management. The patients were classified into group A (women with normal-caliber and patent fallopian tubes seen on laparoscopy) or group B (women with unilateral or bilateral distended and blocked distal ends of their fallopian tubes [hydrosalpinx] seen on laparoscopy). A combined hysteroscopic bubble flow test and proximal tubal peristalsis (Darwishscope test) were performed. The primary outcome was how many patients had positive combined bubble flow and proximal tubal peristalsis tests separately or in combination (Darwishscope test) in both apparently normal and hydrosalpingeal tubes. Feasibility of the procedure, access and any proximal tubal abnormalities were secondary outcome measures. Results: Among 115 infertile women, there was an insignificant difference between both groups regarding basic data except a significant increased history of pelvic inflammatory disease in group B. Endometriosis was reported in 20 (33.9%) and 24 (42.7%) cases in both groups, respectively. On hysteroscopy, the bubble flow test was positive in 106 tubes (89.8%) in group A and 56 (50%) tubes in group B after exclusion of unilateral patent tubes with a sensitivity of 84.8% (95% confidence interval [CI]: 73.0–92.8) and 88.1% (95% CI: 77.1–95.1) on the right and left sides, respectively. Tubal peristalsis was positive in 80 tubes (67.8%) in group A and in 13 tubes (14%) in group B after exclusion of unilateral patent tubes with higher specificity than the bubble flow test (57.1% [95% CI: 43.2–70.3] and 67.9% [95% CI: 54.0–79.7] versus 47.6% [95% CI: 32.0–63.6] and 29.8% [95% CI: 17.3–44.9] on the right and left sides, respectively). Use of the Darwishscope test resulted in a rise of specificity, a positive predictive value, a negative predictive value, and diagnostic accuracy on both sides, compared to either test alone in both normal and pathologic tubes. Conclusions: The bubble flow test is the most-sensitive test of patency of the proximal part of the fallopian tubes. A fallopian tube peristalsis physiologic patency test is more-specific than a bubble flow test. The Darwishscope test is superior to either test alone for assessing proximal tubal function, as it this is test the most-specific test of both anatomical and physiologic patency in normal and pathologic tubes with high diagnostic accuracy. (J GYNECOL SURG 38:49)