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Elsherbeny M, Abdelhay S, Mousa M. Neonatal Single-Stage Surgical Management of Complicated Distal Vaginal Atresia: Revisiting an Appropriate and Feasible Technique. J Pediatr Adolesc Gynecol 2024; 37:63-66. [PMID: 37704035 DOI: 10.1016/j.jpag.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND/PURPOSE Hydrometrocolpos is distension of the vagina and uterus with fluid other than pus or blood. It is due to distal vaginal obstruction, and one of its possible causes is agenesis of the distal vagina. Patients with distal vaginal atresia may present in the neonatal period due to stimulation of uterine and cervical glands by maternal estrogen. In this study, we presented our results in managing neonates with complicated hydrometrocolpos due to distal vaginal atresia through a single-stage abdomino-perineal pull-through vaginoplasty. METHODS During the period from July 2003 to June 2018, neonates presented to the Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University with complicated hydrometrocolpos (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) due to distal vaginal atresia were included in the study. All the patients underwent single-stage abdomino-perineal pull-through vaginoplasty with drainage of the accumulated fluid. The patients were followed up for re-accumulation of fluid or vaginal stenosis for at least 4 years after the procedure. RESULTS During the specified period, 14 neonates with complicated hydrometrocolpos due to distal vaginal atresia (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) presented to the Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University and underwent single-stage abdomino-perineal pull-through vaginoplasty with drainage of the accumulated fluid. Their age ranged between 4 and 18 days (mean 10, median 8). Two patients (14%) developed vaginal stenosis, which responded well to dilatation, and none of the patients had re-accumulation of the fluid during the follow-up period. CONCLUSION Single-stage abdomino-perineal pull-through vaginoplasty in neonates with complicated distal vaginal atresia (complicated with obstructive uropathy, intestinal obstruction, urinary tract infection, or systemic sepsis) is an appropriate and feasible technique with a satisfactory outcome. TYPE OF THE STUDY Treatment study. LEVEL OF EVIDENCE RATING IV.
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Affiliation(s)
- Mohammed Elsherbeny
- Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Sameh Abdelhay
- Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammed Mousa
- Department of Pediatric Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Kim IK, Vellody R, Pohl HG, Sharma K, Yadav B. Ultrasound-guided introital drainage of pyometrocolpos. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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A Case of Distal Vaginal Agenesis Presenting with Recurrent Urinary Tract Infection and Pyuria in a Prepubertal Girl. J Pediatr Adolesc Gynecol 2017; 30:e7-e10. [PMID: 27555476 DOI: 10.1016/j.jpag.2016.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Isolated distal vaginal agenesis is a rare anomaly and mostly becomes symptomatic after menarche. We describe an unusual presentation of this anomaly in a prepubertal girl. CASE An 11-year-old prepubertal girl presented with recurrent urinary tract infection, pyuria, and right-sided renal agenesis. The findings of perineal inspection, ultrasonography, and magnetic resonance imaging were consistent with a distal vaginal agenesis with pyometrocolpos. Discharging pyometrocolpos with dissection of the atretic portion and a pull-through vaginoplasty were performed. A cystoscopy showed no sign of a vesicovaginal or uterine fistula. SUMMARY AND CONCLUSION This rare presentation of distal vaginal agenesis reminds us that congenital malformations of the female genital tract should be considered in patients with congenital anomalies of the urinary system and/or recurrent urinary tract infection, even during the prepubertal period.
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Celik M, Bulbul A, Uslu S, Dursun M, Turkoglu E, Sever N. A rare reason of the elevated serum Ca 19-9 and Ca 125 levels in neonatal period: Hydrometrocolpos due to distal vaginal atresia. Int J Surg Case Rep 2015; 11:44-45. [PMID: 25912008 PMCID: PMC4446670 DOI: 10.1016/j.ijscr.2015.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 02/23/2015] [Accepted: 04/03/2015] [Indexed: 10/26/2022] Open
Abstract
•Hydrometrocolpos is a rare congenital malformation of the female in neonate. •CA 19-9 and CA 125 are widely used as tumor markers, however several benign conditions are also known to increase levels. •Here we report a newborn with hydrometrocolpos due to distal vaginal atresia and elevated serum CA 19-9 and CA 125 levels.
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Affiliation(s)
- Muhittin Celik
- Department of Pediatrics, Division of Neonatology, Diyarbakır Children Hospital, Yenişehir, Diyarbakır 21100, Turkey.
| | - Ali Bulbul
- Department of Pediatrics, Division of Neonatology, Sisli Etfal Research Hospital, Istanbul, Turkey.
| | - Sinan Uslu
- Department of Pediatrics, Division of Neonatology, Sisli Etfal Research Hospital, Istanbul, Turkey.
| | - Mesut Dursun
- Department of Pediatrics, Division of Neonatology, Sisli Etfal Research Hospital, Istanbul, Turkey.
| | - Ebru Turkoglu
- Department of Pediatrics, Division of Neonatology, Sisli Etfal Research Hospital, Istanbul, Turkey.
| | - Nihat Sever
- Department of Pediatric Surgery, Sisli Etfal Research Hospital, Istanbul, Turkey
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Lueth ET, Wood KE. McKusick Kaufman syndrome, complications arising at puberty. J Pediatr Adolesc Gynecol 2014; 27:e125-6. [PMID: 24656697 DOI: 10.1016/j.jpag.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/10/2013] [Accepted: 10/07/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND McKusick Kaufman Syndrome (MKS), a rare genetic condition, presents in the neonatal period with a classic triad of postaxial polydactyly, congenital heart disease, and hydrometrocolpos. The diagnosis is typically clinical, based on the presence of polydactyly and hydrometrocolpos. CASE We report the case of a 13-year-old female, who was diagnosed with MKS in infancy and underwent vaginal reconstructive surgery for a urogenital sinus. She was lost to follow-up thereafter. She presented to our institution at age 13 with pyometra, pyosalpinx, and tubo-ovarian abscess due to a stenotic cervix obstructing menstrual outflow. SUMMARY AND CONCLUSION Gynecologic follow-up is imperative in patients with history of vaginal reconstruction to monitor for hematometra from outflow obstruction to prevent life threatening secondary bacterial infections.
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Affiliation(s)
| | - Kelly E Wood
- University of Iowa Children's Hospital, Iowa City, IA.
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Ugur MG, Balat O, Ozturk E, Bekerecioglu M, Dikensoy E. Pitfalls in diagnosis and management of distal vaginal agenesis: 10-year experience at a single centre. Eur J Obstet Gynecol Reprod Biol 2012; 163:85-90. [PMID: 22503607 DOI: 10.1016/j.ejogrb.2012.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 01/23/2012] [Accepted: 03/18/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To discuss common pitfalls in diagnosis and management of distal vaginal agenesis, and summarize 10 years of experience among 11 patients using an interposition full-thickness graft and fibrin glue. STUDY DESIGN Eleven patients with distal vaginal agenesis were evaluated and managed with an interposition full-thickness graft to bridge the gap between the upper vagina and the introitus. Associated renal abnormalities and complications including infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, vaginal stricture and graft uptake were all investigated. RESULTS The mean age of the patients was 12.91 (standard deviation 1.22) years. All patients had primary amenorrhoea, cryptomenorrhea, and cyclical or constant pelvic pain. None of the patients had associated urological abnormalities, and there were no cases of infection, total lack of skin graft take, stress urinary incontinence, partial graft loss or vaginal stricture. Graft uptake was 100% in 10 of the 11 patients. Four patients have subsequently married and report a satisfactory sex life. CONCLUSION Accurate diagnosis of distal vaginal agenesis and careful pre-operative set-up, including evaluation of associated anomalies, bowel preparation, available vaginal stents and a multidisciplinary approach for the potential need for grafts, may be key to success.
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Affiliation(s)
- M G Ugur
- Department of Obstetrics and Gynaecology, School of Medicine, Gaziantep University, Gaziantep, Turkey.
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A Novel Image-guided Balloon Vaginoplasty Method to Treat Obstructive Vaginal Anomalies. J Vasc Interv Radiol 2011; 22:691-4. [DOI: 10.1016/j.jvir.2011.01.432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 12/26/2010] [Accepted: 01/01/2011] [Indexed: 11/22/2022] Open
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Algin O, Erdogan C, Kilic N. Ultrasound-guided percutaneous drainage of neonatal pyometrocolpos under local anesthesia. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S271-6. [PMID: 20130873 DOI: 10.1007/s00270-010-9814-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 01/08/2010] [Indexed: 11/28/2022]
Abstract
Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.
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Affiliation(s)
- Oktay Algin
- Department of Radiology, Atatürk Training and Research Hospital, Bilkent, Ankara, Turkey.
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Tugay M, Tugay S, Inan N, Ozkan SO, Anik Y. Distal vaginal agenesis in monozygotic twins: case report. J Pediatr Surg 2008; 43:765-7. [PMID: 18405732 DOI: 10.1016/j.jpedsurg.2007.12.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 10/16/2007] [Accepted: 12/19/2007] [Indexed: 10/22/2022]
Abstract
Distal vaginal agenesis is one of the rarest congenital malformations of female genital tract. We describe successfully operated teenaged monozygotic twins by combined abdominal and perineal approach. The imaging studies and surgical experience were presented.
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Affiliation(s)
- Melih Tugay
- Department of Pediatric Surgery, Medical Faculty of Kocaeli University, Kocaeli 41380, Turkey.
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Dursun I, Gunduz Z, Kucukaydın M, Yıldırım A, Yılmaz A, Poyrazoglu HM. Distal vaginal atresia resulting in obstructive uropathy accompanied by acute renal failure. Clin Exp Nephrol 2007; 11:244-246. [PMID: 17891355 DOI: 10.1007/s10157-007-0488-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 06/28/2007] [Indexed: 12/01/2022]
Abstract
Children with hydrometrocolpos due to distal vaginal atresia may present with severe obstructive uropathy. Here we report a 27-day-old infant with a hydrometrocolpos causing life-threatening renal failure. Percutaneous drainage of the hydrometrocolpos resulted in dramatically improved clinical and laboratory findings in the patient.
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Affiliation(s)
- Ismail Dursun
- Department of Pediatric Nephrology, Erciyes University Faculty of Medicine, Bahçelievler Mah, Mevlana Cad, Nihavend Sok, No. 10/10 38039, Talas/Kayseri, Turkey.
| | - Zubeyde Gunduz
- Department of Pediatric Nephrology, Erciyes University Faculty of Medicine, Bahçelievler Mah, Mevlana Cad, Nihavend Sok, No. 10/10 38039, Talas/Kayseri, Turkey
| | - Mustafa Kucukaydın
- Department of Pediatric Surgery, Erciyes University Faculty of Medicine, Talas/Kayseri, Turkey
| | - Afra Yıldırım
- Department of Pediatric Radiology, Erciyes University Faculty of Medicine, Talas/Kayseri, Turkey
| | - Aysegul Yılmaz
- Department of Pediatrics, Erciyes University Faculty of Medicine, Talas/Kayseri, Turkey
| | - Hakan M Poyrazoglu
- Department of Pediatric Nephrology, Erciyes University Faculty of Medicine, Bahçelievler Mah, Mevlana Cad, Nihavend Sok, No. 10/10 38039, Talas/Kayseri, Turkey
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Affiliation(s)
- D Geggie
- A&E Department, Warrington General Hospital, Lovely Lane, Warrington, Cheshire WA13 OPS, UK.
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Nazir Z, Rizvi RM, Qureshi RN, Khan ZS, Khan Z. Congenital vaginal obstructions: varied presentation and outcome. Pediatr Surg Int 2006; 22:749-53. [PMID: 16871398 DOI: 10.1007/s00383-006-1730-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2006] [Indexed: 10/24/2022]
Abstract
Congenital obstructing lesions of vagina, hydrometrocolpos, and hematocolpos, present at a variable time during early childhood and adolescence to different medical and surgical specialties. Twenty-six cases presenting over an 18-years period (1987-2005) were divided into three groups; Group A: neonates (6), Group B: adolescents (18), and Group C: adults (2). Common presentations in neonates (Group A) were abdominal mass (5), neonatal sepsis (3), and respiratory distress (2); whereas abdominal pain (18), voiding dysfunctions (13), and backache (7) were prevalent in adolescents (Group B). Adults (Group C) presented with inability to consummate and infertility (2). Four patients received erroneous treatment; exploratory laparotomy (1) and appendectomy (3). Urinary symptoms and associated urinary abnormalities were present in more than 50% of cases, especially those with complex anomalies. Management included excision of imperforate hymen (16) and transverse vaginal septum (8) through perineal (20) and abdominoperineal approach (4). Patients with urogenital sinus (1) and cloacal malformation (1) had staged reconstruction at 2.5 years of age following preliminary vesicostomy and colostomy at birth. On follow up (range 1-15 years; mean 7) more than 60% patients have menstrual irregularity (11), endometriosis (5), and infertility (4). In conclusion, rarity and variable presentation of congenital vaginal obstructions can lead to delayed diagnosis and erroneous management. A high index of suspicion and cross-sectional imaging help in early diagnosis and associated renal anomalies. A comprehensive management is imperative to preserve the reproductive potentials, as significant proportion of patients may experience sexual difficulties, menstrual irregularity, and infertility.
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Affiliation(s)
- Zafar Nazir
- Section of Pediatric Surgery, Department of Surgery, The Aga Khan University, P. O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
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