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Clinical Presentation
Hesitancy Urgency

Incomplete bladder

emptying Drippling Decreased stream flow

Physical Examination
Suprapubic area for sign

of bladder distension DRE: Prostate gland size , nodularity , masses, surface, tenderness, anal tone

The standard first line investigation Increase in volume of the prostate with a calculated volume exceeding 30cc ( (A x B x C)/2 ). The central gland is enlarged, and is hypoechoic or of mixed echogenicity Calcification can be seen both within the hypertrophied gland as well as in the pseudocapsule (representing compressed peripheral zone) Post micturition residual volume is typically elevated.

The bladder floor can be elevated and the distal ureters

lifiting medially (J-shaped ureters or Fishhook ureters). Chronic bladder outlet obstruction can lead to detrusor hypertrophy , trabecullation and formation of bladder diverticula.


The end of 1st week after the menstrual period Empty bladder before investigation Technique :
Patient is placed in the lithotomy position on the

screening table The external os is visualized through a vaginal speculum and is swabbed with a mild antiseptic solution The anterior lip of the cervix is grasped by vulsellum forceps and a cannula is then inserted into the cervical canal

Contrast media : Water soluble non ionic (Iopamiro) 6-10 cc

Congenital abnormalities of uterus and tubal obstruction

After tubal surgery

Patency & configuration of the Fallopian tubes following surgery

for tubal obstruction After tubal ligation 6 weeks after After ectopic pregnancy

Recurrent abortion
The width and configuration of the internal os and cervical canal

Distortion of the uterine cavity Uterine fibroids

Abnormal uterine bleeding

Fibroids, endometrial polyps, adenomyosis and intrauterine


Post-caesarean section
The integrity of the uterine scars following caesarian section

Pregnancy Pelvic infection
Salpingitis 6 months before Acute vaginitis Cervicitis

Immediate pre- and postmenstrual phases

Thickened/denuded endometrium venous intravasation Water soluble media obscure adrenal detail

Sensitivity to contrast medium

Antihistamine Corticosteroid

Distension of the uterus & Fallopian tubes Peritoneal spillage

Pelvic infection
Acute exacerbation of pre-existing chronic pelvic infection

Organic lesion Polyps ,carcinoma,endometrial damage

Allergic phenomena
Urticaria, asthma, laryngeal oedema

Vasovagal attack Venous intravasation

After an initial film, 3 to 5 mL of dye should be injected slowly to allow adequate visualization of

the uterine cavity. A second film is then taken. Cervical traction is often necessary to completely evaluate the uterine cavity. A small acorn tip is preferred over balloon-type catheters because the latter obstructs the visualization of the cavity. After this, another 5 mL is injected to evaluate tubal patency, followed by a third film. A follow-up film is taken to evaluate peritubal adhesions and usually is performed in 10 minutes (using water-soluble media) or 24 hours (using oil-based media).



Anomalies varying between a completely double vagina, cervix,

and uterus Fibroids Polyps Endometrial hyperplasia Adenomyosis Intrauterine synechia Tubal disease and defect

Hydrosalpinx, nodular salpingitis, tubal occlusion from infection Tubo-ovarian cavities Kinking and adhesions Endometriosis Tubal amputation and closure

Carcinoma of the uterus Cervical lesion : stenosis, polyp, adenomyosis Lesion to internal os : stenosis, polyposis, dilatation or widening,

scarring, extreme spasm Ovarian tumors


Uterus didelphys

Unicornuate uterus


HSG : tubal dilatation, especially of the ampullary portion, with loculation and absent or limited peritoneal spillage of contrast medium

Diverticulosis Isthmica Nodosa

Small diverticula of the Fallopian tubes. The diverticula are up to 2 mm in diameter and are usually situated on a 10-20 mm long segment of the proximal portion of the Fallopian tubes

Tuberculous salpingitis

Calcification in the region of the Fallopian tubes and ovaries, tubal occlusion usually bilateral in isthmic or ampullary portions. On HSG, there may be iiregular or ragged outline of tubal contours due to multiple strictures, giving a beaded or rosary appereance

Fibroid Uterine

Multiple submucosal fibroids are associated with separated filling defects and sometimes gross distortion of the uterine cavity