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Walawender L, Santhanam N, Davies B, Fei YF, McLeod D, Becknell B. Müllerian anomalies in girls with congenital solitary kidney. Pediatr Nephrol 2024; 39:1783-1789. [PMID: 38197956 PMCID: PMC11026257 DOI: 10.1007/s00467-023-06266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The prevalence of Müllerian anomalies (MA) among patients with congenital solitary functioning kidney (SFK) is not well defined. A delay in diagnosis of obstructive MA can increase the risk of poor clinical outcomes. This study describes the prevalence of MA in patients with congenital SFK. METHODS A retrospective review was performed of patients within the Nationwide Children's Hospital system with ICD9 or ICD10 diagnostic codes for congenital SFK defined as either unilateral renal agenesis (URA) or multicystic dysplastic kidney (MCDK) and confirmed by chart review. Patients with complex urogenital pathology were excluded. Renal anomaly, MA, reason for and type of pelvic evaluation, and age of diagnosis of anomalies were evaluated. RESULTS Congenital SFK occurred in 431 girls due to URA (209) or MCDK (222). Pelvic evaluation, most commonly by ultrasound for evaluation of abdominal pain or dysmenorrhea, occurred in 115 patients leading to MA diagnosis in 60 instances. Among 221 patients ages 10 years and older, 104 underwent pelvic evaluation and 52 were diagnosed with an MA of which 20 were obstructive. Isolated uterine or combined uterine and vaginal anomalies were the most common MA. MA were five-fold more common in patients with URA compared to MCDK. In 75% of patients, the SFK was diagnosed prior to the MA. CONCLUSIONS The prevalence of MA in patients with congenital SFK was 24% among those age 10 years or older, and 38% were obstructive. This justifies routine screening pelvic ultrasound in girls with congenital SFK to improve early diagnosis.
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Affiliation(s)
- Laura Walawender
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA
| | - Natasha Santhanam
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Benjamin Davies
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Y Frances Fei
- Section of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Daryl McLeod
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Department of Urology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Brian Becknell
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA.
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Bortoletto P, Romanski PA, Pfeifer SM. Müllerian Anomalies: Presentation, Diagnosis, and Counseling. Obstet Gynecol 2024; 143:369-377. [PMID: 37989138 DOI: 10.1097/aog.0000000000005469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Abstract
Müllerian anomalies represent a complex collection of developmental defects occurring in up to 5% of the general population. They are increasingly more common in individuals with infertility (8.0%) and in those with a history of pregnancy loss (13.3%); they have the highest prevalence in individuals with a history of both (24.5%). A wide spectrum of anomalies can occur based on the stage at which müllerian development ceases in utero, ranging from mild (eg, a partial uterine septum) to severe, with complete absence of the cervix, uterus, and fallopian tubes (eg, müllerian agenesis). The components of the reproductive tract involved and, importantly, whether an obstruction of the tract is involved correlates with the timing of presentation, the constellation of associated symptoms, and the necessity for either medical or surgical management. Individuals, regardless of the severity of the defect, should be counseled on the gynecologic, reproductive, and obstetric risks associated with their specific müllerian anomaly to minimize adverse sequela and outcomes. We will review the clinical presentation, diagnostic evaluation, and clinical counseling of individuals with müllerian anomalies.
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Affiliation(s)
- Pietro Bortoletto
- Boston IVF, Waltham, and Harvard Medical School and the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and Shady Grove Fertility and the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York
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Moon LM, Anderson Z, Cisneros-Camacho AL, Dietrich JE. Presentation and Management of Uterine Didelphys with Unilateral Cervicovaginal Agenesis/Dysgenesis (CVAD): A Multicenter Case Series. J Pediatr Adolesc Gynecol 2024; 37:72-77. [PMID: 37558159 DOI: 10.1016/j.jpag.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/04/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION There are several well-described presentations of uterine didelphys (UD): UD without vaginal septum, UD with non-obstructed longitudinal vaginal septum, or UD with duplicated vaginas and an obstructed hemivagina on one side with ipsilateral renal anomaly. STUDY OBJECTIVE To describe another variant of UD and compare the presentation and management across different institutions METHODS: This was a retrospective case series approved by the NASPAG Fellows Research Consortium. Participating institutions obtained IRB approval. Inclusion criteria included a diagnosis of UD and unilateral cervicovaginal agenesis/dysgenesis (CVAD). Descriptive statistics were used. RESULTS Five patients met the inclusion criteria, with ages ranging from 13 to 27 years. Presenting symptoms included dysmenorrhea (80%), irregular bleeding (40%), acute onset left lower quadrant pain (20%), and abdominal mass (20%). Three patients had additional known abnormalities, including solitary kidney and solitary adrenal gland. All patients underwent pelvic magnetic resonance imaging. Two cases were only suspicious for unilateral CVAD on imaging and required pathology review postoperatively to confirm diagnosis. Two cases required a 2-staged approach with an initial diagnostic surgery followed by a second definitive procedure. Three patients were noted to have endometriosis intraoperatively. Postoperative follow-up ranged from 2 months to 2 years, with 1 patient reporting chronic pelvic pain. CONCLUSION Diagnosis on the basis of pelvic imaging can be difficult, as this unique variant may mimic classic obstructed hemivagina with ipsilateral renal anomaly. In patients with UD with unilateral CVAD, standard management is removal of the obstructed uterine horn. This multicenter series stresses awareness about the clinical presentation, distinguishes cases of cervical agenesis from dysgenesis, and reviews approaches to management.
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Affiliation(s)
- Lisa M Moon
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas; Department of Obstetrics & Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.
| | - Zachary Anderson
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma; Department of Obstetrics & Gynecology, University of Southern California, Los Angeles, California
| | | | - Jennifer E Dietrich
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas
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Mori A, Fujino S, Honda R, Kamijo K, Sano M, Imai T, Muramoto T, Kobayashi Y. Significance of expeditious diagnosis and treatment following menarche in obstructed hemivagina and ipsilateral renal agenesis syndrome: A case report. Radiol Case Rep 2024; 19:141-145. [PMID: 37941983 PMCID: PMC10628782 DOI: 10.1016/j.radcr.2023.09.070] [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: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023] Open
Abstract
Obstructed hemivagina and ipsilateral renal agenesis syndrome is a rare complex of structural abnormalities of female urogenital tract. Moreover, delayed treatment of this condition can reportedly lead to pelvic infection, endometriosis, and infertility. We present a rare case of obstructed hemivagina and ipsilateral renal agenesis syndrome wherein appropriate treatment was initiated early due to the identification of left renal agenesis. A 14-year-old girl visited the gynecology department due to worsening left lower abdominal pain after menarche. She was diagnosed with renal dysplasia in the pediatric department at the ages of 3 and 9 years, and it was recommended that she visits the gynecology department right after menarche. She experienced her first menarche at the age of 14 years. Imaging studies revealed uterine didelphys with occlusion of the left vagina and formation of hematocolpos. Additionally, hematomas were observed in the left uterine cavity and the left fallopian tube; left renal agenesis was confirmed. Based on these findings, we diagnosed this patient with obstructed hemivagina and ipsilateral renal agenesis syndrome and performed a surgical incision and excision of the closed left vaginal wall, resulting in the disappearance of the hematocolpos. Approximately 2 years postoperatively, the patient has remained recurrence-free. Early diagnosis and treatment are crucial for preserving fertility in patients with obstructed hemivagina and ipsilateral renal agenesis syndrome, and early referral to the obstetrics and gynecology department is recommended if renal dysplasia is detected during childhood.
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Affiliation(s)
- Atsushi Mori
- Gynecology Service, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano City, Nagano Prefecture, Japan
| | - Shotaro Fujino
- Gynecology Service, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano City, Nagano Prefecture, Japan
| | - Riku Honda
- Gynecology Service, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano City, Nagano Prefecture, Japan
| | - Kyosuke Kamijo
- Gynecology Service, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano City, Nagano Prefecture, Japan
| | - Megumi Sano
- Gynecology Service, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano City, Nagano Prefecture, Japan
| | - Takashi Imai
- Gynecology Service, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano City, Nagano Prefecture, Japan
| | - Tsutomu Muramoto
- Gynecology Service, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano City, Nagano Prefecture, Japan
| | - Yaeko Kobayashi
- Gynecology Service, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano City, Nagano Prefecture, Japan
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Crofts VL, Forbes T, Grover SR. Chronic, severe abdominal pain in a girl with a renal anomaly: Answers. Pediatr Nephrol 2023; 38:3985-3988. [PMID: 37261516 DOI: 10.1007/s00467-023-06008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Victoria L Crofts
- Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Thomas Forbes
- Paediatric Nephrology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sonia R Grover
- Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, VIC, Australia
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Murphy C, Wilcox A, Vash-Margita A. Diagnostic and surgical approaches to congenital uterine anomalies for the minimally invasive gynecologic surgeon. Curr Opin Obstet Gynecol 2023; 35:328-336. [PMID: 37266575 DOI: 10.1097/gco.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW Congenital uterine anomalies (CUAs) impact the physical and psychosocial wellbeing of affected patients. Managing these conditions depends on the clinical scenario, and in some cases, can involve the use of minimally invasive surgical techniques. The purpose of this review is to provide an update of the diagnosis, perioperative considerations, and treatment of CUAs. RECENT FINDINGS The American Society for Reproductive Medicine (ASRM) updated the guidelines for classification of CUAs to provide practitioners with a standardized classification system and have created an interactive tool designed for provider use. SUMMARY Gynecologic surgeons are likely to encounter CUAs during their career. This review provides updated guidance for the workup and treatment of CUAs.
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Affiliation(s)
| | | | - Alla Vash-Margita
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
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