1
|
Tayade SD, Mehdi N, Dube R, Bose V, Ameer A, Hakim ZT, Wattiez A. A rare variant of mullerian agenesis: a case report and review of the literature. J Med Case Rep 2024; 18:126. [PMID: 38523311 PMCID: PMC10962068 DOI: 10.1186/s13256-024-04438-x] [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: 01/07/2023] [Accepted: 02/05/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION Menstruation is a developmental milestone and usually marks healthy and normal pubertal changes in females. Menarche refers to the onset of first menstruation in a female. The causes of primary amenorrhea include outflow tract abnormalities, resistant endometrium, primary ovarian insufficiency, and disorders of the hypothalamus, pituitary, or other endocrine glands. A rare variant of mullerian agenesis, which warrants an individualized approach to management, is presented here. CASE REPORT We present here the case of a 25-year-old Indian female with pain in the lower abdomen and primary amenorrhea. After a thorough history, clinical examination, imaging, and diagnostic laparoscopy, two small uteri, a blind upper half vagina, bilateral polycystic ovaries, and a blind transverse connection between the two uteri-a horseshoe band cervix-were detected, which confirmed the diagnosis of mullerian agenesis. There was evidence of adenomyosis in the mullerian duct element. This is a rare form of Müllerian abnormality with an unusual presentation. CONCLUSION Mullerian agenesis is the most common cause of primary amenorrhea with well-developed secondary sexual characteristics. There are various forms of mullerian agenesis. Most of the cases are managed by a multidisciplinary team. Rare variants warrant an individualized approach to management.
Collapse
Affiliation(s)
| | | | - Rajani Dube
- Obstetrics and Gynecology, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE.
| | - Vaishnavi Bose
- Intern, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Ashna Ameer
- Intern, RAK Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Zainabsadat Tabatabaei Hakim
- Obstetrics and Gynecology, Specialist in Minimally Invasive Surgery, Latifa Women and Children Hospital, Dubai, UAE
| | - Arnaud Wattiez
- Gynecology and Minimally Invasive Surgery, Department of Gynecology, Latifa Women and Children Hospital, Dubai, UAE
| |
Collapse
|
2
|
Meutia AP, Ksyatria Y, Priyatini T, Hakim S, Djusad S, Moegni F, Hidayah GN, Harzif AK. Satisfactory Outcome of Various Novel Modified Laparoscopic Neovaginoplasty Using Autologous Peritoneal Graft. Gynecol Minim Invasive Ther 2024; 13:48-52. [PMID: 38487607 PMCID: PMC10936726 DOI: 10.4103/gmit.gmit_33_23] [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] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 03/17/2024] Open
Abstract
Management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome patients is by creating functional neovagina through surgical or nonsurgical route. Surgical repair using minimally invasive technique is a favorable option in creating neovagina. In this study, the patients underwent neovaginoplasty. Clinical follow-ups were done at 3, 6, and 12 months postoperatively. The primary outcomes were anatomic and functional successes; anatomical success was defined as a ≥6 cm-long neovagina that allows for easy introduction of two fingers, and functional success was defined with Female Sexual Function Index FSFI-6 questionnaire score above 19. Modified neovaginoplasty using autologous peritoneal graft was performed on the patients (n = 6). Follow-up showed mean vaginal lengths of 8.16 cm, mean surgery time of 175 min, mean blood loss of 59.17 ml, and mean duration of hospital stay of 2 days, with an average FSFI-6 score of 25,2. Therefore, we concluded that laparoscopic approach using modified technique of autologous peritoneal graft provides satisfactory result.
Collapse
Affiliation(s)
- Alfa Putri Meutia
- Division of Urogynecology, Department of Obstetrics and Gynecology, Faculty of Medicine - Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yudhistya Ksyatria
- Division of Urogynecology, Department of Obstetrics and Gynecology, Faculty of Medicine - Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tyas Priyatini
- Division of Urogynecology, Department of Obstetrics and Gynecology, Faculty of Medicine - Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Surahman Hakim
- Division of Urogynecology, Department of Obstetrics and Gynecology, Faculty of Medicine - Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Suskhan Djusad
- Division of Urogynecology, Department of Obstetrics and Gynecology, Faculty of Medicine - Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fernandi Moegni
- Division of Urogynecology, Department of Obstetrics and Gynecology, Faculty of Medicine - Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Gita Nurul Hidayah
- Division of Urogynecology, Department of Obstetrics and Gynecology, Faculty of Medicine - Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Achmad Kemal Harzif
- Division of Reproductive Endocrinology and Fertility, Department of Obstetrics and Gynecology, Faculty of Medicine - Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| |
Collapse
|
3
|
Bouko-Levy E, Vialaret C, Sallée C, Marquet P, Margueritte F, Dion L, Lavoue V, Gauthier T. Estimation of the prevalence of uterine infertility and its different causes in France according to data from a literature review. J Gynecol Obstet Hum Reprod 2023; 52:102684. [PMID: 37866776 DOI: 10.1016/j.jogoh.2023.102684] [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: 07/07/2023] [Accepted: 10/20/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Uterine infertility (UI) is defined as the complete absence of a uterus (absolute uterine infertility or AUI) or the presence of a non functional uterus (non-absolute uterine infertility or NAUI). The exact prevalence of uterine infertility is currently unknown. Our aim was to assess the number of French women concerned by Uterine Infertility according to a recent literature review. MATERIALS AND METHODS We have previously conducted a systematic review of the literature on UI and its various causes in the world. Based on these study and demographic data of 2022 from INSEE (Institut National de la Statistique et des Études Économiques), we attempted to estimate the number of women under 40 years of age in France affected by potential UI using direct standardization. RESULTS AND DISCUSSION Based on the estimation from INSEE data, approximately 2066 women of childbearing age would have MRKH syndrome in France, 380 the Androgen Insensitivity Syndrome and 3700 had an haemostasis hysterectomy in France. We did not find data on the prevalence of hysterectomies before the age of 40 in France. For the following pathologies: uterine malformations, radiation uterus, synechiae, myomas and adenomyosis there was a huge amount of missing data, which does not allow us to estimate the number of potentially infertile patients. CONCLUSION Prevalence of UI is poorly known. UI probably concerns several thousand patients in France. The creation of a UI registry would make enable to assess the number of patients potentially eligible for adoption, uterus transplantation or even surrogacy.
Collapse
Affiliation(s)
- E Bouko-Levy
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - C Vialaret
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - C Sallée
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - P Marquet
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, Limoges 87000, France
| | - F Margueritte
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - L Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes 35000, France
| | - V Lavoue
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes 35000, France
| | - T Gauthier
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France; Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, Limoges 87000, France.
| |
Collapse
|
4
|
Aslan K, Gurbuz TB, Orhan A, Kasapoglu I, Ozerkan K, Uncu G. Long term sexual outcomes of Mayer Rokitansky Küster Hauser Syndrome patients after Uncu-modified Davydov procedure. Facts Views Vis Obgyn 2023; 15:235-242. [PMID: 37742200 PMCID: PMC10643009 DOI: 10.52054/fvvo.15.3.091] [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: 09/26/2023] Open
Abstract
Background Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure. Objective To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure. Materials and Methods Patients with MRKH syndrome who underwent paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty (aka Uncu-modified Davydov procedure) between January 2008 and December 2021. The procedure involves laparoscopic circular dissection of the pelvic peritoneum followed by pulling down, through the opened vaginal orifice, and suturing the vaginal cuff with the support of uterine remnants. The long-term complication rate, anatomical outcomes, and sexual function outcomes (as measured by Female Sexual Function Index (FSFI)) were ascertained. Main outcome measures Main Outcome Measures: The long-term complication rate, anatomical outcomes and FSFI survey results. Results A total of 50 patients with MRKH syndrome underwent the Uncu-modified Davydov procedure between Jan 2008- Dec 2021. There were four perioperative complications: three bladder injuries (6%) and one rectal serosa injury (2%). Four long-term postoperative complications were identified: one vesicovaginal fistula (2%), one recto-vaginal fistula (2%), and two vaginal stenoses (4%). All patients were physically examined at least one year after surgery. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (minimum score of 24, maximum score of 36). Conclusion Conclusion: The Uncu-modified Davydov procedure has been demonstrated to be a safe and effective treatment option with high female sexual function index scores for patients with MRKH syndrome. What is new? The long-term complication rate, anatomical and sexual outcomes of Uncu-modified laparoscopic peritoneal pull-down vaginoplasty were reported in this study. The results indicated that the surgical approach could be used in selective MRKH patients who failed first-line self-dilatation therapy.
Collapse
|
5
|
Serrano S, Pereira I, Henriques A, Valentim Lourenço A. Neovagina in Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: Vaginoplasty Using Ileal Flap. ACTA MEDICA PORT 2023. [PMID: 36599171 DOI: 10.20344/amp.18563] [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: 05/15/2022] [Accepted: 09/23/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Surgical treatment of patients with malformations of the female genital tract is a complex problem and there are different techniques described in the literature. The goal of all these techniques is the reconstruction of a neovagina that is anatomically similar to a vagina, with adequate length to facilitate sexual functioning and with the lowest risk of possible complications. The aim of this study is to describe the surgical technique for the reconstruction of a neovagina from an ileal segment without a vascular pedicle. MATERIAL AND METHODS Description of a surgical technique developed in our tertiary university center in a patient with Mayer-Rokitansky-Küster-Hauser syndrome. RESULTS The vaginoplasty surgery using ileal flap was performed in three steps. In the first part of the intervention a laparoscopic hysterectomy with bilateral salpingectomy was performed. The second step consisted of isolating the ileal segment, ileal anastomosis and preparing the ileal segment. After the isolated segment was prepared, it was repositioned in a vagina mold to configure the neovagina. Finally, the third step included the adaptation of the vaginal mold with the ileal mucosa to the vesicorectal space. CONCLUSION Ileal vaginoplasty without a vascular pedicle is an option that can be used to reconstruct the vagina, because it provides an excellent tissue for vaginal replacement. This technique can be used in patients with genital malformations of the genital tract with absence or vaginal hypoplasia.
Collapse
Affiliation(s)
- Sílvia Serrano
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Inês Pereira
- Department of Gynecology and Obstetrics. Hospital CUF Descobertas. Lisbon; Department of Gynecology and Obstetrics. Hospital CUF Torres Vedras. Torres Vedras. Portugal
| | - Alexandra Henriques
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Lisbon School of Medicine. Lisbon Academical Medical Center. Lisbon. Portugal
| | - Alexandre Valentim Lourenço
- Department of Obstetrics, Gynecology and Reproductive Medicine. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Lisbon School of Medicine. Lisbon Academical Medical Center. Lisbon. Portugal
| |
Collapse
|
6
|
Bindra V, Satpathy G, Reddy CA, Swetha P. Managing the triad of triple mullerian anomaly, endometriosis and adenomyosis - A case report. Int J Surg Case Rep 2022; 100:107762. [PMID: 36302313 PMCID: PMC9615313 DOI: 10.1016/j.ijscr.2022.107762] [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: 09/09/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction and importance Report of an extremely rare case of triple Mullerian anomaly consisting of cervical agenesis, partial vaginal agenesis and complete bicorporeal uterus with functioning endometrium associated with adenomyosis and pelvic endometriosis in a young girl managed with hysterectomy of both uterine horns and excision of pelvic endometriosis. Presentation of case A 20-year-old young woman presented with primary amenorrhoea and severe cyclical pain abdomen. She was diagnosed with a rare triple Mullerian anomaly consisting of cervical agenesis, partial vaginal agenesis and complete bicorporeal uterus with functioning endometrium associated with adenomyosis and pelvic endometriosis. She had undergone laparoscopic hematosalpinx drainage in an outside setting which provided her a temporary relief from symptoms. After an accurate pre-operative diagnosis of her condition, she underwent hysterectomy of both uterine horns as both the horns were grossly adenomyotic with hematometra. Discussion This case is unique as two different developmental anomalies agenesis and lateral fusion defect were found together leading to a triple Mullerian anomaly with co-existing adenomyosis and endometriosis. Conservative surgery in this particular case had high probability for developing obstruction, sepsis or pelvic abscess later or repeat procedures/surgeries leading to increased morbidity. She was given the option for oocyte freezing along with gestational surrogacy if she desired fertility in future. Conclusion Early diagnosis and tailored intervention of Mullerian anomalies is essential to improve patients' quality of life. Definitive surgery in the form of hysterectomy should be considered if there are associated pathologies such as adenomyosis and endometriosis and findings such as hematometra. Cervical agenesis, partial vaginal agenesis and complete bicorporeal uterus with functioning endometrium is a rare complex Mullerian anomaly. Significant complications occur following conservative procedures which may lead to repeat procedures/ surgeries increasing morbidity. Complex mullerian anomalies need individualised management based on the presence of other pathologies such as adenomyosis and endometriosis.
Collapse
Affiliation(s)
- Vimee Bindra
- Consultant Gynaecologist, Minimally Invasive Surgeon, Endometriosis Centre, Apollo Health City, Hyderabad 500033, India,Corresponding author at: Room No 31, Apollo Health City, Hyderabad 500033, India.
| | - Gayatri Satpathy
- Fellow Minimally Invasive Gynaecology, Apollo Health City, Hyderabad 500033, India
| | - C. Archana Reddy
- Consultant Gynaecologist, Minimally Invasive Surgeon, Endometriosis Centre, Apollo Health City, Hyderabad 500033, India
| | - P. Swetha
- Consultant Gynaecologist, Minimally Invasive Surgeon, Endometriosis Centre, Apollo Health City, Hyderabad 500033, India
| |
Collapse
|
7
|
Zainordin NA, Mohd Shah FZ, Eddy Warman NA, Wan Muhammad Hatta SF, Mohamad AF, Abdul Ghani R. A rare case of macroprolactinoma in a patient with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM210105. [PMID: 34889204 PMCID: PMC8686180 DOI: 10.1530/edm-21-0105] [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: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
SUMMARY A 17-year-old lady presented with primary amenorrhoea, headache, nausea and lethargy. She had delayed pubertal development that also includes under-developed breast (Tanner Stage 2). Hormonal investigations showed a high serum prolactin level of 1 680 000 mIU/L (normal value: 45-375 mIU/L), with low oestradiol, progesterone, follicular-stimulating hormone and luteinizing hormone. Early morning cortisol level was 206 nmol/L (normal value: >450 nmol/L), thyroxine was 7.5 pmol/L (normal value: 9.0-24.0 pmol/L) with TSH 5.091 mIU/L (normal value: 0.4-4.5 mlU/L). A pituitary MRI showed a 2.7 (AP) × 3.7 (W) × 4.6 cm (CC) macroadenoma, with invasion into the left cavernous sinus and encasement of cavernous portion of the left internal carotid artery. MRI pelvis showed absent uterus, cervix and 2/3 upper vagina confirming Mullerian hypoplasia. Cytogenetics showed 46XX. These findings were suggestive of Mayer-Rokitansky-Kauser-Hauser (MRKH) syndrome with the presence of a pituitary macroprolactinoma and panhypopituitarism. She was treated with hydrocortisone, levothyroxine and cabergoline. Repeated MRI showed a reduction in tumour size by approximately 50%. This case illustrated a rare coexistence of these two conditions, being only the third reported case in the world. In addition, this would be the first case of a functioning pituitary adenoma in a patient with MRKH syndrome. LEARNING POINTS Comprehensive hormonal and radiological investigations are important in the management of a young patient with primary amenorrhoea. Coexistence pathology of two separate pathologies should be considered in patient presenting with primary amenorrhoea. Early diagnosis of MRKH or any disorders of sex development should be treated early, providing pharmacological, surgical, psychological and emotional support to the patient and reducing risk of associated complications. Abnormal pituitary hormones, particularly panhypopituitarism, would impose greater impact not only psychologically but also metabolically leading to cardiovascular, morbidity and mortality risks in this patient if not treated early. A multidisciplinary approach is necessary for patients presenting with MRKH to ensure appropriate treatments and follow-up across the lifespan of the patient.
Collapse
Affiliation(s)
- Nur Aisyah Zainordin
- Internal Medicine Discipline, Faculty of Medicine, University Technology MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Fatimah Zaherah Mohd Shah
- Internal Medicine Discipline, Faculty of Medicine, University Technology MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Nur Aini Eddy Warman
- Internal Medicine Discipline, Faculty of Medicine, University Technology MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | | | - Aimi Fadilah Mohamad
- Internal Medicine Discipline, Faculty of Medicine, University Technology MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Rohana Abdul Ghani
- Internal Medicine Discipline, Faculty of Medicine, University Technology MARA, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| |
Collapse
|
8
|
Long Term Findings Concerning the Mental and Physical Condition, Quality of Life and Sexuality after Laparoscopically Assisted Creation of a Neovagina (Modified Vecchietti Technique) in Young MRKHS (Mayer-Rokitansky-Küster-Hauser-Syndrome) Patients. J Clin Med 2021; 10:jcm10061269. [PMID: 33803863 PMCID: PMC8003280 DOI: 10.3390/jcm10061269] [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: 02/04/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022] Open
Abstract
The Mayer-Rokitansky-Küster-Hauser-syndrome (MRKHS) is characterized by a congenital uterine and vaginal aplasia. A large body of literature reports that a diagnosis of MRKHS has a variety of psychological effects on patients and doubts about female identity. The aim of the underlying study was to detect the patient-reported physical and mental health and sexual function before and after laparoscopically assisted creation of a neovagina. 160 women with MRKHS who underwent this type of surgery between September 2009 and December 2015 were invited to complete the questionnaires. Packages consisting of six questionnaires were handed out before surgery, six and 12 months after surgery. Data from 82 patients could be included in the study. Patients had a mean age of 19.9 years at inclusion in the study. We detected an impairment of the health-related mental quality of life. There was no higher risk for psychological disorders. MRKHS patients show similar self-acceptance and normal body image compared to the general population. The sexual function is limited before surgery and normalizes after surgery. Useful factors for coping with the disease are an interdisciplinary approach in diagnostics and treatment, psychosocial adaptation as well as a supportive social environment.
Collapse
|
9
|
Passos IDMPE, Britto RL. Diagnosis and treatment of müllerian malformations. Taiwan J Obstet Gynecol 2020; 59:183-188. [PMID: 32127135 DOI: 10.1016/j.tjog.2020.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 11/27/2022] Open
Abstract
Anomalies in the müllerian ducts are congenital alterations with more prevalence than it is imagined, varying from 0.5 to 6.7% in the general population and up to 16.7% in women with recurrent miscarriage. The main findings are primary amenorrhea, dysmenorrhea, pelvic pain, endometriosis, sexual difficulties and low self-esteem. The major impact on the quality of life in women stricken by these problems justifies this study, whose objective is to analyze their most important aspects such as etiopathogeny, classification, diagnostic methods and proposed treatments. The research was performed on the Medline-PubMed database from 1904 to 2018. The American Fertility Society, European Society of Human Reproduction and Embryology, and the European Society of Gynaecological Endoscopy classify malformations as: Class 1/U5bC4V4: agenesis or hypoplasia of uterus and vagina; Class 1/U5aC4V4: cervical hypoplasia, associated with total or partial vaginal agenesis; Class 2/U4: unicornuate uterus; Class 3/U3bC2V1 or Class3/U3bC2V2: uterus didelphys; Class 4/U3C0: bicornuate uterus; Class 5/U2: septate uterus; Class 6: arcuate uterus; Class 7/U1: induced by diethylstilbestrol, represented by a T-shaped uterus; and V3: transverse vaginal septum. The diagnostic methods are the two-dimensional or three-dimensional ultrasound, MRI, hysterosalpingo-contrast-sonography, X-ray hysterosalpingography, hysteroscopy and laparoscopy. Some müllerian malformations are healed with surgery and/or self-dilatation. For vaginal agenesis, dilatation by Frank technique shows good results while malformations with obstruction of the menstrual flow need to be rapidly treated by surgery.
Collapse
Affiliation(s)
- Itana de Mattos Pinto E Passos
- Center for Women's Health, University Hospital Professor Edgard Santos, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.
| | - Renata Lopes Britto
- Center for Women's Health, University Hospital Professor Edgard Santos, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil; Department of Gynecology and Obstetrics, Faculty of Medicine, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| |
Collapse
|
10
|
Evaluation and Management of Unexpected Functional Rudimentary Uteri in Mayer-Rokitansky-Küster-Hauser Syndrome of Chinese Women. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6808409. [PMID: 33299874 PMCID: PMC7707935 DOI: 10.1155/2020/6808409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022]
Abstract
Objective To elucidate the characteristics of symptomatic attack of rudimentary uteri in MRKH syndrome and highlight the rare and unexpected possibilities. Methods A cohort of 202 Chinese MRKH syndrome patients admitted to the Peking Union Medical College Hospital from Jan 2009 to Dec 2016 was analyzed retrospectively. Based on the symptoms of abdominal pain before vaginoplasty, the patients were categorized into the asymptomatic and symptomatic groups. Results Totally, 21 patients had their uteri removed due to obstructive bleeding, 19 of them had symptoms of abdominal pain before vaginoplasty, the mean duration of abdominal pain before artificial vaginoplasty was 5.0 years (range, 0.5-10 years), and the mean age at first onset of recurrent abdominal pain was 14.3 years old (range 11-18). Two special cases showed unusual long incubation periods up to 23 years. Ultrasound detected endometrioid echo in four asymptomatic patients. Among the symptomatic group, 7 patients had no imaging evidence for endometrial cavities despite clinical pain. Two of them developed severe symptoms over the next two or four years and eventually had their uteri removed. Two patients reported persistent abdominal pain with a visual analog scale (VAS) score of 4-5, still under observation. Three patients were lost to follow-up. Conclusion More than 10% of the patients with MRKH syndrome had surgical indication to remove the rudimentary uteri. The discrepancy between clinical symptoms and imaging calls for the vigilance for prophylactic surgery or prolonged follow-up.
Collapse
|
11
|
Ogliari KCM, Rios SDS, Chen ACR, Chen JR, Resende CN, Araujo Júnior E. An alternative approach to vaginal dilation in patients with Meyer-Rokitanski-Küster-Hauser syndrome: two case reports. Gynecol Endocrinol 2020; 36:746-748. [PMID: 31994956 DOI: 10.1080/09513590.2020.1719061] [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] [Indexed: 10/25/2022] Open
Abstract
Vaginal dilation, currently considered as the first-line therapy for vaginal aplasia in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, is a safe and effective treatment that aims to create a functional neovagina. However, rigid vaginal dilators classically described in the literature usually cause physical discomfort and side effects that can lead to vaginal necrosis. Here, we present two cases of MRKH syndrome patients with vaginal agenesis whose main complaint was the inability to have sexual intercourse with their partners. Considering unavailability of acrylic dilators and previous studies reporting good responses with the use of silicone dilators in women with post-radiotherapy vaginal stenosis, the medical team and patients opted for creation of a neovagina through the daily use of silicone vaginal dilators. Patient 1 developed an 8-cm vagina after 6 months of treatment and had a satisfactory sex life with her partner. Patient 2 developed a 7-cm vagina and reported significant symptom improvement. None of the patients developed side effects after the treatment. The use of inexpensive and easily accessible silicone vaginal dilators may be an effective and noninvasive alternative with few side effects for women with vaginal agenesis, particularly in the developing countries.
Collapse
Affiliation(s)
| | - Salete da Silva Rios
- Department of Gynecology and Obstetrics, University of Brasília (UnB), Brasília-DF, Brazil
| | - Ana Carolina Rios Chen
- Department of Gynecology and Obstetrics, University of Brasília (UnB), Brasília-DF, Brazil
| | - Juliana Rios Chen
- Department of Gynecology and Obstetrics, University of Brasília (UnB), Brasília-DF, Brazil
| | - Ceres Nunes Resende
- Department of Gynecology and Obstetrics, University of Brasília (UnB), Brasília-DF, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
- Medical Course, Bela Vista Campus, Municipal University of São Caetano do Sul (USCS), São Paulo-SP, Brazil
| |
Collapse
|
12
|
Vaginal Reconstruction in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome-One Centre Experience. MEDICINA-LITHUANIA 2020; 56:medicina56070327. [PMID: 32630225 PMCID: PMC7404697 DOI: 10.3390/medicina56070327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The Mayer–Rokitansky–Küster–Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The aim of this study is to report our experience in the management of twelve patients with congenital absence of the vagina due to the MRKH syndrome. Materials and Methods: We performed a retrospective study on 12 patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania, for vaginal reconstruction within a period of eleven years (January 2009–December 2019). All patients were diagnosed by the gynaecologists with vaginal agenesis, as part of the Mayer–Rokitansky–Küster–Hauser syndrome. The Abbe‘–McIndoe technique with an autologous skin graft was performed in all cases. Results: The average age of our patients was 20.16 (16–28) years. All patients were 46 XX. The average surgical timing was 3.05 h (range 2.85–4h). Postoperative rectovaginal fistula was encountered in 1 patient. Postoperative average vaginal length was 10.4 cm (range 9.8–12.1 cm). Regular sexual life was achieved in 10 patients. Conclusion: Nowadays, there is no established standard method of vaginal reconstruction. In Romania, the McIndoe technique is the most applied. Unfortunately, even if the MRKH syndrome is not uncommon, less and less surgeons are willing to perform the procedure to create a neovagina.
Collapse
|
13
|
Baruch Y, Nale R, Parma M, Di Fatta S, Fedele L, Candiani M, Salvatore S. Lower urinary tract symptoms in patients with Mayer-Rokitansky-Kuster-Hauser syndrome after neo-vagina creation by Davydov's procedure. Int Urogynecol J 2020; 31:2529-2533. [PMID: 32377800 DOI: 10.1007/s00192-020-04311-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) in subjects with Mayer-Rokitansky-Küster-Hauser syndrome treated by Davydov's laparoscopic neo-vaginoplasty were measured. METHODS Davydov's laparoscopic neo-vaginoplasty was undertaken at the Department of Obstetrics/gynecology, San Raffaele Hospital, Milan, Italy, from November 2015 to July 2017, by two highly qualified surgeons. All women completed the ICIQ-UI Short Form questionnaire before and after treatment. LUTS were scored at recruitment, hospitalization, and 1, 3, 6 and 12 months after surgery. RESULTS Twenty-one women (mean age 21 years ± 5.9) were operated on with no major complications. Mean surgery duration was 79 min (± 55 min). Before the operation, one patient (1/21; 4.8%) reported occasional urinary loss that persisted after surgery and throughout 12 months of follow-up. After the operation, one patient (1/21; 4.8%) had urinary retention, requiring self-catheterization for 2 weeks. One month after surgery, stress incontinence was recorded in one case (1/19; 5.2%) and urge incontinence in two cases (2/19; 10.5%). At 3-month follow-up, these three patients were free of symptoms. CONCLUSION The rate of LUTS is lower than that reported by others using alternative surgical procedures. To the best of our knowledge, this is the first report validating LUTS after Davydov's neo-vaginoplasty.
Collapse
Affiliation(s)
- Yoav Baruch
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy.
| | - Roberta Nale
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Marta Parma
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Simona Di Fatta
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Olgettina, 60, 20132, Milan, MI, Italy
| |
Collapse
|
14
|
Typical and atypical pelvic MRI characteristics of Mayer-Rokitansky-Küster-Hauser syndrome: a comprehensive analysis of 201 patients. Eur Radiol 2020; 30:4014-4022. [PMID: 32140817 DOI: 10.1007/s00330-020-06681-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/29/2019] [Accepted: 01/28/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To comprehensively evaluate the pelvic magnetic resonance imaging (MRI) findings of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and summarize the typical and atypical characteristics. METHODS A retrospective analysis of 201 consecutive MRKH patients was carried out. Pelvic MRI was reviewed by two experienced gynecological radiologists in consensus. Characteristics including the morphology, signal pattern and volumes of the uterine rudiments, location and volume of the ovaries, and the degree of vaginal dysgenesis were evaluated. Other noted abnormalities were also recorded. RESULTS Morphologically, the majority (95%) of patients displayed bilateral uterine rudiments combined with a fibrous band. The minority of patients showed no (3.5%) or unilateral (1.5%) uterine rudiments. A total of 385 uterine rudiments were detected which showed four types of signal patterns: one-layer differentiation (325, 84.4%), two-layer differentiation (27, 7%), three-layer differentiation without subsequent alteration (23, 6.0%), and three-layer differentiation with hematometra and/or ipsilateral hematosalpinx (10, 2.6%). The median volumes of these four types of uterine rudiments were 2.6 ml (1.69-3.81 ml), 3.19 ml (2.67-4.51 ml), 6.05 ml (3.37-12.44 ml), and 31.97 ml (19.2-38.7 ml), respectively. The mean ovarian volume was 6.49 ± 3.91 ml. Abnormally located ovaries were detected in 63 (31.3%) patients. The distal vagina was discernable in 25.1% of patients. CONCLUSION MRKH patients typically display bilateral uterine rudiments combined with a fibrous band and normally located ovaries. The uterine rudiments are generally small with only one-layer differentiation, a subset of which might be large and exhibited other atypical presentations, including two- or three-layer differentiation or even hematometra. Abnormally located ovaries are not rare. KEY POINTS • Morphologically, MRKH patients typically displayed bilateral uterine rudiments combined with a fibrous band. • Typically, the uterine rudiments (84.4%) were small and displayed only one-layer differentiation. • About 15.6% of rudiments showed atypical characteristics including two- or three-layer differentiation, even complicated with hematometra or hematosalpinx.
Collapse
|
15
|
A rare form of Mayer-Rokitansky-Küster-Hauser syndrome: Case report and review of literature. Case Rep Womens Health 2019; 24:e00137. [PMID: 31453113 PMCID: PMC6700489 DOI: 10.1016/j.crwh.2019.e00137] [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: 07/15/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction Primary amenorrhea is failure to reach menarche. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the second most common cause of primary amenorrhea, after gonadal dysgenesis. Herein, we report a rare case of an unusual subtype of MRKH syndrome. Case Report This report describes the case of a 28-year-old woman with primary amenorrhea and coital difficulties. On examination, she had normal secondary sexual characteristics but a blind-ending vagina. Her hormonal profile was within normal limits; ultrasound examination was inconclusive due to technical difficulties. Subsequently, she underwent pelvic magnetic resonance imaging, which revealed bilateral rudimentary uterine horns in the presence of normal ovaries and normal length of a blind-ending narrow vagina. Conclusion MRKH syndrome with bilateral rudimentary uterine horns and normal-length vagina is an unusual form of Müllerian agenesis.
Collapse
|
16
|
Detection of de novo genetic variants in Mayer-Rokitansky-Küster-Hauser syndrome by whole genome sequencing. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100089. [PMID: 31517310 PMCID: PMC6728744 DOI: 10.1016/j.eurox.2019.100089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/09/2019] [Accepted: 07/28/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to use whole genome sequencing (WGS) help detect de novo mutations or pathogenic genes of Mayer-Rokitansky-Küster-Hauser syndrome type 1(MRKH syndrome type 1). Study design This was a case-parent trios study. Nine unrelated probands, with MRKH syndrome type 1 and their parents were enrolled. The enrollment, sequencing process, establishment of the de novo mutations detecting procedure and experiment part were performed over a 2-year period. Results we detected 632 de novo single nucleotide variants (SNVs), 267 de novo small insertions/deletions (indels), 39 de novo structural variations (SVs) and 28 de novo copy number alterations (CNAs). Three novel damaging coding de novo SNVs with three damaging coding de novo genes (PIK3CD, SLC4A10 and TNK2) were revealed. Two SNVs were annotated of the promoter region of gene NBPF10 and 3'UTR of NOTCH2NL, potentially contributing to the pathogenesis of MRKH. Conclusion We identified five de novo mutations in BAZ2B, KLHL18, PIK3CD, SLC4A10 and TNK2 by performing WGS, the functional involvement of all deleterious mutations in MRKH candidate genes of the trios warrant further study. WGS may complement conventional array to capture the complete landscape of the genome in MRKH.
Collapse
|
17
|
Schwaab T, Bryand A. [Place of ultrasound in the management of Mayer-Rokitansky-Kuster-Hauser syndrome. Observational study from 2000 to 2017 within university hospital of Strasbourg]. ACTA ACUST UNITED AC 2019; 47:783-789. [PMID: 31280033 DOI: 10.1016/j.gofs.2019.07.002] [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: 02/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is the most common cause of congenital absence or severe hypoplasia of structures derived from Muller's canals including the upper vagina, uterus and fallopian tubes. The definition of this syndrome is the presence of normal female secondary sexual development criteria relating to the presence of functional ovaries associated with vaginal agenesis and uterine anomalies ranging from a rudimentary uterus to the total absence of uterus. The main clinical sign of MRKH is primary amenorrhea. Confirmation of diagnosis and identification of associated abnormalities are based primarily on imaging and Magnetic Resonance Imaging (MRI) is currently the gold standard in the comprehensive evaluation of MRKH syndrome. Therefore, this study evaluated the place of ultrasound in the diagnostic and therapeutic management of patients treated for MRKH syndrome. METHODS This retrospective, single-center, observational study collected all patients in charge of diagnosis or treatment of MRKH Syndrome between January 2000 and June 2017 within the University Hospital Gynecology and Obstetrics Department of Strasbourg. The analysis of the medical files allowed the evaluation of ultrasound in the different stages of the patient's care. RESULTS Twenty-one patients were included and 81% get an ultrasound, 38% of them had a referred ultrasound performed by a certified radiologist. Forty-eight percent of the patients had an MRI and every ultrasound provided a correct diagnosis. Sixteen patients received therapeutic management and only 50% of patients had preoperative MRI. CONCLUSION The role of medical imaging is to define the extent of uterovaginal abnormalities for accurate diagnosis, describe any coexisting abnormalities, and provide a roadmap for surgical planning. The first-line examination is transabdominal ultrasound, a simple, non-invasive procedure. The use of MRI in our series did not bring any diagnostic surplus value. Despite the faster and easier access to MRI; ultrasound remains an indispensable tool in the diagnostic and therapeutic management of MRKH patients.
Collapse
Affiliation(s)
- T Schwaab
- Service de chirurgie gynécologique, pôle de gynécologie-obstétrique, centre médico-chirurgical obstétrique (CMCO), CHRU de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
| | - A Bryand
- Service de chirurgie gynécologique, pôle de gynécologie-obstétrique, centre médico-chirurgical obstétrique (CMCO), CHRU de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| |
Collapse
|
18
|
Dear J, Creighton SM, Conway GS, Williams L, Liao LM. Sexual Experience before Treatment for Vaginal Agenesis: A Retrospective Review of 137 Women. J Pediatr Adolesc Gynecol 2019; 32:300-304. [PMID: 30582973 DOI: 10.1016/j.jpag.2018.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To summarize the self-reported sexual experiences of women with vaginal agenesis before treatment and discuss the clinical implications. DESIGN A retrospective review of pretreatment baseline sexuality data and medical records of women with vaginal agenesis seeking vaginal construction. SETTING A specialist multidisciplinary center for women with genital differences associated with diverse sex development. PARTICIPANTS One hundred thirty-seven women with untreated vaginal agenesis associated with Mayer-Rokitansky-Küster-Hauser Syndrome and complete androgen insensitivity syndrome aged 15 to 41 years (mean age, 20 years). INTERVENTIONS Gynecological examination and completion of questionnaires. MAIN OUTCOME MEASURES (1) Sexual Experiences Questionnaire; (2) Multidimensional Sexuality Questionnaire; (3) Vaginal Self-Perceptions; and (4) vaginal length. RESULTS A sizable proportion of women reported having had sexually intimate experiences before any medical intervention on the vagina. Vaginal length, which ranged from dimple to 7 cm and averaged 2.7 cm for the cohort, was unrelated to the range of sexual experiences. Most women perceived their vagina as being too small, but less than half believed that a sexual partner would notice this. Two-thirds of the cohort subsequently completed the dilation program, which was not predicted by pretreatment vaginal length or sexual experience. CONCLUSION Contrary to the assumption that a vagina of certain dimensions is a prerequisite for women to "have sex," many women with Mayer-Rokitansky-Küster-Hauser syndrome and complete androgen insensitivity syndrome reported having experienced genital and nongenital sexual activities with no medical interventions. It is recommended that treatment providers affirm women's capacity for sexual intimacy, relationships, and enjoyment before they introduce the topic of vaginal construction as a non-urgent choice.
Collapse
Affiliation(s)
- Joanna Dear
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sarah M Creighton
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gerard S Conway
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louise Williams
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lih-Mei Liao
- Women's Health Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
| |
Collapse
|
19
|
Briosa F, Valsassina R, Mira C, Zagalo A. Zinner and Mayer-Rokitansky-Küster-Hauser syndromes: when unilateral renal agenesis meets genital anomalies. BMJ Case Rep 2019; 12:12/5/e229034. [PMID: 31061196 DOI: 10.1136/bcr-2018-229034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Congenital unilateral renal agenesis is a relatively frequent condition at birth diagnosed mostly incidentally. Despite the excellent prognosis, unilateral renal agenesis is associated with an increased risk of other structural abnormalities, including genital malformations. The authors present two cases of asymptomatic adolescents with known congenital unilateral renal agenesis and associated genital malformations solely diagnosed during puberty-a man with Zinner syndrome and a female with Mayer-Rokitansky-Küster-Hauser syndrome.
Collapse
Affiliation(s)
- Filipa Briosa
- Department of Paediatrics, Hospital Beatriz Angelo, Loures, Portugal
| | - Rita Valsassina
- Department of Paediatrics, Hospital Beatriz Angelo, Loures, Portugal
| | - Catarina Mira
- Department of Radiology, Hospital Beatriz Angelo, Loures, Portugal
| | - Ana Zagalo
- Department of Paediatrics, Hospital Beatriz Angelo, Loures, Portugal
| |
Collapse
|
20
|
Gentileschi S, Pino V, Albanese R, Salgarello M, Scambia G, Ercoli A. Simultaneous correction of breast hypertrophy and vaginal agenesis: Aesthetic surgery to the aid of reconstructive surgery. J Obstet Gynaecol Res 2019; 45:1398-1403. [PMID: 30916459 DOI: 10.1111/jog.13967] [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: 11/05/2018] [Revised: 01/31/2019] [Accepted: 03/10/2019] [Indexed: 11/29/2022]
Abstract
Mayer-Rokitansky-Küster-Hauser syndrome is characterized by aplasia of the uterus and the upper ⅔ of the vagina, with normal female genotype (46,XX) and the development of secondary sexual characters. One of the most popular surgical treatment is the McIndoe procedure, which major drawbacks are the scar of split thickness skin graft (STSG)harvesting, and risk of vaginal stenosis for graft retraction. We report the case of a patient, operated modifying the McIndoe technique, by harvesting a full thickness skin grafts (FTSG) from patient's breasts, undergone simultaneous reduction mammoplasty. The FTSG provided a complete lining of the reconstructed neovagina. At 6 months, we observed complete mucinous metaplasia of the vaginal walls and 1 year after surgery no sign of stenosis, without the use of the mold. The advantages of this technique are reduced donor site morbidity, when compared with traditional McIndoe technique, and reduced risk of neovagina retraction ensured by FTSG, compared with STSG. If future patients' series confirm the good results achieved, we could consider it as a first-line option in patients undergoing neovagina reconstruction, seeking breasts or body contouring surgery.
Collapse
Affiliation(s)
- Stefano Gentileschi
- Plastic Surgery Unit, Department of Woman and ChildHealth and Public Health, Fondazione Policlinico Universitario A. GemelliIRCCS - Largo Agostino Gemelli 1, Rome, Italy.,Istituto di ClinicaChirurgica, Università Cattolica del Sacro Cuore Largo Francesco Vito 8, Rome, Italy
| | - Valentina Pino
- Istituto di ClinicaChirurgica, Università Cattolica del Sacro Cuore Largo Francesco Vito 8, Rome, Italy
| | - Roberta Albanese
- Istituto di ClinicaChirurgica, Università Cattolica del Sacro Cuore Largo Francesco Vito 8, Rome, Italy
| | - Marzia Salgarello
- Plastic Surgery Unit, Department of Woman and ChildHealth and Public Health, Fondazione Policlinico Universitario A. GemelliIRCCS - Largo Agostino Gemelli 1, Rome, Italy.,Istituto di ClinicaChirurgica, Università Cattolica del Sacro Cuore Largo Francesco Vito 8, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS - LargoAgostino Gemelli 1, Rome, Italy.,Istituto diClinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore - Largo Francesco Vito 8, Rome, Italy
| | - Alfredo Ercoli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS - LargoAgostino Gemelli 1, Rome, Italy.,Università degli Studi delPiemonte Orientale "Amedeo Avogadro" - Via Solaroli, 17, Novara, Italy
| |
Collapse
|
21
|
Wang Y, Lu J, Zhu L, Sun Z, Jiang B, Feng F, Jin Z. Evaluation of Mayer-Rokitansky-Küster-Hauser syndrome with magnetic resonance imaging: Three patterns of uterine remnants and related anatomical features and clinical settings. Eur Radiol 2017; 27:5215-5224. [PMID: 28674963 DOI: 10.1007/s00330-017-4919-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/17/2017] [Accepted: 05/31/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To characterize the anatomical features and clinical settings of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and correlate them with patterns of uterine involvement. METHODS Pelvic magnetic resonance images and medical records of 92 MRKH patients were retrospectively reviewed. Patients were subgrouped by uterine morphology: uterine agenesis, unilateral rudimentary uterus and bilateral rudimentary uteri. Uterine volume, presence of endometrium, location of ovary, endometriosis and pelvic pain were compared among groups. RESULTS The mean uterine volume was 33.5 ml (17.5-90.0 ml) for unilateral uterine remnants, and 16.1 ml (3.5-21.5 ml) for bilateral uterine rudiments (p<0.01). The incidence of presence of endometrium (100% vs. 22%, p<0.001), haematometra (56% vs. 3%, p<0.001) and ovarian endometriosis (22% vs. 3%, p<0.01) was significantly increased in the group of unilateral rudimentary uteri as compared with the group of bilateral uterine remnants. Thirty-one patients (38%) showed ectopic ovaries. Pelvic pain was more common in individuals with unilateral rudimentary uterus than those who had no (56% vs. 5%, p<0.01) or bilateral uterine remnants (56% vs. 14%, p<0.05). CONCLUSION MRKH patients with different patterns of uterine involvement may have differentiated anatomical features and clinical settings. KEY POINTS • Rudimentary uteri, especially bilateral rudimentary uteri, were quite common in MRKH syndrome. • Uterine remnants can be relatively large, especially the unilateral rudimentary uterus. • Presence of endometrium and related complications are not rare in MRKH syndrome. • Existence of endometrium and complications are more frequent in unilateral rudimentary uterus.
Collapse
Affiliation(s)
- Yue Wang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jingjing Lu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Lan Zhu
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China.
| | - Zhijing Sun
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China
| | - Bo Jiang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China
| |
Collapse
|
22
|
Laganà AS, Vitale SG, Salmeri FM, Triolo O, Ban Frangež H, Vrtačnik-Bokal E, Stojanovska L, Apostolopoulos V, Granese R, Sofo V. Unus pro omnibus, omnes pro uno: A novel, evidence-based, unifying theory for the pathogenesis of endometriosis. Med Hypotheses 2017; 103:10-20. [DOI: 10.1016/j.mehy.2017.03.032] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/21/2017] [Indexed: 01/17/2023]
|
23
|
Zaidi MS, Hassan A, Almogbel E. Mayer-Rokitansky-Küster-Hauser Syndrome In A Young Woman. AACE Clin Case Rep 2017. [DOI: 10.4158/ep151105.cr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
24
|
Diagnostic imaging and cataloguing of female genital malformations. Insights Imaging 2016; 7:713-26. [PMID: 27507534 PMCID: PMC5028344 DOI: 10.1007/s13244-016-0515-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/13/2016] [Accepted: 07/20/2016] [Indexed: 11/27/2022] Open
Abstract
Abstract To help physicians and radiologists in the diagnosis of female genito-urinary malformations, especially of complex cases, the embryology of the female genital tract, the basis for Müllerian development anomalies, the current classifications for such anomalies and the comparison for inclusion and cataloguing of female genital malformations are briefly reviewed. The use of the embryological system to catalogue female genito-urinary malformations may ultimately be more useful in correlations with clinical presentations and in helping with the appropriate diagnosis and treatment. Diagnostic imaging of the different genito-urinary anomalies are exposed, placing particular emphasis on the anomalies within group II of the embryological and clinical classification (distal mesonephric anomalies), all of them associated with unilateral renal agenesis or dysplasia. Similarly, emphasis is placed on cases of cervico-vaginal agenesis, cavitated noncommunicated uterine horns, and cloacal and urogenital sinus anomalies and malformative combinations, all of them complex malformations. Diagnostic imaging for all these anomalies is essential. The best imaging tools and when to evaluate for other anomalies are also analysed in this review. Teaching points • The appropriate cataloguing of female genital malformations is controversial. • An embryological classification system suggests the best diagnosis and appropriate management. • The anomalies most frequently diagnosed incorrectly are the distal mesonephric anomalies (DMAs). • DMAs are associated with unilateral renal agenesis or renal dysplasia with ectopic ureter. • We analyse other complex malformations. Diagnostic imaging for these anomalies is essential.
Collapse
|
25
|
Maniglio P, Ricciardi E, Laganà AS, Triolo O, Caserta D. Epigenetic modifications of primordial reproductive tract: A common etiologic pathway for Mayer-Rokitansky-Kuster-Hauser Syndrome and endometriosis? Med Hypotheses 2016; 90:4-5. [DOI: 10.1016/j.mehy.2016.02.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/12/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
|
26
|
Białka A, Gawlik A, Drosdzol-Cop A, Wilk K, Małecka-Tendera E, Skrzypulec-Plinta V. Coexistence of Mayer-Rokitansky-Küster-Hauser Syndrome and Turner Syndrome: A Case Report. J Pediatr Adolesc Gynecol 2016; 29:e35-8. [PMID: 26524664 DOI: 10.1016/j.jpag.2015.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Turner syndrome is a common chromosomal disorder, with an incidence of 1 in 2000 live-born female infants. Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) affects 1 in 4500 female births and, rarely, it might be associated with gonadal dysgenesis. CASE A 17-year-old girl was referred to our clinic with short stature and primary amenorrhea. The patient was diagnosed with Turner syndrome and underwent estrogen therapy. At the age of 24 years, just after the patient's sexual initiation, the first complete gynecological examination was performed. A blind-ending vagina was revealed and the patient was diagnosed with MRKH. SUMMARY AND CONCLUSION Early diagnosis of coexistence of MRKH and Turner syndrome, although very difficult, might prevent patients from developing serious complications.
Collapse
Affiliation(s)
- Agnieszka Białka
- School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aneta Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | | | - Krzysztof Wilk
- School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ewa Małecka-Tendera
- Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | | |
Collapse
|
27
|
Comparison of Two Techniques of Laparoscopy-Assisted Peritoneal Vaginoplasty. J Minim Invasive Gynecol 2016; 23:346-51. [DOI: 10.1016/j.jmig.2015.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 11/20/2022]
|
28
|
Acién P, Acién M. The presentation and management of complex female genital malformations. Hum Reprod Update 2015; 22:48-69. [DOI: 10.1093/humupd/dmv048] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/14/2015] [Indexed: 11/13/2022] Open
|
29
|
Ma W, Li Y, Wang M, Li H, Su T, Li Y, Wang S. Associations of Polymorphisms in WNT9B and PBX1 with Mayer-Rokitansky-Küster-Hauser Syndrome in Chinese Han. PLoS One 2015; 10:e0130202. [PMID: 26075712 PMCID: PMC4468103 DOI: 10.1371/journal.pone.0130202] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/16/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare syndrome that is characterized by congenital aplasia of the uterus and the upper portion (2/3) of the vagina. Previous attempts to identify causal mutations of MRKH syndrome have primarily resulted in negative outcomes. We investigated whether these reported variants are associated with MRKH syndrome (types I and II) in a relatively large sample size of Chinese Han patients, and whether any gene-gene epistatic interactions exist among these variants. METHODS This study included 182 unrelated Chinese women with MRKH syndrome (155 with type I and 27 with type II) and 228 randomized female controls. Seventeen candidate loci in the AMH, PBX1, WNT4, WNT7A, WNT9B, HOXA10, HOXA11, LHXA1 and GALT genes were genotyped using the Sequenom MassARRAY iPLEX platform. Single-marker association, additive effects and multifactor interactions were investigated. RESULTS The gene frequency distributions of MRKH type 1 and type 2 were similar. Rs34072914 in WNT9B was found to be associated with MRKH syndrome (P = 0.024, OR = 2.65, 95%CI = 1.14-6.17). The dominant models of rs34072914 and rs2275558 in WNT9B and PBX1, respectively, were significantly associated with MRKH syndrome risk in the Chinese Han patients. Additive gene-gene interaction analyses indicated a significant synergetic interaction between WNT9B and PBX1 (RERI = 1.397, AP = 0.493, SI = 4.204). Multifactor dimensionality reduction (MDR) analysis revealed novel dimensional epistatic four-gene effects (AMH, PBX1, WNT7A and WNT9B) in MRKH syndrome. CONCLUSIONS This association study successfully identified two susceptibility SNPs (WNT9B and PBX1) associated with MRKH syndrome risk, both separately and interactively. The discovery of a four-gene epistatic effect (AMH, PBX1, WNT7A and WNT9B) in MRKH syndrome provides novel information for the elucidation of the genetic mechanism underlying the etiology of MRKH syndrome.
Collapse
Affiliation(s)
- Wenqing Ma
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Ya Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Man Wang
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Haixia Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Tiefen Su
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Yan Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Shixuan Wang
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| |
Collapse
|
30
|
Importance of Laparoscopic Assessment of the Uterine Adnexa in a Mayer-Rokitansky-Kuster-Hauser Syndrome Type II Case. CURRENT HEALTH SCIENCES JOURNAL 2015; 40:144-7. [PMID: 25729598 PMCID: PMC4340458 DOI: 10.12865/chsj.40.02.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/15/2014] [Indexed: 11/23/2022]
Abstract
In the case reported, diagnosed with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, the presence of normal ovaries proved to be challenging to confirm due to unusual high positioned (ectopic) ovaries. MRKH syndrome is a rare pathological condition characterized by a spectrum of the Mullerian duct abnormalities resulting in congenital aplasia of the uterus and of the upper part (2/3) of the vagina, developed during embryogenesis. At the same time, the mullerian development is interdependent with the Wolffian (mesonephric) duct and this explains the associated renal abnormalities (MRKH type II). Laparoscopic assessment was of great importance in defining the exact anatomic characteristics of MRKH syndrome.
Collapse
|
31
|
Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome: A historical perspective. Gene 2015; 555:33-40. [DOI: 10.1016/j.gene.2014.09.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/19/2014] [Accepted: 09/21/2014] [Indexed: 12/15/2022]
|
32
|
Sladakovic I, Guzman DSM, Petritz OA, Mohr FC, McGraw SN. Unilateral Cervical and Segmental Uterine Horn Aplasia With Endometrial Hyperplasia, Mucometra, and Endometritis in a Domestic Rabbit (Oryctolagus cuniculus). J Exot Pet Med 2015. [DOI: 10.1053/j.jepm.2014.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
33
|
Bombard DS, Mousa SA. Mayer-Rokitansky-Kuster-Hauser syndrome: complications, diagnosis and possible treatment options: a review. Gynecol Endocrinol 2014; 30:618-23. [PMID: 24948340 DOI: 10.3109/09513590.2014.927855] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a disorder in women that presents as Mullerian agenesis. These patients present internal genitalia abnormalities that include the absence of a uterus and the upper two-thirds of the vagina. In this review, current diagnostic methods, accompanying complications (congenital and psychological) and non-surgical and surgical treatments are summarized. Ultrasound and MRI have been the most documented options in MRKH syndrome diagnosis. Many women with MRKH syndrome have renal, skeletal, hearing or cardiac congenital anomalies and increased levels of psychological distress. Non-surgical interventions can be used to create a sexually functional neovagina through vaginal dilation, and surgical interventions provide alternate methods of creating a neovagina. Additionally, vaginal tissue engineering and gene therapy might provide more effective approaches in solving MRKH syndrome.
Collapse
Affiliation(s)
- David S Bombard
- Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences , Rensselaer, NY , USA
| | | |
Collapse
|
34
|
Abstract
Congenital anomalies of the upper urinary tract are common and frequently diagnosed on prenatal ultrasound. In the absence of infection, these anomalies are often asymptomatic. This article reviews key features and long-term implications to assist in discussions with families. In contrast, a perinatal renal tumor is rare but extremely alarming. This update on the most common tumors and their treatment is useful in reassuring parents that most infants, after primary surgical resection, are cured without adjuvant therapies. To understand renal agenesis and other congenital renal malformations and their associated anomalies, a brief review of normal renal development is presented.
Collapse
Affiliation(s)
- Ellen Shapiro
- Department of Urology, New York University School of Medicine, 150 32nd Street, 2nd Floor, New York, NY 10017, USA.
| |
Collapse
|
35
|
Hutson JM, Grover SR, O'Connell M, Pennell SD. Malformation syndromes associated with disorders of sex development. Nat Rev Endocrinol 2014; 10:476-87. [PMID: 24913517 DOI: 10.1038/nrendo.2014.83] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
When embryological development of the internal and/or external genitalia is disrupted, the patient presents with a disorder of sex development (DSD) in the neonatal period or sometime later in life. Some of these patients have other, nongenital malformations, which makes their overall management more complex than if they just had a DSD. This Review summarises these malformation syndromes and discusses the recent research into their aetiology. The genetic causes of these malformation syndromes, when they are known, will also be described. Many specific genetic mutations are now known in malformation syndromes with a defect in hormonal function. By contrast, the genetic causes remain unknown in many nonhormonal morphological anomalies that affect the genitalia.
Collapse
Affiliation(s)
- John M Hutson
- Department of Urology, The Royal Children's Hospital, Flemington Road, Melbourne, VIC 3051, Australia
| | - Sonia R Grover
- Department of Gynaecology, The Royal Children's Hospital, Flemington Road, Melbourne, VIC 3051, Australia
| | - Michele O'Connell
- Department of Endocrinology, The Royal Children's Hospital, Flemington Road, Melbourne, VIC 3051, Australia
| | - Samuel D Pennell
- Department of Surgery, Austin Hospital, Studley Park Road, Heidelberg, Melbourne, VIC 3058, Australia
| |
Collapse
|
36
|
Abstract
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome consists of Mullerian aplasia with or without other anomalies, most commonly renal and skeletal. The genetic etiology of MRKH syndrome is unknown for most patients, but supportive evidence exists for heterozygous mutations in WNT4, LHX1, and HNF1B. Chromosomal microarray analyses have demonstrated chromosomal regions with copy number variants in multiple patients - deletions in17q12 and 16p11.2, and either deletions or duplications in 22q11.2. Genomic analyses of expression and methylation have also suggested potential molecular pathways. Positional cloning in MRKH patients with chromosomal rearrangements and exome sequencing are likely to result in new genes. Although some single gene defects and copy number variant regions have been identified, the molecular basis for the vast majority of MRKH remains unknown.
Collapse
Affiliation(s)
- Lawrence C Layman
- a Section of Reproductive Endocrinology, Infertility and Genetics, Department of Obstetrics and Gynecology, Institute of Molecular Medicine and Genetics, Neuroscience Program, Medical College of Georgia, Georgia Regents University, 1120 15th Street, Augusta, GA 30912, USA
| |
Collapse
|
37
|
Kisku S, Barla RK, Sen S, Karl S, Mathai J, Varghese L. Rectovestibular fistula with vaginal atresia: our experience and a proposed course of management. Pediatr Surg Int 2014; 30:633-9. [PMID: 24793106 DOI: 10.1007/s00383-014-3517-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Rectovestibular fistula with coexisting vaginal atresia poses a surgical dilemma with regard to the timing and type of reconstruction. We present our experience and suggest an appropriate course of management. METHODS Seven patients with rectovestibular fistula and coexisting vestibular atresia were operated in our hospital during January 2004 through December 2013. The details of their bowel, menstrual and sexual functions were recorded. RESULTS Five of the seven patients who underwent anoplasty in childhood presented to us in their teens with primary amenorrhea and cyclical abdominal pain. All five had sigmoid colon neovaginoplasty. Four of these had the uterus or its remnants anastomosed to the neovagina. All four have regular menstrual cycles. One patient is sexually active and has satisfactory sexual function. The bowel function in all the five patients is good. The remaining two patients presented in their infancy and had the anorectovestibular fistula left as the neovagina. The recto-sigmoid was pulled down to form the neoanus. Both these patients have bowel incontinence. CONCLUSION We recommend the rectovestibular fistula be used as the neoanus and not as the neovagina. Delayed bowel vaginal replacement has excellent results and allows for optimal assessment of functioning uterine body or remnants.
Collapse
Affiliation(s)
- Sundeep Kisku
- Department of Pediatric Surgery, Christian Medical College, Vellore, 632004, India,
| | | | | | | | | | | |
Collapse
|