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Srinivas S, Scheiber AJ, Ahmad H, Thomas J, Weaver L, Wood RJ, Hewitt G, McCracken K. Examining Results of Post-Thelarche Screening Pelvic Ultrasound in Females with Anorectal Malformations. J Pediatr Adolesc Gynecol 2024; 37:500-504. [PMID: 38768703 DOI: 10.1016/j.jpag.2024.05.001] [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: 01/12/2024] [Revised: 05/08/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
STUDY OBJECTIVE Mullerian duct anomalies are common in females with anorectal malformations (ARMs), although there are no universally recommended screening protocols for identification. Historically, at our institution, we have recommended a screening pelvic ultrasound (PUS) 6 months after thelarche and menarche. We aimed to evaluate outcomes associated with our post-thelarche screening PUS in females with ARMs. METHODS An institutional review board-approved retrospective chart review was performed for all female patients 8 years old or older with ARMs and documented thelarche. Data were collected on demographic characteristics and clinical course. The primary outcome was adherence to the recommended PUS. Secondary outcomes included imaging correlation with suspected Mullerian anatomy and need for intervention on the basis of imaging findings. RESULTS A total of 112 patients met the inclusion criteria. Of them, 87 (77.7%) completed a recommended post-thelarche screening PUS. There were no differences in completion on the basis of age, race, establishment with a primary care provider, insurance status, or type of ARM. Nine patients (10.3%) had findings on their PUS that did not correlate with their suspected Mullerian anatomy; five (5.7%) required intervention, with two requiring menstrual suppression, two requiring surgical intervention, and one requiring further imaging. CONCLUSION Most patients completed the recommended post-thelarche screening PUS. In a small subset of patients, PUS did not correlate with suspected Mullerian anatomy and generated a need for intervention. Post-thelarche PUS can be a useful adjunct in patients with ARMs to identify gynecologic abnormalities.
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Affiliation(s)
- Shruthi Srinivas
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio.
| | | | - Hira Ahmad
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Jessica Thomas
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Geri Hewitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kate McCracken
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
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Hambraeus M, Börjesson A, Ekmark AN, Tofft L, Arnbjörnsson E, Stenström P. Genital Malformations in Children With VACTERL - Has Time Come to Include "G" in the Acronym? J Pediatr Surg 2024; 59:161575. [PMID: 38849227 DOI: 10.1016/j.jpedsurg.2024.05.005] [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: 02/24/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Genital malformations are frequently diagnosed in patients with VACTERL, but are currently not included in the acronym. This study aimed to analyze the frequency of genital anomalies in patients with esophageal atresia (EA) and/or anorectal malformation (ARM), with a subgroup analysis of children fulfilling the VACTERL criteria. METHOD This was a cross-sectional retrospective analysis of two prospectively collected registries of patients operated on for ARM and EA between 2012 and 2022 at a specialized national center. Children were screened routinely for malformations according to the VACTERL acronym. RESULTS A total of 174 children were included in the study. VACTERL was diagnosed in 60 children (34%), while 114 children (66%) were defined as non-VACTERL. Genital malformations were diagnosed in 38% (23/60) of the children with VACTERL, and in 11% (13/114) of the children without VACTERL (p < 0.001). The presence of genital malformations correlated linearly with the number of diagnosed component features (CFs). In boys with VACTERL, the most common genital malformation was undescended testes present in 10/27 (21%) compared to 1/71 (1%) in non-VACTERL boys (p < 0.001). Müllerian duct anomalies were found in 26% of girls with VACTERL vs. 7% in non-VACTERL girls (p < 0.05). CONCLUSION There was a higher frequency of genital malformations in patients with VACTERL emphasizing the importance of genital assessment for these patients. We propose VACTERL-G as an extension of the current acronym aiming to reduce the risk of long-term morbidity due to delayed diagnosis of reproductive anomalies. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Mette Hambraeus
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden.
| | - Anna Börjesson
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
| | - Ann Nozohoor Ekmark
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
| | - Louise Tofft
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
| | - Einar Arnbjörnsson
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
| | - Pernilla Stenström
- Institution of Clinical Sciences, Lund University, Department of Pediatric Surgery, Skane University Hospital Lund, 221 85 Lund, Sweden
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Forero LT, Henderson R, Galarreta C, Swee S, Bird LM. Expansion of the core features of VACTERL association to include genital anomalies. Am J Med Genet A 2024; 194:e63587. [PMID: 38687163 DOI: 10.1002/ajmg.a.63587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
Genital anomalies have been reported with VACTERL association but not considered a core feature. Acute and chronic complications stemming from unrecognized genital anomalies have been reported in adolescents and young adults with VACTERL association. We sought to determine the frequency and severity of genital anomalies in VACTERL patients and identify which core features were more frequently associated with genital anomalies. A retrospective chart review from January 2010 to October 2021 identified 211 patients with two or more core VACTERL features, 34% of whom had a genital anomaly. The majority of genital anomalies (83% of those in males and 90% in females) were classified as functionally significant (requiring surgical intervention or causing functional impairment). The frequency of genital anomalies in the VACTERL cohort was higher if anorectal malformations or renal anomalies were present in both males and females and if vertebral anomalies were present in females. Due to their functional significance, genital anomalies should be assessed in all patients with two or more core features of VACTERL association, especially in those with anorectal or renal anomalies. Most genital anomalies in males will be detected on physical examination but additional investigation is often needed to detect genital anomalies in females. The timing and type of investigation are subjects for future study.
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Affiliation(s)
- Laura T Forero
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
| | | | - Carolina Galarreta
- Department of Genetics and Metabolism, Valley Children's Hospital, Madera, California, USA
| | - Steven Swee
- Division of Extended Studies, University of California, San Diego, California, USA
| | - Lynne M Bird
- Department of Pediatrics, Division of Genetics and Dysmorphology, UC San Diego/Rady Children's Hospital, San Diego, California, USA
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4
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Arion K, Araoye I, Lo A, Beaudry P, McQuillan S. Revision of the VACTERL Acronym for the Screening of Gynecologic/Genitourinary Anomalies in Patients With Anorectal Malformations. J Pediatr Surg 2024:161638. [PMID: 39142957 DOI: 10.1016/j.jpedsurg.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Kristina Arion
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada; Department of Pediatric and Adolescent Gynecology, Alberta Children's Hospital, Calgary, AB, Canada.
| | - Ibukunoluwa Araoye
- Department of Pediatric General Surgery, Alberta Children's Hospital, Calgary, AB, Canada
| | - Andrea Lo
- Department of Pediatric General Surgery, Alberta Children's Hospital, Calgary, AB, Canada; Section of Pediatric Surgery, Department of Surgery, University of Calgary, AB, Canada
| | - Paul Beaudry
- Department of Pediatric General Surgery, Alberta Children's Hospital, Calgary, AB, Canada; Section of Pediatric Surgery, Department of Surgery, University of Calgary, AB, Canada
| | - Sarah McQuillan
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada; Department of Pediatric and Adolescent Gynecology, Alberta Children's Hospital, Calgary, AB, Canada
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Clain EC, Woodfield K, Hutchens KJ, Bischoff A, Alaniz VI. Obstructed Hemivagina and Renal Anomalies in Patients with and without Anorectal Malformations. J Pediatr Adolesc Gynecol 2024; 37:205-208. [PMID: 38122961 DOI: 10.1016/j.jpag.2023.12.004] [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: 08/30/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
STUDY OBJECTIVE To compare the anatomic variation between patients with a diagnosis of an obstructed hemivagina with an anorectal malformation (ARM) and those without an ARM. METHODS This was a retrospective chart review conducted at a single tertiary children's hospital. Patients with an obstructed hemivagina seen from 2004 to 2019 were included. RESULTS We identified a total of 9 patients diagnosed with an obstructed hemivagina: 4 patients with a history of ARM and 5 patients without an ARM. Patients presented with obstructive symptoms between the ages of 11 and 20. Two-thirds of patients had a left-sided obstruction. All patients without an ARM had ipsilateral congenital anomalies of the kidney and urinary tract. Half the patients with a history of ARM had an ipsilateral renal anomaly, and the other half had a contralateral renal anomaly. CONCLUSION Obstructed hemivagina occurs in patients with a history of ARM. However, unlike patients with isolated obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), patients with an ARM and an obstructed hemivagina can present with associated renal anomalies on either the ipsilateral or contralateral side. In our small case series, patients with a history of ARM had high septa and required more complex surgical management due to the inability to access the septum vaginally. Knowledge of renal anatomy and ureteral path is important because a hysterectomy may be needed to relieve the obstruction in patients with ARMs. A larger case series is needed to better characterize the spectrum of complex anomalies in patients with ARMs.
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Affiliation(s)
- Elizabeth C Clain
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado.
| | - Kellie Woodfield
- Department of Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Aurora, Colorado
| | - Kendra J Hutchens
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
| | - Andrea Bischoff
- Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Veronica I Alaniz
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado; Department of Pediatric and Adolescent Gynecology, Children's Hospital Colorado, Aurora, Colorado
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de Beaufort CMC, Hooijer IN, Kuijper CF, Arguedas Flores OE, de Jong JR, van den Boogaard E, Dekker JJML, Gorter RR. Anatomical Gynecological Anomalies in Girls Born with Anorectal Malformations: A Retrospective Cohort Study of 128 Patients. J Pediatr Adolesc Gynecol 2024; 37:56-62. [PMID: 37777168 DOI: 10.1016/j.jpag.2023.09.007] [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: 07/03/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/02/2023]
Abstract
STUDY OBJECTIVE In girls born with an anorectal malformation (ARM), anatomical gynecological anomalies (GA) may be present and might need treatment. Therefore, the aim of this study was to provide an overview of GA in girls born with ARM in our cohort. Additionally, diagnostic timing and methods for GA were assessed. METHODS A retrospective mono-center study was performed from January 2000 to December 2022. All patients assigned female at birth were eligible for inclusion. GA were classified according to ESHRE/ESGE classification. Outcomes were the number of girls with GA with subsequent screening methods, factors associated with GA, and GA requiring treatment. Uni- and multivariable logistic regression analyses were performed to identify the association between baseline characteristics and the presence of GA. RESULTS In total, 128 girls were included, of whom 30 (24.1%) had additional GA, with vaginal anomalies being present most often (n = 17). Fifty-six patients (43.8%) underwent full screening, and this number improved over time (37.7% before 2018 vs 72.7% after 2018; P = .003). Thirteen of 30 patients (43.3%) required surgical treatment for their GA, without the occurrence of postoperative complications. CONCLUSION Additional GA were present in almost a quarter of the girls born with an ARM, with vaginal anomalies most often identified. Despite GA being most often found in patients with cloacal malformations, these anomalies were also identified in patients with other ARM types. Surgical treatment was required in almost half of the girls with GA. Therefore, this study emphasizes the importance of screening for GA in patients with an ARM, regardless of the ARM type.
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Affiliation(s)
- Cunera M C de Beaufort
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Isabelle N Hooijer
- Amsterdam UMC, location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Caroline F Kuijper
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Urology, Amsterdam, the Netherlands
| | - Olga E Arguedas Flores
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Urology, Amsterdam, the Netherlands
| | - Justin R de Jong
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Emmy van den Boogaard
- Amsterdam UMC, location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Judith J M L Dekker
- Amsterdam UMC, location University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands
| | - Ramon R Gorter
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Pediatric Surgery, Amsterdam, the Netherlands; Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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de Beaufort CMC, Boom DT, Mackay TM, Dekker JJML, Arguedas Flores OE, de Jong JR, Kuijper CF, Gorter RR. Potential benefits of routine cystoscopy and vaginoscopy prior to reconstructive surgery in patients with an anorectal malformation. Pediatr Surg Int 2023; 39:284. [PMID: 37889354 PMCID: PMC10611826 DOI: 10.1007/s00383-023-05565-0] [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] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE First, to assess the number of patients with anorectal malformations (ARM) in whom additional urological and/or gynecological anomalies were identified through routine screening with cysto- or vaginoscopy prior to reconstructive surgery. Second, to assess potential procedure-related complications. METHODS Retrospective mono-center cohort study, including all ARM patients born between January 2019 and December 2022. Routine screening consisted of cystoscopy for male patients, with the addition of vaginoscopy for female patients. Chi-square was used to compare the screening percentages over time. RESULTS In total, 38 patients were included, of whom 27 (71.1%) underwent cystoscopy ± vaginoscopy, without the occurrence of complications. Nine of 13 females (69.2%) underwent cysto- and vaginoscopy and 18 of 25 males (72.0%) underwent a cystoscopy. The percentage of patients that underwent these procedures improved over the 2 time periods (50.0% in 2019-2020 vs 90.0% in 2021-2022, p = 0.011). In 15 of 27 patients (55.6%) that underwent cystoscopy ± vaginoscopy, additional anomalies were found that were not identified through physical examination or US-kidney. CONCLUSIONS In 56% of the patients that underwent cysto- ± vaginoscopy, additional anomalies were identified that were not with imaging studies or physical examination. This study emphasizes the potential benefit of routine cysto- and vaginoscopy in the diagnostic work-up of children with ARM. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cunera M C de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Daphne T Boom
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tara M Mackay
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Judith J M L Dekker
- Amsterdam UMC, Department of Gynecology, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Olga E Arguedas Flores
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Caroline F Kuijper
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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Ahmad H, Wood RJ, Avansino JR, Calkins CM, Dickie BH, Durham MM, Frischer J, Fuller M, Ralls M, Reeder RW, Rentea RM, Rollins MD, Saadai P, Oelschlager AMEA, Breech LL, Hewitt GD, Kluivers K, van Leeuwen KD, McCracken KA. Does presence of a VACTERL anomaly predict an associated gynecologic anomaly in females with anorectal malformations?: A Pediatric Colorectal and Pelvic Learning Consortium Study. J Pediatr Surg 2023; 58:471-477. [PMID: 35879143 DOI: 10.1016/j.jpedsurg.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND VACTERL association is defined by the presence of 3 or more anomalies in any of the following systems: vertebral, anorectal, cardiac, trachea-esophageal, renal, or limb. This study hypothesized that the presence of VACTERL association would correlate with an increased risk of gynecologic anomalies in patients with anorectal malformation (ARM). METHODS This study is a cross-sectional, retrospective analysis from the prospectively collected, multicenter registry of the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). The 834 female patients with ARM who were enrolled in the registry by January 1, 2020 were included in this study. The relationship of VACTERL association with presence of a gynecologic anomaly was evaluated with Fisher's exact test. The relationship of each VACTERL system with presence of a gynecologic anomaly was assessed in patients with cloaca, rectovestibular fistulas and rectoperineal fistulas. P-values reported were based on a 2-sided alternative and considered significant when less than 0.05. RESULTS 834 patients with ARM underwent VACTERL screening and gynecologic evaluation with the three most common subtypes being cloaca (n = 215, 25.8%), rectovestibular fistula (n = 191, 22.9%) and rectoperineal fistula (n = 194, 23.3%). A total of 223 (26.7%) patients with ARM had gynecologic anomalies. VACTERL association was seen in 380 (45.6%) of patients with ARM. Gynecologic anomalies were present in 149 (39.1%) vs. 74 (16.3%) of subjects with vs. without VACTERL association (p < 0.001). VACTERL association did not significantly increase the risk of gynecologic anomaly in patients with cloaca and VACTERL (n = 88, 61.5%) vs. cloaca without VACTERL (n = 39, 54.2% p = 0.308). VACTERL association increased the risk of gynecologic anomalies in patients with rectoperineal fistulas (n = 7, 14.9% vs n = 9, 6.1% p = 0.014) and rectovestibular fistulas (n = 19, 31.1% vs. n = 13, 10.0% p<0.001). In patients with ARM who had a VACTERL association, when one of the associated anomalies was renal, there was an even higher risk of having an associated gynecologic anomaly (n = 138, 44.2% vs. n = 85, 16.3% p<0.001). CONCLUSIONS VACTERL association in patients with rectoperineal and rectovestibular fistulas correlates with an increased risk of gynecologic anomalies. The presence of VACTERL associated findings, especially renal, should prompt a thorough evaluation of the gynecologic system. LEVEL OF EVIDENCE III. Retrospective comparative study.
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Affiliation(s)
- Hira Ahmad
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, FOB 6B, Columbus, OH 43205, United States; Seattle Children's Hospital, Seattle, WA, United States.
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, FOB 6B, Columbus, OH 43205, United States
| | | | - Casey M Calkins
- Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | | | - Megan M Durham
- Emory-CHOA Pediatric Institute, Atlanta, GA, United States
| | - Jason Frischer
- Cincinnati Children's Hospital, Cincinnati, OH, United States
| | | | - Matt Ralls
- University of Michigan, Ann Arbor, MI, United States
| | - Ron W Reeder
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | | | - Michael D Rollins
- Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Payam Saadai
- University of California Davis, Davis, CA, United States
| | | | - Lesley L Breech
- Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Geri D Hewitt
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, FOB 6B, Columbus, OH 43205, United States
| | - Kirsten Kluivers
- Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | | | - Katherine A McCracken
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, FOB 6B, Columbus, OH 43205, United States
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de Waal AC, van Amstel T, Dekker JJML, Ket JCF, Kuijper CF, Salvatore CM, de Jong JR, Gorter RR. Outcome after vaginal delivery of women with a previous medical history of surgically corrected anorectal malformations: a systematic review. BMC Pregnancy Childbirth 2023; 23:94. [PMID: 36739371 PMCID: PMC9898899 DOI: 10.1186/s12884-023-05389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Discussion remains on how to advise women with a past medical history of surgically corrected anorectal malformations (ARMs) regarding vaginal delivery. The aim of this review is to evaluate and review the reported obstetrical complications and outcomes after vaginal delivery for these women. DATA SOURCES A systematic search was performed from inception up to 25 July 2022 in PubMed, Embase.com and Clarivate Analytics/Web of Science Core Collection, with backward citation tracking. STUDY ELIGIBILITY CRITERIA/APPRAISAL All articles reported on the outcomes of interest in women with a past medical history of surgically corrected anorectal malformation and had a vaginal delivery were included with the exception of editorial comments or invitational commentaries. Screening, data extraction and risk of bias assessment was done by two authors independently with a third and fourth reviewer in case of disagreement. Tool for Quality assessment depended on the type of article. As low quality evidence was expected no meta-analysis was performed. RESULTS Only five of the 2377 articles screened were eligible for inclusion with a total of 13 attempted vaginal deliveries in eight women. In three patients complications were reported: failed vaginal delivery requiring urgent cesarean section in two patients, and vaginal tearing in one patient. CONCLUSION High quality evidence regarding outcomes and complications after vaginal delivery in women with a history of surgically corrected anorectal malformation is lacking. Therefore, based upon this systematic review no formal recommendation can be formulated regarding its safety. Future studies are essential to address this problem. TRIAL REGISTRATION CRD42020201390. Date: 28-07-2020s.
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Affiliation(s)
- Ayla C. de Waal
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
| | - Tim van Amstel
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
| | - Judith J. M. L. Dekker
- grid.7177.60000000084992262Department of Obstetrics and Gynecology Division of Reproductive Medicine, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes C. F. Ket
- grid.12380.380000 0004 1754 9227Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Caroline F. Kuijper
- grid.7177.60000000084992262Department of Paediatric Urology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Concetta M. Salvatore
- grid.7177.60000000084992262Department of Obstetrics and Gynecology Division of Reproductive Medicine, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Justin R. de Jong
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
| | - Ramon R. Gorter
- grid.7177.60000000084992262Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, P.O. Box 22600, 1100 DD Amsterdam, the Netherlands
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10
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Management of Anorectal Malformations and Hirschsprung Disease. Surg Clin North Am 2022; 102:695-714. [DOI: 10.1016/j.suc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mittal PG, Peters NJ, Samujh R, Bhatia A. A Rare Association of Obstructed Hemivagina with Ipsilateral Renal Agenesis with Congenital Pouch Colon. J Pediatr Adolesc Gynecol 2022; 35:387-390. [PMID: 34848341 DOI: 10.1016/j.jpag.2021.11.008] [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: 05/30/2021] [Revised: 10/15/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA), or Herlyn-Werner-Wunderlich syndrome, is a rare Mullerian duct anomaly. Several associations of OHVIRA with other anomalies are being reported. CASE A 13-year-old girl reported with acute onset abdominal pain. Patient was operated on in the past for type IV congenital pouch colon (all stages complete). She was diagnosed with hematometrocolpos and underwent tube vaginostomy. Further workup was suggestive of OHVIRA, which was subsequently managed with surgical repair. CONCLUSION Delineation of reproductive anomalies in female patients with anorectal malformations is of paramount importance. OHVIRA syndrome should be considered at a high index of suspicion in female patients with a solitary functioning kidney. Nonspecific symptoms in an adolescent female can lead to erroneous judgment, leading to unnecessary investigations, which, if not well managed in time, can be detrimental to fertility.
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Affiliation(s)
- Priyanka Garg Mittal
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin J Peters
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ram Samujh
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Swieter E, McKee J, Ming J, Maxwell JR. Prenatal diagnosis of cloacal anomaly: A case of unexpected anatomical abnormalities after birth. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Magnetic resonance imaging of Müllerian anomalies in girls: concepts and controversies. Pediatr Radiol 2022; 52:200-216. [PMID: 34152437 DOI: 10.1007/s00247-021-05089-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Female Müllerian anomalies are the result of failure of formation, fusion or resorption of the Müllerian ducts and are relatively common, with a prevalence of 5.5-7.0% in the general population. While some of these anomalies are asymptomatic, those presenting with obstruction require accurate identification for optimal clinical management including potential surgical treatment. MRI is a useful adjunct to sonography in the evaluation of Müllerian anomalies, typically allowing a more complete characterization of the malformation. Technical aspects, embryologic concepts and controversies regarding classification systems are highlighted in this review. Several Müllerian anomalies are discussed and illustrated in more detail utilizing various cases with pelvic MRI studies.
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Bicelli N, Trovalusci E, Zannol M, Gamba P, Bogana G, Zanatta C, Midrio P. Gynecological and psycho-sexual aspects of women with history of anorectal malformations. Pediatr Surg Int 2021; 37:991-997. [PMID: 33900437 PMCID: PMC8241745 DOI: 10.1007/s00383-021-04905-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Women with anorectal malformation (ARM) are expected to have a normal life span, therefore, gynecological and psycho-sexual issues are also important. Aim of the study was to assess these aspects in adult females with history of ARM. METHODS Thirty-seven women from two ARM referral centers, aged ≥ 16, were identified. Gynecologic visit, cervicovaginal swab, pelvic ultrasound, FSH, LH, prolactin, progesterone, 17-β-estradiol, DHEAS, testosterone, TSH during follicular and luteal phases, and administration of FSFI questionnaire to screen the female sexual functioning were performed. Data were compared with six controls. RESULTS Nineteen patients, mean age 21.7 (16-45), participated to the study. Associated anomalies, mostly affecting limbs, vertebrae and genitalia, were present in 57.8% of cases. Mullerian anomalies were retrieved in 36.8%. Hormones' levels were normal. Concerning sexual functioning, four women (21%) reported dyspareunia or impossible penetration, four did not answer the FSFI questionnaire due to lack of confidence about their sexuality, and three scored lower than the cut-off value for female sexual function. CONCLUSION This study confirms the importance of a multidisciplinary long-term follow-up for ARM patients, including a careful study of the reproductive tract to detect and treat those conditions that could affect the fertility. Moreover, an appropriate psychological support should be provided.
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Affiliation(s)
- Noemi Bicelli
- grid.413196.8Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy ,grid.5608.b0000 0004 1757 3470Pediatric Surgery, Università Di Padova, Padova, Italy
| | - Emanuele Trovalusci
- grid.413196.8Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy ,grid.5608.b0000 0004 1757 3470Pediatric Surgery, Università Di Padova, Padova, Italy
| | - Monica Zannol
- grid.413196.8Obstetrics&Gynecology, Cà Foncello Hospital, Treviso, Italy
| | - Piergiorgio Gamba
- grid.5608.b0000 0004 1757 3470Pediatric Surgery, Università Di Padova, Padova, Italy
| | - Gianna Bogana
- grid.411474.30000 0004 1760 2630Obstetrics&Gynecology, Azienda Ospedaliera, Padova, Italy
| | - Cinzia Zanatta
- grid.413196.8Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy
| | - Paola Midrio
- grid.413196.8Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy ,grid.5608.b0000 0004 1757 3470Pediatric Surgery, Università Di Padova, Padova, Italy
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Saxena R, Pathak M, Sinha A, Thummalapati JK. Single perineal opening with 'H-type' cecovesical fistula and blind-ending foreshortened distal colon: a new variant of persistent cloaca. BMJ Case Rep 2021; 14:e236364. [PMID: 33664021 PMCID: PMC7934755 DOI: 10.1136/bcr-2020-236364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/03/2022] Open
Abstract
Persistent cloaca is a rare and severe variety of anorectal malformation, which is more common in females and includes a spectrum of abnormalities. The urinary tract, genital tract and rectum open into a common channel, which exteriorises as a single perineal opening. We are reporting a patient with a novel variation in the classical anatomy of the cloaca. The child has a short blind-ending colon with a cecovesical fistula associated with mullerian agenesis and lipomyelomeningocoele. The child is being managed in a stepwise approach and she has completed the anal reconstruction. Here, we discuss this novel variation in anatomy and challenges in its management.
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Affiliation(s)
- Rahul Saxena
- Pediatric Surgery, All India Institute of Medical Sciences Jodphur, Jodhpur, India
| | - Manish Pathak
- Pediatric Surgery, All India Institute of Medical Sciences Jodphur, Jodhpur, India
| | - Arvind Sinha
- Pediatric Surgery, All India Institute of Medical Sciences Jodphur, Jodhpur, India
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The use of a Meckel's diverticulum for a neo-vagina in a patient with cloacal anomaly. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wu CQ, Childress KJ, Traore EJ, Smith EA. A Review of Mullerian Anomalies and Their Urologic Associations. Urology 2020; 151:98-106. [PMID: 32387292 DOI: 10.1016/j.urology.2020.04.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
Structural anomalies of the female reproductive tract, known as Mullerian anomalies, can occur in isolation or in association with anomalies of other organ systems. Due to shared embryology, the most common association in up to 40% of patients is with renal, ureteral, and bladder anomalies. Affected girls can have a wide range of genitourinary symptoms with urologists playing an integral role in their diagnosis and treatment. To facilitate the recognition and management of these conditions, we provide a review of Mullerian anomalies including the embryology, classifications, syndromes, evaluation, and treatments with attention to their urologic applicability.
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Affiliation(s)
- Charlotte Q Wu
- Division of Pediatric Urology, Children's Healthcare of Atlanta; Emory University School of Medicine, Atlanta, GA.
| | - Krista J Childress
- Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Emory University School of Medicine; Divisions of Pediatric Surgery and Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Elizabeth J Traore
- Division of Pediatric Urology, Children's Healthcare of Atlanta; Emory University School of Medicine, Atlanta, GA
| | - Edwin A Smith
- Division of Pediatric Urology, Children's Healthcare of Atlanta; Emory University School of Medicine, Atlanta, GA
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