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Bezabih NA, Mehammed AH, Gebresilassie MY, Regasa ND. A rare case of OHVIRA (obstructed hemivagina and ipsilateral renal anomaly) syndrome: Case report. Radiol Case Rep 2024; 19:3667-3671. [PMID: 38983302 PMCID: PMC11228635 DOI: 10.1016/j.radcr.2024.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 07/11/2024] Open
Abstract
Obstructed hemivagina and ipsilateral renal anomaly syndrome (OHVIRA) also known as Herlyn-Werner-Wunderlich syndrome is a rare type of Müllerian duct anomaly with concomitant mesonephric duct anomalies. It is characterized by uterus didelphys, obstructed hemi-vagina, and commonly renal agenesis however; other types of mesonephric duct anomalies such as duplicated kidneys, dysplastic kidneys, rectovesical bands, or crossed fused ectopia have also been reported. We present a case report of a 21-year-old female patient experiencing new-onset vaginal bleeding and pelvic pain over the past month. Subsequent multi-sequence MRI revealed characteristic features indicative of OHVIRA syndrome. Clinical manifestations typically encompass pelvic pain and menstrual abnormalities but mainly depend upon the presence of communication between the hemi-uterus. This article aims to discuss the clinical presentation, types, and diagnostic utility of ultrasound and MRI in OHVIRA syndrome. Additionally, we discuss the possible management plans.
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Affiliation(s)
- Natnael Alemu Bezabih
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Abdudin Heru Mehammed
- Saint Paul's Hospital, Millennium Medical College, Department of Radiology, Addis Ababa, Ethiopia
| | | | - Nebiyu Damtew Regasa
- Saint Paul's Hospital, Millennium Medical College, Department of Radiology, Addis Ababa, Ethiopia
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Oliveira JVQA, Philip CE, Pereira TAR, Garcia GMP, Villamil QTMF. Patient with Herlyn-Werner-Wunderlich syndrome and endometriosis achieves successful full-term pregnancy (40 weeks and 6 days): a case report. J Med Case Rep 2024; 18:361. [PMID: 39095912 PMCID: PMC11297602 DOI: 10.1186/s13256-024-04695-w] [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: 11/06/2023] [Accepted: 03/25/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Herlyn-Werner-Wunderlich syndrome , a rare Müllerian ducts congenital disease, is characterized by a diphtheritic uterus, blind hemivagina, and ipsilateral renal agenesis. Diagnosis is at young age by ultrasound and magnetic resonance imaging, and the prognosis is good. Usually, complications evolve endometriosis and secondary pelvic inflammation. CASE REPORT A 40-year-old female patient, Brazilian, white, primigravida, diagnosed at 30 years with a didelphic uterus on ultrasound, and 4 years later, with a left ovarian endometrioma, multiple ovarian cysts, and left renal agenesis on magnetic resonance imaging. Subsequently, due to dyspareunia and a feeling of swelling, the patient underwent transvaginal ultrasound with bowel preparation, and a hematocolpos was found and Herlyn-Werner-Wunderlich syndrome was suspected; 10 years after the diagnosis she had a planned pregnancy. She presented frequent contractions following the 15th week of pregnancy and fortunately there were no complications or premature labor. Labor was inducted at 40 weeks and 6 days without progress and a cesarean section was indicated and performed without complications. Herlyn-Werner-Wunderlich syndrome often goes unnoticed, leading to inadequate treatment. Individuals with Herlyn-Werner-Wunderlich syndrome commonly face fertility issues, such as high miscarriage rate (21-33%), and obstetric complications, such as spontaneous abortions (40% risk), intrauterine growth restriction, postpartum hemorrhage, increased fetal mortality, preterm delivery (21-29%), and elevated rates of cesarean sections. In addition, there is higher susceptibility of developing endometriosis, especially with hemivaginal obstruction, and pelvic adhesions. CONCLUSION Early diagnosis enables timely treatment and, consequently, fewer complications. Still, when these factors are absent, vaginal birth may still be possible. The true prevalence and incidence of complications related to Herlyn-Werner-Wunderlich syndrome are still unknown.
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Kaji T, Maeda K, Imaizumi J, Shirakawa A, Mineda A, Yoshida A, Iwasa T. Prenatal diagnosis of uterus didelphys without hydrocolpos. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:838-839. [PMID: 38180304 DOI: 10.1002/uog.27572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Affiliation(s)
- T Kaji
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - K Maeda
- Department of Obstetrics and Gynecology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - J Imaizumi
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - A Shirakawa
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - A Mineda
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - A Yoshida
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - T Iwasa
- Department of Obstetrics and Gynecology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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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.
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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;
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Kerimkulova MK, Oliveira Souza Lima SR, Elamin AE, Hamid YH, Faran N, Khan I. Multidisciplinary Management of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome in an Adolescent With Complex Congenital Anomalies: A Case Report. Cureus 2024; 16:e56961. [PMID: 38665700 PMCID: PMC11044895 DOI: 10.7759/cureus.56961] [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] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome presents with complex diagnostic and therapeutic challenges and is characterized by uterine didelphys, obstructed hemivagina, and ipsilateral renal anomaly. A 14-year-old female with a history of anorectal malformation and urogenital sinus anomaly presented with menstrual blood in her urine, abdominal pain, and distension. Investigations revealed a bicornuate uterus, vesicovaginal fistula, and right ovarian cyst, leading to the diagnosis of OHVIRA syndrome. A multidisciplinary approach resulted in salpingo-oophorectomy and subtotal hysterectomy. This case highlights the diagnostic challenges and emphasizes the role of advanced imaging and a multidisciplinary team in managing such complex conditions. It stresses the importance of patient-centered surgical planning tailored to the individual's anatomy and reproductive goals. Early recognition and a tailored, multidisciplinary approach are crucial in managing OHVIRA syndrome and improving outcomes for patients with rare congenital anomalies.
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Affiliation(s)
| | | | | | - Yusra H Hamid
- Community Medicine, University of Khartoum, Faculty of Medicine, Khartoum, SDN
| | - Nuzhat Faran
- Internal Medicine, Fatima Memorial Hospital, Lahore, PAK
| | - Ismail Khan
- Internal Medicine, Nishtar Medical University, Multan, PAK
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Borges AL, Sanha N, Pereira H, Martins A, Costa C. Herlyn-Werner-Wunderlich syndrome also known as obstructed hemivagina and ipsilateral renal anomaly: A case report and a comprehensive review of literature. Radiol Case Rep 2023; 18:2771-2784. [PMID: 37388267 PMCID: PMC10300495 DOI: 10.1016/j.radcr.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/05/2023] [Indexed: 07/01/2023] Open
Abstract
Herlyn-Werner-Wunderlich syndrome, also known as obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), is a Müllerian duct anomaly. It is a rare clinical condition consisting of a duplicated uterus with an oblique vaginal septum that causes partial genital tract outflow obstruction. A urinary tract anomaly, most commonly renal agenesis, is usually present on the obstructed side. The diagnosis of genital tract outflow obstruction is often delayed due to the normal functioning of the unaffected side. The most frequent complications are dysmenorrhea, chronic pelvic pain, infection, infertility and endometriosis. This report describes a 17-year-old G0P0 patient with a history of severe dysmenorrhea and left-sided renal agenesis, who was admitted for complaints of foul vaginal discharge over the past 3 months that was unsuccessfully treated with antibiotics. Transrectal ultrasound revealed the presence of 2 separate hemicavities on transverse and longitudinal views. A cystic lesion with ground-glass opacities was detected between the bladder and a normal-appearing cervix, which was determined to be hematocolpos. The diagnosis of OHVIRA was made. This case highlights the importance of excluding a Müllerian anomaly in the presence of renal system abnormalities. Being aware of the type of anomalies, combinations and variants is crucial to determine the diagnosis and the best surgical approach. Ultrasound was an invaluable imaging exam to determine the type of anomaly and its complexity. Awareness of this syndrome and its variants will prevent misdiagnosis and will help to define the appropriate treatment for these patients.
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Affiliation(s)
- André Luís Borges
- Obstetrics and Gynecology Department, Hospital de São Francisco Xavier-Centro Hospitalar de Lisboa Ocidental, Estrada Forte do Alto Duque, Edificio 2 Piso 3, Lisboa, 1449-005, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Nhalim Sanha
- Obstetrics and Gynecology Department, Hospital de São Francisco Xavier-Centro Hospitalar de Lisboa Ocidental, Estrada Forte do Alto Duque, Edificio 2 Piso 3, Lisboa, 1449-005, Portugal
| | - Helena Pereira
- Obstetrics and Gynecology Department, Hospital de São Francisco Xavier-Centro Hospitalar de Lisboa Ocidental, Estrada Forte do Alto Duque, Edificio 2 Piso 3, Lisboa, 1449-005, Portugal
| | - Ana Martins
- Obstetrics and Gynecology Department, Hospital de São Francisco Xavier-Centro Hospitalar de Lisboa Ocidental, Estrada Forte do Alto Duque, Edificio 2 Piso 3, Lisboa, 1449-005, Portugal
| | - Cristina Costa
- Obstetrics and Gynecology Department, Hospital de São Francisco Xavier-Centro Hospitalar de Lisboa Ocidental, Estrada Forte do Alto Duque, Edificio 2 Piso 3, Lisboa, 1449-005, Portugal
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Vaidya P, Agarwal P, Vaidya A. Herlyn-Werner-Wunderlich Syndrome: A Case Report. JNMA J Nepal Med Assoc 2023; 61:283-286. [PMID: 37203938 PMCID: PMC10231529 DOI: 10.31729/jnma.8096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Indexed: 06/13/2024] Open
Abstract
UNLABELLED Herlyn-Werner-Wunderlich syndrome is a rare Mullerian and mesonephric ductal anomaly characterized by a triad of didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis complex. This entity is also known as obstructed hemivagina and ipsilateral renal anomaly. We present a case of a 24-year-old nulliparous female with Herlyn-Werner-Wunderlich who presented with dysmenorrhea and intermenstrual bleeding. The diagnosis was initially made through ultrasound and confirmed on magnetic resonance imaging. The nonspecific nature of symptoms and variability in presentation depending on the classification and type of Herlyn-Werner-Wunderlich syndrome often leads to misdiagnosis or a delay in diagnosis. Therefore, a high index of suspicion is required. KEYWORDS case reports; mesonephric ducts; mullerian ducts.
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Affiliation(s)
- Priyanka Vaidya
- Department of Obstetrics and Gynaecology, Toowoomba Hospital, Toowoomab, Queensland, Australia
| | - Pooja Agarwal
- Department of Radiology, Norvic International Hospital, Thapathali, Kathmandu, Nepal
| | - Achala Vaidya
- Department of Obstetrics and Gynaecology, Norvic International Hospital, Thapathali, Kathmandu, Nepal
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Sijmons A, Broekhuizen S, van der Tuuk K, Verhagen M, Besouw M. OHVIRA syndrome: Early recognition prevents genitourinary complications. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:61-64. [PMID: 36794112 PMCID: PMC9923143 DOI: 10.1177/1742271x221102576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
Introduction The obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is characterized by the triad uterus didelphys, obstructed hemivagina, and ipsilateral renal dysplasia. To make a radiological diagnosis, knowledge of this syndrome is of paramount importance. Early recognition may prevent complications such as unnecessary surgical procedures, endometriosis, and infections, which could adversely affect fertility. Case report A 1-day-old female newborn in whom a right-sided cystic kidney abnormality was seen on antenatal ultrasound was admitted with anuria and intralabial mass. Besides the multicystic dysplastic right kidney, ultrasound revealed a uterus didelphys with right-sided uterus dysplasia, an obstructed right hemivagina, and an ectopic ureteric insertion. The diagnosis of obstructed hemivagina and ipsilateral renal anomaly syndrome with hydrocolpos was made and the hymen was incised. Later, ultrasound helped in diagnosing a pyelonephritis in the afunctional right kidney that was not draining into the bladder (hence no culture could be obtained), requiring intravenous antibiotics and a nephrectomy. Discussion Obstructed hemivagina and ipsilateral renal anomaly syndrome is an anomaly of the Müllerian and Wolffian ducts of unknown cause. Patients typically present after menarche with (progressive) abdominal pain, dysmenorrhea, or urogenital malformations. In contrast, prepubertal patients can present with urinary incontinence or an (external) vaginal mass. The diagnosis is confirmed by an ultrasound or magnetic resonance imaging. Follow-up includes repeated ultrasounds and monitoring of kidney function. Treatment consists of drainage of the hydrocolpos/hematocolpos; in some cases, further surgery is indicated. Conclusion Consider obstructed hemivagina and ipsilateral renal anomaly syndrome in girls with genitourinary abnormalities: early recognition prevents complications later in life.
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Affiliation(s)
- Anne Sijmons
- Department of Pediatrics, Wilhelmina
Hospital, Assen, The Netherlands
- Treant Zorggroep, Department of Internal
Medicine, Scheper Hospital, Emmen, The Netherlands
| | | | - Karin van der Tuuk
- Department of Gynecology, University Medical
Centre Groningen, Groningen, The Netherlands
| | - Martijn Verhagen
- Department of Radiology, University Medical
Centre Groningen, Groningen, The Netherlands
| | - Martine Besouw
- Department of Pediatrics, University Medical
Centre Groningen, Groningen, The Netherlands
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9
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Two Cases of Herlyn-Werner-Wunderlich Syndrome with Severe Dysmenorrhea, One Misdiagnosis and One Missed Diagnosis. SURGERIES 2022. [DOI: 10.3390/surgeries4010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Herlyn-Werner-Wunderlich (HWW) syndrome is a rare variant of mullerian duct anomalies characterized by the triad of uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis. We report two cases of HWW syndrome in young women with abdominal pain. This diagnosis can easily be missed if a clinician is not aware of the syndrome. In one case, the computed tomography image of obstructed hemivagina with hematocolpos was initially mistaken for a cystic tumor of adnexa by the radiologist; in the other case, correct diagnosis was missed for years despite numerous visits to different hospitals due to lack of awareness of the syndrome.
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10
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Zarfati A, Lucchetti MC. OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly or Herlyn-Werner-Wunderlich syndrome): Is it time for age-specific management? J Pediatr Surg 2022; 57:696-701. [PMID: 35487798 DOI: 10.1016/j.jpedsurg.2022.04.002] [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: 11/17/2021] [Revised: 03/18/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly or Herlyn-Werner-Wunderlich syndrome) is a rare Müllerian malformation. Usually, symptoms begin with worsening dysmenorrhea in post-menarche adolescents. The management in pre-menarche period is controversial and has only recently been subject of study. AIMS To review the experience of a pediatric tertiary center and to propose an age-specific management protocol for patients diagnosed before menarche. METHODS A retrospective cohort study (review of medical records - period 2009-2021). RESULTS Twenty-eight patients were diagnosed (mean age 11.9 years), seven (25%) before menarche, one (3%) perinatally. One patient had Floating-Harbor syndrome. Twenty-three patients had ipsilateral renal agenesis, while five had a multicystic-dysplastic kidney. The contralateral kidney showed hypertrophy in 25 patients, pelvicalyceal ectasia in 8 and dysplasia in 1. Twenty-four patients were symptomatic. Three of the seven diagnosed prior to menarche had symptoms. All post-menarche diagnosed patients were symptomatic. Twenty-six patients underwent surgery (one-stage drainage, vaginal septal resection, and vaginoplasty). Asymptomatic pre-menarche patients were followed-up until surgery after menarche onset. No patient underwent surgery prior to menarche solely for OHVIRA diagnosis. At follow-up (median 3.5 years, 3 lost to follow-up), eighteen patients were asymptomatic, one developed endometriosis, one had impaired renal function, two needed reoperations. CONCLUSIONS Pre-menarche OHVIRA patients, without symptoms, should undergo regular follow-up until the onset of menarche. Surgery must be considered in post-menarche or symptomatic patients. Post-operative, long-term follow-up is required, evaluating both renal and gynecological issues. LEVEL-OF-EVIDENCE IV.
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Affiliation(s)
- Angelo Zarfati
- Department of Pediatric Surgery, Bambino Gesù Pediatric Hospital, Piazza di Sant'Onofrio, 4, Roma 00165, Italy; University of Rome Tor Vergata, Via Cracovia, 50, Roma 00133, Italy.
| | - Maria Chiara Lucchetti
- Department of Pediatric Surgery, Bambino Gesù Pediatric Hospital, Piazza di Sant'Onofrio, 4, Roma 00165, Italy
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Matsubara S, Watanabe T. An adolescent girl with acute abdominal pain and abdominal mass. BMJ 2022; 379:e068444. [PMID: 36265874 DOI: 10.1136/bmj-2021-068444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Shigeki Matsubara
- Jichi Medical University, Department of Obstetrics and Gynecology, Tochigi, Japan
| | - Takashi Watanabe
- Haga Red Cross Hospital, Department of Obstetrics and Gynecology, Tochigi, Japan
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Muacevic A, Adler JR. Vaginoscopic Incision of Vaginal Septum With Preservation of the Hymen in a Child With Obstructed Hemi-Vagina Ipsilateral Renal Agenesis (OHVIRA) Syndrome. Cureus 2022; 14:e30450. [PMID: 36407203 PMCID: PMC9672824 DOI: 10.7759/cureus.30450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 01/25/2023] Open
Abstract
Obstructed hemi-vagina ipsilateral renal agenesis (OHVIRA) syndrome, also known as Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare variant of Mullerian duct anomalies that usually presents after menarche. Although there is increasing awareness about OHVIRA syndrome, high suspicion is needed for the diagnosis. Awareness of the syndrome is crucial for the management and to prevent serious complications. Surgical techniques and age at the surgery are still debatable but, minimally invasive vaginoscopic resection of the vaginal septum should be considered when feasible as it not only allows division of septum with preservation of hymen, but it provides excellent visualization, is less traumatic, and has promising postoperative outcomes. Hymenal integrity is of great concern in specific populations with cultural values. In this report, we present the case of a 24-month-old girl diagnosed with OHVIRA syndrome during a routine follow-up for renal agenesis and was managed with vaginoscopic incision of the vaginal septum using a pediatric cystoscope while maintaining the hymenal integrity.
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Aljahdali EA, Sharafuddin LI, Baamer WO, Enani MA, Alzhrani FS. Successful pregnancies in an adolescent with Herlyn-Werner-Wunderlich (HWW) syndrome: a case report and literature review. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Müllerian anomaly is a congenital defect in the development of the female reproductive system that varies according to the stage of developmental failure resulting in agenesis, hypoplasia, or fusion defect in one or both Mullerian ducts; in such patients, it is expected to have higher pregnancy and delivery complications.
Case presentation
This case presentation of a 14-year-old adolescent girl with uterine didelphys, obstructed right hemi-vagina, and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome, HWW) that was corrected surgically, then got married at the age of 16 with successful two consecutive term uncomplicated pregnancies of favorable maternal and fetal outcomes without a history of any miscarriage or recurrent collections.
Conclusions
Herlyn-Werner-Wunderlich syndrome is a rare case and represents a challenge to diagnose and treat especially in pediatrics and adolescents. Early recognition and treatment will help to improve outcome and reduce possible complications resulting from obstruction with retrograde menstruation and its consequences. Successful early management of our patient improved her quality of life by relieving her cyclical obstructive pain, preserve fertility, and normal sexual life.
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Hayat AM, Yousaf KR, Chaudhary S, Amjad S. The Herlyn-Werner-Wunderlich (HWW) syndrome – A case report with radiological review. Radiol Case Rep 2022; 17:1435-1439. [PMID: 35265236 PMCID: PMC8899131 DOI: 10.1016/j.radcr.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/02/2022] [Indexed: 11/05/2022] Open
Abstract
Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly of female urogenital tract involving combined mullerian duct anomalies and mesonephric duct malformation characterized by uterus didelphys, obstructed hemi-vagina and ipsilateral renal agenesis which is also known as OHVIRA syndrome. It can be classified based on a completely or incompletely obstructed hemivagina. It presents soon after menarche or shows delayed presentation depending on the type. The most common presentation is lower abdominal pain, dysmenorrhea, and abdominal mass in the lower abdomen secondary to hematometra or hematocolpos. We present a 15-year-old unmarried patient with an unusual case of OHVIRA syndrome suffering from dysmenorrhea and painful mass in suprapubic region. We described the role of imaging modalities in diagnosis of the Herlyn-Werner Wunderlich syndrome with a review of literature. On USG and MRI, she had right renal agenesis with compensatory hypertrophy of the left kidney, didelphic uterus with an obstructed hemi-vagina on right side which led to marked distention of ipsilateral cervix and proximal vagina in the form of hematometrocolpos. OHVIRA syndrome can present early or late, depending on the type. In patients with uterine and vaginal abnormalities, a work-up for associated renal anomalies should be performed. The choice imaging modalities for the diagnosis of OHVIRA syndrome are ultrasound and MRI. Knowing the imaging findings of this rare condition is crucial for early diagnosis in order to prevent complications which may lead to endometriosis and infertility.
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Gutiérrez-Montufar OO, Zambrano-Moncayo CP, Otálora-Gallego MC, Meneses-Parra AL, Díaz-Yamal I. Síndrome de Herlyn-Werner-Wunderlich: reporte de caso y revisión de la literatura. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2021; 72:407-422. [PMID: 35134287 PMCID: PMC8833243 DOI: 10.18597/rcog.3699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022]
Abstract
Objetivo: Presentar un reporte de caso de síndrome de Herlyn Werner Wunderlich (SHWW) y hacer una revisión de la literatura para determinar los hallazgos clínicos e imagenológicos en estas pacientes. Materiales y métodos: Se presenta el caso de una mujer de 16 años que consultó, en un hospital de las fuerzas militares en Bogotá, por dolor pélvico recurrente, su diagnostico final fue SHWW. Se realizó una búsqueda sistemática de la literatura en las diferentes bases de datos, revisiones sistemáticas, cohortes, series de casos y reportes de casos en pacientes con diagnóstico de SHWW en cualquier edad, se obtuvo información sobre las características de presentación clínica, y las tecnologías diagnósticas más frecuentemente utilizadas. Se hace resumen narrativo de los hallazgos. Resultados: Se incluyeron 77 publicaciones, un total de 676 pacientes. Los síntomas más frecuentes fueron dismenorrea (63,9 %), seguido de dolor pélvico (35,2%). Las tecnologías diagnósticas más utilizadas fueron el ultrasonido pélvico en un 92,1% y la resonancia magnética nuclear en un 74,6% de los casos. La histeroscopia y laparoscopia son poco utilizados en el diagnóstico. Conclusión: El SHWW es una entidad poco frecuente, debe hacer parte del estudio complementario de la agenesia renal del paciente pediátrico y del diagnóstico diferencial de la dismenorrea primaria en pacientes en la adolescencia. Se requiere evaluar con estudios de cohorte más grandes la utilidad de la histeroscopia en estas pacientes.
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Affiliation(s)
| | | | | | | | - Ivonne Díaz-Yamal
- Docente de la Universidad Militar Nueva Granada, Bogotá (Colombia)..
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Imaeda K, Kobayashi Y, Nakamura K, Hayashi S, Morisada T, Banno K, Aoki D. Usefulness of Endoscopy for Female Genital Plastic Surgery: A Series of 4 Cases with Genital Malformations. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934363. [PMID: 34743169 PMCID: PMC8588711 DOI: 10.12659/ajcr.934363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/29/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Female genital plastic surgery is rare and requires specific patient anatomical information to successfully carry out the appropriate procedure for each female genital malformation. Performing endoscopic surgery can increase the amount of information intraoperatively. We report on our experience of proactively using endoscopy to obtain additional intraoperative information to perform the appropriate surgical procedure suited to each female genital malformation, and evaluate the usefulness of concurrent endoscopy for improved surgical outcomes. CASE REPORT In Case 1, an 18-year-old woman underwent colpoplasty for Mayer-Rokitansky-Küster-Hauser syndrome using the laparoscopic Davydov procedure, wherein the pelvic peritoneum was precisely dissected using light from a laparoscope as a guide. In Case 2, a 25-year-old woman presented with suspected Wunderlich syndrome. Since the junction of the affected uterus with the normal uterus was unclear on preoperative imaging, we performed total hysterectomy of the affected uterus after identifying the anatomical structure by hysteroscopy. In Case 3, a 12-year-old girl with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome underwent transvaginal fenestration of the obstructed vaginal wall to prevent future menstrual molimen. Simultaneous hysteroscopy and laparoscopy allowed us to determine the location of a unilateral vaginal wall cyst and drain it safely. In Case 4, a 29-year-old woman had OHVIRA syndrome, and we conducted a laparoscope-based fenestration of the cervical canal safely and accurately. CONCLUSIONS Our series showed how, even for gynecological malformations without established standards for surgical procedure, a safe and minimally invasive surgery can be ensured if the amount of anatomical information is increased via endoscopy.
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Kudela G, Wiernik A, Drosdzol-Cop A, Machnikowska-Sokołowska M, Gawlik A, Hyla-Klekot L, Gruszczyńska K, Koszutski T. Multiple variants of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome - one clinical center case series and the systematic review of 734 cases. J Pediatr Urol 2021; 17:653.e1-653.e9. [PMID: 34274235 DOI: 10.1016/j.jpurol.2021.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/10/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare female urogenital tract malformation. STUDY OBJECTIVE To present 10 patients with OHVIRA treated at the clinical center. To perform a systematic review of OHVIRA case series related to the prevalence of anatomical variants, surgical interventions and endometriosis, and to compare them with our case series. MATERIALS AND METHODS Medical records from 10 OHVIRA patients treated between 2016 and 2020 were retrospectively reviewed. For the systematic review, PubMed and Web of Science were used to search for relevant studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were strictly followed. RESULTS The most common anatomical variant includes left obstructed hemivagina (50.7%) with isolated hematocolpos or hydrocolpos (55.9%), uterus didelphys (82.9%), and ipsilateral renal agenesis (92.2%). Vaginal septectomy was the most common surgical approach (86.5%). Hemivaginectomy (2.2%), hemihysterectomy (4.2%), or total hysterectomy (0.7%) were also performed in several patients. Some subjects required salpingectomy (3.3%) or oophorectomy (1.8%). 7.5% of patients, mainly infants, did not require surgery due to the spontaneous resolution of hydrocolpos. Endometriosis was fortuitously found in 13.6% of the selected cases who underwent laparoscopy or laparotomy. DISCUSSION The most common variant of OHVIRA includes isolated hematocolpos and a thick vaginal septum between adjacent hemivaginas. Endometriosis was present in approximately 14% of OHVIRA patients, but this number is probably underestimated. Routine laparoscopy is not required. However, all patients need further monitoring due to a higher risk of endometriosis. Based on the analyzed studies and our case series, vaginal septectomy is a sufficient surgical technique to relieve symptoms and prevent possible complications in most OHVIRA patients.
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Affiliation(s)
- Grzegorz Kudela
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland.
| | - Agnieszka Wiernik
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Drosdzol-Cop
- Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland
| | - Lidia Hyla-Klekot
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
| | | | - Tomasz Koszutski
- Department of Pediatric Surgery and Urology, Medical University of Silesia, Katowice, Poland
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Jomaa S, Tawashi K, All Rass FA, Abdallah E, Tawashi N. A challenging diagnosis and management of Herlyn-Werner-Wunderlich Syndrome in low-resource Settings: A case report complicated with hydronephrosis. Ann Med Surg (Lond) 2021; 70:102843. [PMID: 34540220 PMCID: PMC8437768 DOI: 10.1016/j.amsu.2021.102843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Herlyn-Werner-Wunderlich syndrome is a rare congenital disorder that consists of a didelphic uterus, hemivaginal septum, and unilateral renal agenesis. Both diagnosis and management can be challenging in low-income countries. Case presentation a 13-year-old female who experienced recurrent pelvic pain, dysmenorrhea, and abdominal mass for one month. We could not obtain the MRI as it was unavailable in our hospital, and the patient cannot afford its expensive cost in a private center. Instead, US showed an absent right kidney and doubled uterus with a heterogeneous cystic formation. A pelvic CT scan revealed an absent right kidney, an enlarged left kidney, a double uterus, and a left hematocolpos. We established the diagnosis of Herlyn-Werner-Wunderlich syndrome and started planning for correcting the anomalies via laparotomy. Discussion ultrasound detects uterus didelphys, hematocolpos, hematometrocolpos, and renal agenesis but cannot identify the vaginal septum and the type of müllerian defect. The MRI is more convenient for a thorough assessment, but it is a high-priced diagnostic method. Conclusion although MRI is the gold standard for establishing the diagnosis and preoperative planning, ultrasound and CT scan can be an alternative, less expensive, and reliable approach. In addition, Laparoscopy or vaginoscopy may not be available in these countries. Therefore, correcting the anomalies can be achieved with laparotomy, which results in acceptable outcomes without any complications. Herlyn-Werner-Wunderlich Syndrome is a rare müllerian anomaly. Although MRI can implant the diagnosis, US and CT scan are a sufficient alternative approach. Laparotomy can be used to correct the anomaly while preserving the hymen with minimal or no post-operative complications.
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Affiliation(s)
- Sami Jomaa
- Faculty of Medicine, Damascus University, Damascus, Syria
- Corresponding author. Damascus University, Damascus, 97009, Syria
| | | | | | - Eyad Abdallah
- Faculty of Medicine, University of Kalamoon, Damascus, Syria
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Li X, Liu T, Li L. Herlyn-Werner-Wunderlich syndrome and its complications: A report of two cases and literature review. Radiol Case Rep 2021; 16:2319-2324. [PMID: 34194598 PMCID: PMC8237300 DOI: 10.1016/j.radcr.2021.05.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/13/2022] Open
Abstract
Herlyn–Werner–Wunderlich syndrome (HWWS) is a rare congenital malformation characterized by uterus didelphys, unilateral blind hemivagina, and ipsilateral renal agenesis. The obstructed vagina affects menstrual flow, leading to related clinical symptoms after menarche. However, the age of onset, initial symptoms, and clinical complications differ among patients owing to the different types of vaginal septum. Herein, we report 2 cases. The first case is of a 20-year-old woman who presented with fever; she was diagnosed with vaginitis and pelvic inflammation due to the vaginal septum with ostiole. The second case is of a 12-year-old girl who complained of abdominal pain; she was diagnosed as having pelvic inflammation, omentitis, and suppurative appendicitis due to the atretic vaginal septum.
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Affiliation(s)
- Xiaodan Li
- Department of Gynaecology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai 519000, China
| | - Tianzhu Liu
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai 519000, China
| | - Lina Li
- Department of Gynaecology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai 519000, China
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Morales Vicente A, de Prados Alonso A, García Sánchez Y, Velasco Esteban M, Díaz Sierra C, Gilabert Estellés J. Diagnóstico y tratamiento histeroscópico del síndrome de Herlyn-Werner-Wünderlich. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Yang M, Wen S, Liu X, He D, Wei G, Wu S, Huang Y, Ni Y, Shi Y, Hua Y. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA): Early diagnosis, treatment and outcomes. Eur J Obstet Gynecol Reprod Biol 2021; 261:12-16. [PMID: 33873082 DOI: 10.1016/j.ejogrb.2021.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/25/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe and summarize the early diagnosis, treatment and outcomes of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). METHODS Data from patients with OHVIRA treated at the study centre over the last decade were analysed retrospectively, including demographic characteristics, symptoms, diagnosis, treatment and outcomes. Relevant published literature was also reviewed in this study. RESULTS In total, 11 cases were diagnosed with OHVIRA over the study period, ranging in age from 3 to 14 years (median 11 years). Four cases were asymptomatic, four had abdominal pain and three had urinary symptoms. All 11 cases underwent vaginoplasty. Ureteral bladder re-implantation (n = 1), dysplastic nephrectomy (n = 1), separation of labia minora adhesions (n = 1), perineoplasty (n = 1) and urethroplasty (n = 1) were performed. Cases were followed up for 2 months to 8 years (median 5 years) with good follow-up outcomes. CONCLUSIONS Based on the cases in this study and the relevant literature, ultrasound appears to be an effective method for the diagnosis of OHVIRA. Experienced ultrasonographers are able to achieve a high corrected diagnosis rate. The differential diagnosis of OHVIRA should be considered by paediatric surgeons, urologists, emergency physicians and gynaecologists when they identify patients with didelphys uterus or renal agenesis. Early surgery can reduce the risk of potential genital tract infection and gynaecological complications.
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Affiliation(s)
- Meng Yang
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China; Paediatrics Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Centre for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Paediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, PR China
| | - Sheng Wen
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China; Paediatrics Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Centre for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Paediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, PR China
| | - Xing Liu
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China; Paediatrics Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Centre for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Paediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, PR China
| | - Dawei He
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China; Paediatrics Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Centre for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Paediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, PR China
| | - Guanghui Wei
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China; Paediatrics Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Centre for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Paediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, PR China
| | - Shengde Wu
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China; Paediatrics Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Centre for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Paediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, PR China
| | - Yitian Huang
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China
| | - Yuansong Ni
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China
| | - Yan Shi
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China
| | - Yi Hua
- Department of Urology, Children's Medicine Affiliated to Chongqing Medical University, Chongqing, PR China; Paediatrics Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Centre for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Chongqing Key Laboratory of Paediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, PR China.
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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: 15] [Impact Index Per Article: 5.0] [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.
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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
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Gündüz R, Ağaçayak E, Evsen MS. OHVIRA syndrome presenting with acute abdomen findings treated with minimally invasive method: three case reports. Acta Chir Belg 2021; 122:275-278. [PMID: 33820484 DOI: 10.1080/00015458.2021.1911096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND One of the least common forms of Müllerian anomalies is Herlyn-Werner-Wunderlich syndrome (HWWS), characterized by uterus didelphys, obstructed hemi-vagina, and ipsilateral renal agenesis (OHVIRA). HWWS is also known as OHVIRA syndrome. Patients with OHVIRA syndrome generally present with increasing pelvic pain, dysmenorrhoea, and pelvic mass during puberty, shortly after menarche. These patients may be treated successfully with a minimally invasive method. CASE REPORT We present three previously asymptomatic patients with OHVIRA syndrome who presented with acute abdomen shortly after menarche. These patients were treated with a minimally invasive method. CONCLUSION Patients with OHVIRA syndrome may be treated with minimally invasive method after definitive diagnosis and, laparoscopy and laparotomy should be avoided as much as possible. Minimally invasive treatment modality is not only cost-effective, but also provides symptomatic relief and preserves fertility.
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Affiliation(s)
- Reyhan Gündüz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Dicle University, Diyarbakır, Turkey
| | - Elif Ağaçayak
- Faculty of Medicine, Department of Obstetrics and Gynecology, Dicle University, Diyarbakır, Turkey
| | - Mehmet Sıddık Evsen
- Faculty of Medicine, Department of Obstetrics and Gynecology, Dicle University, Diyarbakır, Turkey
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Wdowiarz K, Skrajna A, Reinholz-Jaskólska M. Diagnosis and treatment of Herlyn-Werner-Wunderlich syndrome: a case report. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:52-56. [PMID: 33935621 PMCID: PMC8077801 DOI: 10.5114/pm.2021.104034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly characterized by uterus didelphys with blind hemivagina and ipsilateral renal agenesis. It is one of the rare anomalies of the genitourinary system and is usually identified in the first few years after menarche. CASE REPORT An 18-year-old patient presented with painful menses for 1 year and was suspected for vaginal haematoma. Symptoms appeared 5 years after menarche. DISCUSSION Magnetic resonance imaging of the pelvis revealed a congenital anomaly of the genital tract. Two steps of surgical management were performed. First, a hysteroscopic incision of the vaginal septa and evacuation of vaginal haematoma were performed. Subsequently, the vaginal septum was partially excised during laparohysteroscopy. CONCLUSIONS Ipsilateral renal agenesis was confirmed by ultrasound during hospitalization, and the diagnoses of obstructed hemivagina and ipsilateral renal anomaly syndrome were established.The aim of this study was to present the diagnostic and therapeutic approaches in HWW syndrome, and to draw attention to the challenges in its diagnosis, which can coexist with multiple complications.
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Affiliation(s)
- Kinga Wdowiarz
- Department of Obstetrics and Gynaecology, Praski Hospital, Warsaw, Poland
| | - Adrianna Skrajna
- Department of Obstetrics and Gynaecology, Praski Hospital, Warsaw, Poland
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Haverland R, Wasson M. Longitudinal Vaginal Septum: Accurate Diagnosis and Appropriate Surgical Management with Resection. J Minim Invasive Gynecol 2020; 27:1228-1229. [DOI: 10.1016/j.jmig.2020.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
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Tan YG, Laksmi NK, Yap TL, Sadhana N, Ong CCP. Preventing the O in OHVIRA (Obstructed Hemivagina Ipsilateral Renal Agenesis): Early Diagnosis and Management of Asymptomatic Herlyn-Werner-Wunderlich Syndrome. J Pediatr Surg 2020; 55:1377-1380. [PMID: 31266634 DOI: 10.1016/j.jpedsurg.2019.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/13/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare variant of Mullerian ductal anomaly associated with ipsilateral renal agenesis. Most patients are diagnosed after menarche with complications of uterovaginal obstruction, genitourinary infection and pelvic adhesions. Patients often undergo additional operations for misdiagnosis or treatment of complications. Our institution manages several HWWS patients diagnosed before symptoms by screening for antenatally-diagnosed renal agenesis. This study aims to improve the presymptomatic management of HWWS patients. METHODS We carried out retrospective case review of patients diagnosed with HWWS from 2010 to 2017 on patient demographics, symptoms, clinical course and operative management and summarize the sparse literature published to date. RESULTS There were 8 patients with HWWS but only 2 symptomatic patients presented acutely with hematocolpos requiring urgent vaginal surgery. The other six patients had early diagnosis through postnatal ultrasound screening. No patient required further operation for diagnosis or complications related to obstructed hemivagina. CONCLUSION Our case series and literature review show that the majority of prepubertal patients with HWWS do not require early gynecological surgery. We recommend that female babies with renal agenesis should be screened for HWWS syndrome with ultrasound. Early diagnosis and presymptomatic elective surgery may prevent urogynecological complications that cause fertility and renal impairment. STUDY DESIGN Case series, level IV evidence.
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Affiliation(s)
| | | | - Te-Lu Yap
- KK Women's and Children's Hospital, Singapore
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Fascilla FD, Olivieri C, Cannone R, De Palma D, Manosperta F, Costantino AS, Carugno J, Vicino M, Cicinelli E, Bettocchi S. In-office Hysteroscopic Treatment of Herlyn-Werner-Wunderlich Syndrome: A Case Series. J Minim Invasive Gynecol 2020; 27:1640-1645. [PMID: 32320799 DOI: 10.1016/j.jmig.2020.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Herlyn-Werner-Wunderlich syndrome (HWWs) is a rare congenital malformation of the female urogenital track characterized by a triad consisting of didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis. We report 5 consecutive cases of patients diagnosed with HWWs treated in our center. Imaging studies with 2-dimensional/3-dimensional ultrasound and abdominopelvic magnetic resonance imaging were obtained to confirm the diagnosis. The treatment consisted of a 1-step surgical in-office hysteroscopic incision of the vaginal septum using 5 Fr hysteroscopic bipolar electrodes. At the follow-up visit, between 1 and 2 months after the initial procedure, the patients underwent a diagnostic vaginoscopy with excision of exceeding vaginal tissue if needed, performed with a vaginal hysteroscopic approach. In-office hysteroscopic treatment of patients diagnosed with HWWs is a safe and effective, minimally invasive treatment modality that provides symptomatic relief and preserves fertility, avoiding the cost and risks of the use of general anesthesia in an operating room setting. We recommend shifting the management of this challenging condition to the office setting.
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Affiliation(s)
- Fabiana Divina Fascilla
- Unit of Obstetrics and Gynecology, Di Venere Hospital, Bari Local Health Authority (Drs. Fascilla and Vicino)
| | - Claudiana Olivieri
- II Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, Policlinico of Bari, (Drs. Olivieri, Cannone, De Palma, Costantino, and Cicinelli)
| | - Rossella Cannone
- II Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, Policlinico of Bari, (Drs. Olivieri, Cannone, De Palma, Costantino, and Cicinelli)
| | - Domenico De Palma
- II Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, Policlinico of Bari, (Drs. Olivieri, Cannone, De Palma, Costantino, and Cicinelli)
| | - Francesco Manosperta
- Student at Medical School of the Faculty of Medicine, University "Aldo Moro" of Bari, Italy (Dr. Manosperta)
| | - Alfredo Sigfrido Costantino
- II Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, Policlinico of Bari, (Drs. Olivieri, Cannone, De Palma, Costantino, and Cicinelli)
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida (Dr. Carugno)
| | - Mario Vicino
- Unit of Obstetrics and Gynecology, Di Venere Hospital, Bari Local Health Authority (Drs. Fascilla and Vicino)
| | - Ettore Cicinelli
- II Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, Policlinico of Bari, (Drs. Olivieri, Cannone, De Palma, Costantino, and Cicinelli)
| | - Stefano Bettocchi
- Inter-Departmental Project Unit of "Minimal-Invasive Gynecological Surgery," Policlinico of Bari (Dr. Bettocchi) University of Bari Aldo Moro, Bari, Italy.
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Salerno S, Terranova MC, Lo Re G, Tudisca C, Chiaramonte C, Li Voti G. Unusual case of continuous urinary dribbling in a young female due to unknown complex urogenital malformation: magnetic resonance features. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Malarazhagan V, Veerasingham M, Sivanesan K. Right-sided obstructed hemivagina ipsilateral renal agenesis (OHVIRA): A case report. Case Rep Womens Health 2020; 26:e00185. [PMID: 32181147 PMCID: PMC7063130 DOI: 10.1016/j.crwh.2020.e00185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Obstructed hemivagina ipsilateral renal agenesis (OHVIRA) is a rare anomaly of the urogenital system. The characteristic triad of this syndrome, which was initially reported in 1950, is didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis (Embrey, 1950 [1]). Case A 17-year-old girl was referred with a 6-month history of offensive vaginal discharge. Magnetic resonance imaging (MRI) established the diagnosis of OHVIRA. She underwent surgery for drainage of the hematocolpos and excision of the vaginal septum followed by an uncomplicated recovery and the patient had normal menstrual cycles after surgery. Conclusion There should be a high suspicion of OHVIRA syndrome when encountering adolescent patients with non-specific abdominal or pelvic symptoms. The characteristic triad of this syndrome includes didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis. Differentials of nonspecific abdominal symptoms with unilateral renal agenesis must include obstructive genital tract anomaly. Early diagnosis and treatment is important to avoid complications.
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Dabi Y, Dray G, Allanche M, Skalli D, Paniel BJ, Haddad B, Touboul C. Fertility and pregnancy outcomes in patients with bicorporeal uterus and blind hemivagina: 20 years of experience in a tertiary referral gynaecological department. J Gynecol Obstet Hum Reprod 2019; 49:101651. [PMID: 31760181 DOI: 10.1016/j.jogoh.2019.101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/28/2019] [Accepted: 10/18/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND To evaluate fertility and pregnancy outcomes in patients with uterus bicorporeal and blind hemivagina. Our second objective was to investigate factors predicting fertility and pregnancy outcomes in those patients. MATERIAL AND METHODS We conducted a retrospective analysis in a tertiary referring gynaecological department, in France. We included all patients with uterus bicorporeal and blind hemivagina who underwent at least one surgery in our centre. Initial characteristics of the patients included were extracted from their medical charts and patients were contacted to assess their fertility and pregnancies outcomes upon their consent to participate to the study. RESULTS Between 1989 and 2010, 79 patients fulfilled inclusion criteria and were selected for analysis. Mean follow up of those patients was of 16.15 (QI 10-21) years. Forty-six patients (58.2%) returned the survey and among them, 21 (45.7%) were fertile, 8 (17.4%) were infertile and 17 (37%) never attempted to get pregnant following initial management. Forty-nine pregnancies were included to assess pregnancies outcomes: 11 (22.5%) early miscarriages, 1 (2.0%) extra-uterine pregnancy, 2 (4.1%) second semester miscarriages and 35 (71.4%) leaded to living birth. Nineteen (54.3%) deliveries occurred by caesarean section and 14 (40.0%) by vaginal delivery. Fifteen pregnancies (42.9%) were complicated. In univariate analysis, adhesiolysis performed at the time of initial surgery was the only factor associated with infertility (p=0.004). CONCLUSIONS Fertility seems to be perfectly conserved in those patients and they do not have increased rate of adverse pregnancies outcomes.
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Affiliation(s)
- Y Dabi
- Faculté de médecine de Créteil UPEC - Paris XII, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France
| | - G Dray
- Faculté de médecine de Créteil UPEC - Paris XII, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France
| | - M Allanche
- Faculté de médecine de Créteil UPEC - Paris XII, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France
| | - D Skalli
- Faculté de médecine de Créteil UPEC - Paris XII, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France
| | - B J Paniel
- Faculté de médecine de Créteil UPEC - Paris XII, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France
| | - B Haddad
- Faculté de médecine de Créteil UPEC - Paris XII, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France
| | - C Touboul
- Faculté de médecine de Créteil UPEC - Paris XII, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000 Créteil, France; UMR INSERM U965: Angiogenèse et Recherche translationnelle, Hôpital Lariboisière, 49 bd de la chapelle 75010 Paris, France.
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Girardi Fachin C, Aleixes Sampaio Rocha JL, Atuati Maltoni A, das Chagas Lima RL, Arias Zendim V, Agulham MA, Tsouristakis A, Dos Santos Dias AIB. Herlyn-Werner-Wunderlich syndrome: Diagnosis and treatment of an atypical case and review of literature. Int J Surg Case Rep 2019; 63:129-134. [PMID: 31586891 PMCID: PMC6796699 DOI: 10.1016/j.ijscr.2019.08.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/15/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022] Open
Abstract
In this report we present a rare case of HWWS diagnosed in a 12-year-old female presenting with disabling abdominal pain after the onset of menarche. We reviewed patient’s clinical history, utility of diagnostic modalities, usual treatments, and recent literature. The purpose of this case report is to offer a better understanding of the pathophysiology of HWWS. When a young female presents with common, nonspecific symptoms, HWWS should be on differential diagnoses list. Greater awareness of HWWS will lead to earlier detection and, consequently, reduced complications caused by delayed diagnosis.
Introduction Herlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome, is a rare congenital abnormality of Müllerian duct development characterized by uterus didelphys, unilateral blind hemivagina, and ipsilateral renal agenesis. Presentation of case In this report, the authors present the case of a 12-year-old patient presenting with progressive and disabling abdominal pain after the onset of menarche diagnosed with HWWS, describe the various diagnostic modalities and treatment options available, along with a current review of the literature. Discussion With normal external genitalia, HWWS is usually asymptomatic until menarche when patients present with worsening abdominal pain during menses and a palpable pelvic or abdominal mass. Untreated, HWWS may lead to a number of complications including endometriosis, infertility, and spontaneous abortion. Conclusion Greater awareness of HWWS will lead to earlier detection and is the key to alleviating patient suffering and avoiding potentially severe complications.
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Affiliation(s)
- Camila Girardi Fachin
- Pediatric Surgery, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.
| | | | | | | | | | - Miguel Angelo Agulham
- Pediatric Surgery, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
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Salastekar N, Coelho M, Majmudar A, Gupta S. Herlyn-Werner-Wunderlich syndrome: A rare cause of abdominal pain and dyspareunia. Radiol Case Rep 2019; 14:1297-1300. [PMID: 31462954 PMCID: PMC6710296 DOI: 10.1016/j.radcr.2019.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/16/2022] Open
Abstract
Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital disease characterized by Mullerian duct anomalies. The characteristic triad of this syndrome includes didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis (hence, also known as Obstructed Hemivagina and Ipsilateral Renal Agenesis or OHVIRA syndrome). The clinical presentation of HWW is nonspecific and patients may present with abdominal/pelvic pain, dyspareunia, or dysmenorrhea. However, the imaging findings of HWW are characteristic and discussed in this case report of a 16-year-old female who presented with abdominal pain and dyspareunia.
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Affiliation(s)
- Ninad Salastekar
- Department of Radiology, SUNY Upstate Medical University, 750 East Adam Street, Syracuse, NY, 13210, USA
| | - Marlon Coelho
- Department of Radiology, SUNY Upstate Medical University, 750 East Adam Street, Syracuse, NY, 13210, USA
| | - Anand Majmudar
- Department of Radiology, SUNY Upstate Medical University, 750 East Adam Street, Syracuse, NY, 13210, USA
| | - Saurabh Gupta
- Department of Radiology, SUNY Upstate Medical University, 750 East Adam Street, Syracuse, NY, 13210, USA
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Rusda M, Umara A, Rambe AYM. Herlyn Werner Wunderlich Syndrome with Hematocolpos Symptom. Open Access Maced J Med Sci 2019; 7:2679-2681. [PMID: 31777633 PMCID: PMC6876813 DOI: 10.3889/oamjms.2019.406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/13/2019] [Accepted: 07/14/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Uterodidelphys with obstructed hemivagina and ipsilateral renal agenesis is referred to as the Herlyn Werner Wunderlich (HWW) syndrome. Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract involving Müllerian ducts and Wolffian structures, and it is Werner by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. CASE REPORT Here, we describe a 17-year-old female patient presented with severe and increasing cyclical abdominal pain. She attained menarche 3 years back. The patient had irregular and scanty menstruation associated with dysmenorrhoea. On physical examination, secondary sexual characters were well developed, and on palpation, lower abdomen tenderness was not present. Diagnosed with HWW syndrome, who was taken up for diagnostic sonography and MRI, followed by vaginal septal resection. CONCLUSION In addition to a definitive diagnosis, this approach helped in symptomatic relief to the patient.
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Affiliation(s)
- Muhammad Rusda
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Medical Faculty, Universitas Sumatera Utara, RSUP Haji Adam Malik Jl. Dr T. Mansur No.5, Medan 20154, Indonesia
| | - Amru Umara
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Medical Faculty, Universitas Sumatera Utara, RSUP Haji Adam Malik Jl. Dr T. Mansur No.5, Medan 20154, Indonesia
| | - Andrina Yunita Murni Rambe
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Medical Faculty, Universitas Sumatera Utara, RSUP Haji Adam Malik Jl. Dr T. Mansur No.5, Medan 20154, Indonesia
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Baños Cándenas L, Abehsera Davó D, de la Peña Rodríguez de Medina M, Martín Orlando J, López Díaz AC. Diagnosis and gestational follow-up in a patient with Herlyn-Werner-Wünderlich syndrome, a case report. Taiwan J Obstet Gynecol 2019; 58:560-565. [DOI: 10.1016/j.tjog.2019.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 10/26/2022] Open
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Tuna T, Estevão-Costa J, Ramalho C, Fragoso AC. Herlyn-Werner-Wunderlich Syndrome: Report of a Prenatally Recognised Case and Review of the Literature. Urology 2019; 125:205-209. [DOI: 10.1016/j.urology.2018.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
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Hamidi H, Haidary N. Late presentation, MR imaging features and surgical treatment of Herlyn-Werner-Wunderlich syndrome (classification 2.2); a case report. BMC WOMENS HEALTH 2018; 18:161. [PMID: 30285830 PMCID: PMC6171225 DOI: 10.1186/s12905-018-0655-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/26/2018] [Indexed: 12/03/2022]
Abstract
Background Herlyn-Werner-Wunderlich syndrome is a very rare congenital genitourinary anomaly characterized by uterus didelphys, blind hemivagina and ipsilateral renal agenesis. Case presentation Authors present a case of Herlyn-Werner-Wunderlich syndrome in a 19-year-old unmarried woman who presented with pelvic pain and pelvic mass. MR imaging revealed the typical features of didelphys uterus, obstructed right hemivagina and ipsilateral renal agenesis. The patient subsequently underwent surgery. Conclusions Herlyn-Werner-Wunderlich syndrome would be suspected in patients with unilateral absent kidney and pelvic mass. Ultrasonography and MR imaging can well depict the disease entity and surgery is the treatment of choice for obstructed hemivagina.
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Affiliation(s)
- Hidayatullah Hamidi
- Radiology Department, French Medical Institute for Mothers and Children (FMIC), 3rd district, Kabul, Afghanistan.
| | - Nilab Haidary
- Obstetrics and Gynecology Department, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
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Gai YH, Fan HL, Yan Y, Cai SF, Zhang YZ, Song RX, Song SL. Ultrasonic evaluation of congenital vaginal oblique septum syndrome: A study of 21 cases. Exp Ther Med 2018; 16:2066-2070. [PMID: 30186441 DOI: 10.3892/etm.2018.6411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 10/13/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to investigate the ultrasound features and classify the lesion types of congenital vaginal oblique septum syndrome (CVOS) in 21 patients prior to surgery. Grey-scale pelvic ultrasound was performed to evaluate the uterus, vagina and kidneys in 21 patients with suspected CVOS. Ultrasound features, including the presence of a double uterus, hematocolpos masses and renal absence, in CVOS types I, II and III were studied and compared with intra-operative results and the results of surgery. Ultrasound identified the presence of double uteruses and cervices with ipsilateral renal agenesis on the oblique septum side in all 21 patients. There were 14 hematocolpos lesions on the right and 7 on the left of the vagina. Type I CVOS was diagnosed in 15 patients with a large hematocolpos mass (volume, 64-268 ml) and these diagnoses were confirmed by surgery. Furthermore, there were 4 patients with type II and 2 patients with type III CVOS exhibiting small hematocolpos lesions (volume, 5-36 ml) identified by ultrasound, which were all confirmed by surgery. Therefore, ultrasound imaging is useful tool to evaluate the abnormal features of CVOS and determine the type of CVOS in patients prior to surgical intervention.
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Affiliation(s)
- Yong-Hao Gai
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Hui-Li Fan
- Department of Ultrasound, Heze Municipal Hospital, Heze, Shandong 274000, P.R. China
| | - Ye Yan
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Shi-Feng Cai
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yue-Zhong Zhang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Ru-Xin Song
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Shu-Liang Song
- Department of Ultrasound, Shanghai Dongfang Hospital Affiliated to Tongji University, Shanghai 200120, P.R. China
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Cheong YL, Laksmi NK. Herlyn–Werner–Wunderlich Syndrome: Case report of a newborn presenting with interlabial cyst. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105818797141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A newborn with Herlyn–Werner–Wunderlich Syndrome presented with interlabial cyst. The cyst was punctured and instilled with contrast medium for cystography to demonstrate the anatomy. Simple resection of the hemivagina septum at the same sitting resolved the obstruction. Early interventions done to clinch diagnosis and institute treatment would help to prevent future complications associated with menses retention and preserve fertility.
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Affiliation(s)
- Yee Ling Cheong
- Department of Paediatric Surgery, KK Women’s & Children’s Hospital, Singapore
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Grant C, Bayne CE, Kern NG, Peters CA. Atypical presentation of obstructed hemivagina and ipsilateral renal anomaly. Urol Case Rep 2018; 19:70-71. [PMID: 29888199 PMCID: PMC5991322 DOI: 10.1016/j.eucr.2018.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Campbell Grant
- Department of Urology, The George Washington University, Washington, DC, USA
| | - Christopher E Bayne
- Division of Pediatric Urology, Children's National Medical Center, Washington, DC, USA
| | - Nora G Kern
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Craig A Peters
- Department of Urology, Children's Medical Center, The University of Texas Southwestern, Dallas, TX, USA
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Kapczuk K, Friebe Z, Iwaniec K, Kędzia W. Obstructive Müllerian Anomalies in Menstruating Adolescent Girls: A Report of 22 Cases. J Pediatr Adolesc Gynecol 2018; 31:252-257. [PMID: 29030159 DOI: 10.1016/j.jpag.2017.09.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To assess the clinical course of obstructive Müllerian anomalies found in girls after menarche. DESIGN A retrospective case series of adolescents who, between 2009 and 2016, were treated for vaginal or uterine obstructive malformations diagnosed after menarche. SETTING Division of Gynecology, Poznań University of Medical Sciences, Poznań, Poland. PARTICIPANTS AND INTERVENTIONS Twenty-two patients who, at the age range between 11.4 and 18.2 (median, 13.1) years, between 2 and 74 (median 7.5) months after menarche, underwent surgical repair of obstructive genital anomaly. MAIN OUTCOME MEASURES Müllerian defect type, presentation, radiologic findings, pre- and postoperative course. RESULTS Eighteen patients (18 of 22; 81.8%) were diagnosed with obstructed hemivagina ipsilateral renal anomaly syndrome. One patient (1 of 22; 4.5%) was diagnosed with uterus didelphys and unilateral cervical atresia. Three patients (3 of 22; 13.6%) had unicornuate uterus with a cavitated, noncommunicating rudimentary horn. The right side was affected in 13 patients (13 of 22; 59.1%), and the left side in 9 patients (9 of 22; 40.9%; P > .05). All but 1 patient had renal agenesis on the side of obstruction. Before repair of the obstructive genital anomaly, 4 patients underwent unnecessary surgeries for misdiagnosed ovarian cysts. Serious complications (pelvic inflammatory disease, vesicovaginal fistula) occurred in 2 patients with microperforated pyocolpos. Pelvic endometriosis was found in 4 of our patients. CONCLUSION Our case series suggests that obstructed hemivagina ipsilateral renal anomaly syndrome is the most common obstructive Müllerian anomaly diagnosed in adolescents after menarche. The differential diagnosis for unilateral kidney agenesis accompanied by dysmenorrhea in adolescent girls should include obstructive genital tract anomaly. Accurate diagnosis of an obstructive genital anomaly early after menarche might help prevent unnecessary surgeries and infection-related complications. Meanwhile, prompt surgical correction of an obstructive genital tract anomaly results in relief of symptoms and might reduce the risk of endometriosis.
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Affiliation(s)
- Karina Kapczuk
- Division of Gynecology, Department of Perinatology and Gynecology, Poznań University of Medical Sciences, Poznań, Poland.
| | - Zbigniew Friebe
- Division of Gynecology, Department of Perinatology and Gynecology, Poznań University of Medical Sciences, Poznań, Poland
| | - Kinga Iwaniec
- Division of Gynecology, Department of Perinatology and Gynecology, Poznań University of Medical Sciences, Poznań, Poland
| | - Witold Kędzia
- Division of Gynecology, Department of Perinatology and Gynecology, Poznań University of Medical Sciences, Poznań, Poland
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Orofino A, Lanzillotto MP, Savino CL, Woldemicael A, Gentile O, Paradies G. Acute abdominal pain in an adolescent female with Herlyn-Werner-Wunderlich syndrome and hemicervicovaginal atresia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Khanna K, Sharma S, Gupta DK. Hydrometrocolpos etiology and management: past beckons the present. Pediatr Surg Int 2018; 34:249-261. [PMID: 29177625 DOI: 10.1007/s00383-017-4218-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Abstract
Hydrometrocolpos is a rare condition in which the uterus and the vagina are grossly distended with a retained fluid other than pus or blood. It may present during the neonatal period or later at puberty. Most cases reported earlier were stillbirths and were diagnosed only on autopsy. Antenatal diagnosis is now possible with the advent of ultrasound. An early diagnosis and speedy management is the key to survival. Many previous case reports have focused on the varied clinical presentations, multiple causes, associated syndromes and/or the radiological diagnosis of this condition. However, management options for different types of hydrometrocolpos have not yet been concisely discussed. We have reviewed the literature and tried to summarize the management options applicable to most case scenarios of hydrometrocolpos.
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Affiliation(s)
- Kashish Khanna
- Department of Pediatric Surgery, All India Institute of Medical Sciences, R. No 4002, 4th floor, Ansari Nagar, New Delhi, 110029, India
| | - Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, R. No 4002, 4th floor, Ansari Nagar, New Delhi, 110029, India
| | - D K Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, R. No 4002, 4th floor, Ansari Nagar, New Delhi, 110029, India.
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Noviello C, Romano M, Nino F, Martino A, Cobellis G. Clinical and radiological findings for early diagnosis of Herlyn-Werner-Wunderlich syndrome in pediatric age: experience of a single center. Gynecol Endocrinol 2018; 34:56-58. [PMID: 28562147 DOI: 10.1080/09513590.2017.1332178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The authors present their experience in the management of pediatric patients with Herlyn-Werner-Wunderlich syndrome (HWWS) considering clinical classification and anatomical characteristics of the malformation. METHODS All the data of the patient presented at our Pediatric Surgery Unit from February 2010 to August 2015 were collected. According to the type of malformations, patients were divided in 3 groups: A (completely obstructed hemivagina), B (incompletely obstructed hemivagina), and C (communication between the duplicated cervices). RESULTS Six patients were treated in the study period. The mean age was 9 years (2 months-15 years). According to the characteristics of the HWWS, we had 5 patients in group A, 1 in group B, and none in group C. One-stage surgical treatment was performed in all cases of complete obstruction, but in one case a second look was necessary for a better resection of the septum. At a mean follow-up of 18 months all patients were symptoms free. CONCLUSIONS Prognosis of this malformation is good in case of early diagnosis and treatment. We suggest that when a renal agenesia is diagnosed, the patient needs an ultrasonographic follow-up of the contralateral kidney but also of the genital tract to find each minimal abnormalities, furthermore, a MRI scanning before the onset of menstruation can be necessary.
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Affiliation(s)
- Carmine Noviello
- a Pediatric Surgery Unit , Salesi Children's Hospital, Università Politecnica delle Marche , Ancona , Italy
| | - Mercedes Romano
- a Pediatric Surgery Unit , Salesi Children's Hospital, Università Politecnica delle Marche , Ancona , Italy
| | - Fabiano Nino
- a Pediatric Surgery Unit , Salesi Children's Hospital, Università Politecnica delle Marche , Ancona , Italy
| | - Ascanio Martino
- a Pediatric Surgery Unit , Salesi Children's Hospital, Università Politecnica delle Marche , Ancona , Italy
| | - Giovanni Cobellis
- a Pediatric Surgery Unit , Salesi Children's Hospital, Università Politecnica delle Marche , Ancona , Italy
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Sakaguchi T, Hamada Y, Nakamura Y, Shirai T, Hamada H, Kon M. Herlyn–Werner–Wunderlich syndrome with a protruding hymen over the vaginal introitus in a neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Herlyn-Werner-Wunderlich syndrome: An unusual presentation with pyocolpos. Obstet Gynecol Sci 2017; 60:374-377. [PMID: 28791270 PMCID: PMC5547086 DOI: 10.5468/ogs.2017.60.4.374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 11/21/2022] Open
Abstract
Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly of the urogenital tract, which is characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. It usually presents at puberty with pelvic pain, dysmenorrhea, and a vaginal or pelvic mass. Although rare, it may present with purulent vaginal discharge due to secondary infection of the obstructed hemivagina, making diagnosis difficult. A careful pelvic examination to identify the cervix and vagina is the key to the diagnosis of Müllerian duct anomalies and magnetic resonance imaging can provide additional useful information. The optimal treatment is full excision and marsupialization of the obstructing vaginal septum so that both uteri can drain through the patent vagina. The authors report a case of a 22-year-old female with an unusual presentation of Herlyn-Werner-Wunderlich syndrome complicated by pyocolpos, which was successfully managed by vaginal septum resection and drainage of pus.
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Locally advanced adenocarcinoma of the cervix on uterus didelphys: a case report. J Contemp Brachytherapy 2017; 9:71-76. [PMID: 28344607 PMCID: PMC5346605 DOI: 10.5114/jcb.2017.65640] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/25/2016] [Indexed: 11/29/2022] Open
Abstract
In November 2013, a woman with Herlyn-Werner-Wunderlich (HWW) syndrome was diagnosed with a locally advanced left cervical adenocarcinoma. The patient’s malformation consisted of two uteri with two cervixes, a obstructed vagina, and a left renal agenesis. Classification FIGO: stage IIIa because of infiltration of the inferior third of the vagina wall. Locoregional management comprised an infrarenal lateral aortic lymphadenectomy followed by concomitant radio-chemotherapy to the pelvic (inguinal, pelvic, and infrarenal para aortic nodes) volumes. A total of 50.4 Gy were delivered (1.8 Gy/fraction/day) to the node (inguinal, pelvic, and aortic infrarenal) and pelvic volume; a concomitant boost to the primary cervical tumor and macroscopic nodes to 59.92 Gy (2.14 Gy/fraction/day) was performed. 20 Gy were delivered with intracavitary brachytherapy boost with mold technique and a pulsed-dose-rate technique due to the rarity of this uterine malformation. After 30 months of follow-up, there was no evidence of locoregional or distant recurrence.
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Clinical Implications of Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) Syndrome in the Prepubertal Age Group. PLoS One 2016; 11:e0166776. [PMID: 27861623 PMCID: PMC5115795 DOI: 10.1371/journal.pone.0166776] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/03/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare syndrome characterized by Müllerian duct and renal anomalies. It is usually regarded as a disease of adolescence; however, due to a number of possible problems, the management of patients before puberty should not be overlooked. We assessed the clinical course of prepubertal patients to propose appropriate management. Materials and Methods We retrospectively assessed 43 prepubertal OHVIRA syndrome patients who were diagnosed and followed up at our institution from July 2004 to June 2015. We reviewed medical records, focusing on presentation, radiologic findings, surgical management, and the overall clinical course. Results Median age at diagnosis was 1.3 months and median follow-up period was 25.5 months. The most common accompanying ipsilateral urologic anomalies were ectopic ureter and ureterocele, while the most common contralateral anomaly was vesicoureteral reflux. During the follow-up period, six patients (14.0%) required surgery at a median age of 31.2 months due to recurrent urinary tract infection, uncontrolled vaginal distention compressing adjacent organs, urinary incontinence, or intractable abdominal pain. Conclusions While OHVIRA syndrome is known as a postpubertal disease, about 13% of prepubertal patients in our study required surgery. When ectopic ureter insertion into the vagina is present, further treatment may be needed to address the complications caused by continuous urine production. Patients should be monitored for complications arising from either obstructed hemivagina or renal anomalies with regular follow-up, especially before the age of five years.
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Tsai JL, Tsai SF. Case Report: A Rare Cause of Complicated Urinary Tract Infection in a Woman with Herlyn-Werner-Wunderlich Syndrome. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e40267. [PMID: 28203451 PMCID: PMC5294448 DOI: 10.5812/ircmj.40267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/22/2016] [Accepted: 10/16/2016] [Indexed: 11/16/2022]
Abstract
Introduction Urinary tract infection is a common disease in the general population. However, in patients with frequent urinary tract infection, it is important to determine any treatable cause to avoid recurrence. Case Presentation Herlyn-Werner-Wunderlich syndrome or OHVIRA syndrome is a very rare congenital anomaly with uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. The earliest presentation of this syndrome is hematocolpos that develops during menstruation and results in dysmenorrhea and a pelvic mass shortly after menarche. Herein, we report a patient with Herlyn-Werner-Wunderlich syndrome manifested with unusual symptoms, delayed onset and without surgery. The unique point of this patient is the partial obstruction of cervico-vaginal junction. Conclusions Early diagnosis and timely treatment of OHVIRA syndrome can prevent long-term complications, such as recurrent urinary tract infection and infertility. A high index of suspicion is required, even though OHVIRA syndrome is extremely rare and may have an atypical presentation.
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Affiliation(s)
- Jun-Li Tsai
- MD, Department of Family Medicine, Cheng Ching General Hospital, Taichung, Taiwan
| | - Shang-Feng Tsai
- MD, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
- Corresponding Author: Shang-Feng Tsai, MD, Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. Tel: +886-423592525, Fax: +886-423594980, E-mail:
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Complexities of Müllerian Anatomy in 46XX Cloacal Exstrophy Patients. J Pediatr Adolesc Gynecol 2016; 29:424-428. [PMID: 26851190 DOI: 10.1016/j.jpag.2016.01.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 01/15/2016] [Accepted: 01/27/2016] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To characterize Müllerian anatomy in 46,XX cloacal exstrophy patients. DESIGN Retrospective review of prospectively maintained, institutionally approved exstrophy-epispadias-cloacal exstrophy database. SETTING Tertiary care, high-volume exstrophy center (Division of Pediatric Urology, The Johns Hopkins Hospital, Baltimore, Maryland). PARTICIPANTS We included 31 patients who were genetically female with cloacal exstrophy for whom records included detailed evaluation of Müllerian anatomy. INTERVENTIONS None. MAIN OUTCOME MEASURES Müllerian structures, method of evaluation, management, and sexual activity. RESULTS Of our patients, 12.9% (3/31) had no identified abnormalities. Vaginal anatomy was described for 30 patients; 3/30 had vaginal agenesis, 14/30 had a single vagina, and 13/30 had vaginal duplication. Of 14 patients with 1 vagina, 5 had atresia/hypoplasia, and 1 had a lateral displacement. One patient with 2 vaginas also had distal atresia. Of the cervices evaluated, 9/14 were duplicated (2/9 with a solitary vagina), and 19/27 of the uteri were duplicated (6/22 with 1 vagina, 1/22 with no vagina). Five patients required imaging to fully characterize their anatomy, and 7 patients had studies that failed to identify Müllerian structures seen in the operating room or on physical examination. Common reconstructive surgeries included vaginoplasties, incisions of vaginal septa, colporrhaphies, and hysterectomies. Sexual activity was confirmed for 3 patients, 2 of whom had conceived. CONCLUSION Most female cloacal exstrophy patients exhibit abnormalities of the Müllerian system. Axial imaging and ultrasound are helpful diagnostic adjuncts but do not replace careful physical examination and assessment in the operating room. Further studies of sexual activity and fertility are warranted.
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