1
|
Navarro V, Acién M, Acién P. Applicability and Suitability of the Embryological-Clinical Classification of Female Genital Malformations: A Systematic Review. J Clin Med 2024; 13:2988. [PMID: 38792529 PMCID: PMC11121905 DOI: 10.3390/jcm13102988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Complex urogenital malformations are clinically highly relevant; thus, they must be appropriately diagnosed and classified before initiating treatment. Background/Objectives: This study aimed to evaluate the applicability and suitability of the embryological-clinical classification of female genital malformations. Methods: A systematic review of cases of genital malformations reported in the literature from 2000 to 2020 was conducted. Case reports and series with the following combinations: "female genital tract" AND (malformation OR anomaly OR müllerian anomaly OR uterine anomaly OR cervical anomaly OR vaginal anomaly OR cloacal anomaly OR urogenital sinus); and "female genital tract" AND (renal agenesis OR ectopic ureter) were searched. A total of 3124 articles were identified, of which 824 cases of genital malformation were extracted. The characteristics of each malformation were included in a database for further analyses. Results: Using the embryological-clinical classification, 89.9% of the published cases and 86.5% of the 52 cases defined as unclassifiable by their authors have been classified in this review. In 73 cases (72.2%), the classification of the malformation using the AFS system was incomplete because although the type of uterine anomaly of the AFS classification matched that of the embryological-clinical classification, characteristics of the urinary system or the vagina were overlooked when using the AFS system. Following a dispersion matrix, we have been able to show that the embryological-clinical classification system is able to classify and subclassify the genitourinary malformations more accurately. Conclusions: The applicability of the embryological-clinical classification has been confirmed after classifying most of the cases of genital malformation previously published. This system also provides a more complete and accurate classification than other classifying systems exclusively based on Müllerian duct development or uterovaginal parameters, demonstrating its suitability.
Collapse
Affiliation(s)
- Victoria Navarro
- Obstetrics and Gynecology Service, Elda University Hospital, 03600 Elda, Alicante, Spain;
- Reproductive Biopathologies Mixed Research Unit FISABIO-UA-UMH, 03550 San Juan, Alicante, Spain
| | - Maribel Acién
- Reproductive Biopathologies Mixed Research Unit FISABIO-UA-UMH, 03550 San Juan, Alicante, Spain
- Obstetrics and Gynecology Service, San Juan University Hospital, 03550 San Juan, Alicante, Spain
- Division of Gynecology, Miguel Hernández University, Campus of San Juan, 03550 San Juan, Alicante, Spain;
- Grant Next Generation EU-EGA Institute for Women’s Health, University College London, London WC1E 6DE, UK
| | - Pedro Acién
- Division of Gynecology, Miguel Hernández University, Campus of San Juan, 03550 San Juan, Alicante, Spain;
| |
Collapse
|
2
|
Fei YF, Quint EH, Hryhorczuk AL, Winfrey OK, Dendrinos ML. Distal Vaginal Atresia with Spontaneous Perforation: A Case Report. J Pediatr Adolesc Gynecol 2022; 35:383-386. [PMID: 34752931 DOI: 10.1016/j.jpag.2021.10.018] [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: 07/15/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The definitive treatment of distal vaginal atresia is surgery, but menstrual suppression is often helpful for initial management. CASE A 13-year-old presented with primary amenorrhea and progressive abdominal pain. She was diagnosed with distal vaginal atresia and started on hormonal suppression. She then re-presented with heavy vaginal bleeding, and follow-up imaging revealed that spontaneous perforation had occurred. There was now evidence of a tract leading from the obstructed vaginal bulge to the introitus. Vaginoplasty was complicated by the tortuosity of the tract. Under ultrasound guidance, a pull-through vaginoplasty was performed. SUMMARY AND CONCLUSION Spontaneous perforation of an atretic vagina is rare, but in such cases, urgent vaginoplasty is indicated to prevent infection. Despite the presence of a spontaneous tract leading to the obstruction, vaginoplasty can be complex, and intraoperative ultrasound could be beneficial.
Collapse
Affiliation(s)
- Y Frances Fei
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan.
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | | | - Olivia K Winfrey
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | - Melina L Dendrinos
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| |
Collapse
|
3
|
Gopalrathinam S, Margabandu BT, Suneesh PJ, Madhurbootheswaran S, Gomathi T, Janardhanam J. A stratified reconstructive approach in the management of congenital vaginal insufficiencies and agenesis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
4
|
Tanitame K, Tanitame N, Urayama S, Ohtsu K. Congenital anomalies causing hemato/hydrocolpos: imaging findings, treatments, and outcomes. Jpn J Radiol 2021; 39:733-740. [PMID: 33840015 PMCID: PMC8338850 DOI: 10.1007/s11604-021-01115-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/30/2021] [Indexed: 12/28/2022]
Abstract
Hemato/hydrocolpos due to congenital urogenital anomalies are rare conditions discovered in neonatal, infant, and adolescent girls. Diagnosis is often missed or delayed owing to its rare incidence and nonspecific symptoms. If early correct diagnosis and treatment cannot be performed, late complications such as tubal adhesion, pelvic endometriosis, and infertility may develop. Congenital urogenital anomalies causing hemato/hydrocolpos are mainly of four types: imperforate hymen, distal vaginal agenesis, transverse vaginal septum, and obstructed hemivagina and ipsilateral renal anomaly, and clinicians should have adequate knowledge about these anomalies. This article aimed to review the diagnosis and treatment of these urogenital anomalies by describing embryology, clinical presentation, imaging findings, surgical management, and postoperative outcomes.
Collapse
Affiliation(s)
- Keizo Tanitame
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, Minami-ku, Ujinakanda, Hiroshima, 734-8530, Japan.
| | - Nobuko Tanitame
- Department of Radiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Saiko Urayama
- Department of Obstetrics and Gynecology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kazuhiro Ohtsu
- Department of Maternal and Child Health Research Center, Hiroshima Prefectural Hospital, Hiroshima, Japan
| |
Collapse
|
5
|
Mansouri R, Dietrich JE. Postoperative Course and Complications after Pull-through Vaginoplasty for Distal Vaginal Atresia. J Pediatr Adolesc Gynecol 2015. [PMID: 26220349 DOI: 10.1016/j.jpag.2014.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To report the usual postoperative course and complications after pull-through vaginoplasty for isolated distal vaginal atresia. DESIGN, SETTING, AND PARTICIPANTS Retrospective chart review at Texas Children's Hospital of all patients who were diagnosed with isolated distal vaginal atresia and underwent pull-through vaginoplasty during the study time frame. INTERVENTIONS None. MAIN OUTCOME MEASURES Postoperative complications such as vaginal stenosis or infection and postoperative vaginal diameter. RESULTS Sixteen patients were identified and charts were reviewed. Patients were initially evaluated by pelvic magnetic resonance imaging and found to have distended hematometrocolpos with distal vaginal atresia. All patients underwent pull-through vaginoplasty with similar operative techniques. The average distance from the perineum to the level of the obstruction was 1.84 ± 1.2 cm. Two patients, both with obstructions at greater than 3 cm, experienced stricture formation postoperatively. Four patients (25%) experienced postoperative vaginitis. One patient (6.25%) experienced a postoperative urinary tract infection. Two groups (3 cm or less versus greater than 3 cm) were compared, and the presence of stricture was statistically different based on mean centimeters from perineum prior to pull-through vaginoplasty (P = .038). CONCLUSIONS Distal vaginal atresia is managed with pull-through vaginoplasty. Atresias that extend greater than 3 cm from the perineum are at increased risk for vaginal stricture formation and should be followed to monitor for their formation. Other complications are infrequent and minor.
Collapse
Affiliation(s)
- Roshanak Mansouri
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
6
|
Management of lower vaginal agenesis in a patient with unicornuate uterus. J Pediatr Adolesc Gynecol 2013; 26:e21-3. [PMID: 23332200 DOI: 10.1016/j.jpag.2012.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/21/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Absence of the lower vagina occurs from abnormal development of the sinovaginal bulbs and vaginal plate. CASE We present a case of an adolescent girl, with a history of VACTERL and VATER status post flap vaginoplasty at 8 m of age and correction of vaginal-urethral fistula, with primary amenorrhea and cyclic pelvic pain. MRI showed a right hematocolpos. On exam the obstructed vagina was deviated to the right. Given prior urologic and rectal surgery, and laterality of unicornuate system, intra-operative ultrasonography (US) was performed. A needle was used to enter the inferior aspect of the obstructed vagina. A pull-through vaginoplasty was performed. SUMMARY AND CONCLUSION Vaginal pull-through is the standard treatment for lower vaginal agenesis. In a unicornuate system, the use of intra-operative US is helpful to determine the appropriate angle of dissection.
Collapse
|
7
|
Clinical approach for the classification of congenital uterine malformations. ACTA ACUST UNITED AC 2012; 9:119-129. [PMID: 22611348 PMCID: PMC3338910 DOI: 10.1007/s10397-011-0724-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 12/28/2011] [Indexed: 11/05/2022]
Abstract
A more objective, accurate and non-invasive estimation of uterine morphology is nowadays feasible based on the use of modern imaging techniques. The validity of the current classification systems in effective categorization of the female genital malformations has been already challenged. A new clinical approach for the classification of uterine anomalies is proposed. Deviation from normal uterine anatomy is the basic characteristic used in analogy to the American Fertility Society classification. The embryological origin of the anomalies is used as a secondary parameter. Uterine anomalies are classified into the following classes: 0, normal uterus; I, dysmorphic uterus; II, septate uterus (absorption defect); III, dysfused uterus (fusion defect); IV, unilateral formed uterus (formation defect); V, aplastic or dysplastic uterus (formation defect); VI, for still unclassified cases. A subdivision of these main classes to further anatomical varieties with clinical significance is also presented. The new proposal has been designed taking into account the experience gained from the use of the currently available classification systems and intending to be as simple as possible, clear enough and accurate as well as open for further development. This proposal could be used as a starting point for a working group of experts in the field.
Collapse
|
8
|
Stec AA, Wang MH. Isolated distal vaginal agenesis masquerading as recurrent urinary infections in an adolescent female. J Pediatr 2011; 158:684. [PMID: 21146185 DOI: 10.1016/j.jpeds.2010.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 10/11/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew A Stec
- Division of Pediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | |
Collapse
|
9
|
Grimbizis GF, Campo R. Congenital malformations of the female genital tract: the need for a new classification system. Fertil Steril 2010; 94:401-7. [PMID: 20356581 DOI: 10.1016/j.fertnstert.2010.02.030] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Revised: 02/04/2010] [Accepted: 02/15/2010] [Indexed: 11/25/2022]
Abstract
Current proposals for classifying female genital anomalies seem to be associated with limitations in effective categorization, creating the need for a new classification system that is as simple as possible, clear and accurate in its definitions, comprehensive, and correlated with patients' clinical presentation, prognosis, and treatment on an evidence-based foundation. Although creating a new classification system is not an easy task, it is feasible when taking into account the experience gained from applying the existing classification systems, mainly that of the American Fertility Society.
Collapse
|
10
|
Abstract
The development of the Müllerian system and the female reproductive tract is a complex process involving an integrated series of events with significant potential for abnormal development and anomalies. Structural anomalies of the female reproductive tract may be isolated or occur in association with other congenital anomalies, including renal or bladder anomalies and anorectal malformations. Although rare in occurrence, it is important to be familiar with these conditions for appropriate diagnosis, management, and possible referral. The diagnosis, management, and surgical treatments of female reproductive tract anomalies in girls and young women have advanced with improvements in diagnostic imaging techniques, surgical and nonsurgical techniques and innovative instrumentation and developments.
Collapse
Affiliation(s)
- Lesley L Breech
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 4000, Cincinnati, OH 45229, USA.
| | | |
Collapse
|
11
|
|