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Lamichhane D, Sutihar A, Janakyraman G, Shrestha RJ, Razeeb MR. Herlyn-Werner-Wunderlich Syndrome: A Case Report. JNMA J Nepal Med Assoc 2023; 61:949-952. [PMID: 38289750 PMCID: PMC10792714 DOI: 10.31729/jnma.8376] [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: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
Herlyn-Werner-Wunderlich syndrome is a rare congenital malformation of the Mullerian ducts characterized by uterine didelphys with obstructed hemivagina and ipsilateral renal agenesis. Commonly, such patients present with pelvic pain, dysmenorrhea following menarche, and an abdominal mass secondary to hematometrocolpos. In this report, a case of a 14-year-old female presented with abdominal pain, back pain and acute urinary retention. She attained menarche at the age of 10 years; however, symptoms of dysmenorrhea only appeared 4 years later. She was eventually diagnosed with the help of ultrasound and computed tomography urogram. She was managed conservatively with an incision and drainage procedure and was also advised for resection of vaginal septum. The nonspecific nature of symptoms such as regular menstruation with cyclical abdominal pain impedes the diagnosis which can lead to an array of complications. Awareness of this syndrome can help avoid misdiagnosis and allow for early surgical intervention. Keywords case reports; dysmenorrhea; uterine didelphys.
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Affiliation(s)
| | - Anshu Sutihar
- Dhaka Medical College, Bakshi Bazar, Dhaka, Bangladesh
| | | | | | - Mahbubur Rahman Razeeb
- Department of Obstetrics and Gynaecology, Dhaka Medical College, Bakshi Bazar, Dhaka, Bangladesh
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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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Roziana R, Nora H, Maharani CR, Yeni CM, Dewi TP, Rusnaidi R, Indirayani I, Aditya R, Al-shather Z, Haryani SD. Herlyn-Werner-Wunderlich syndrome: Challenges in diagnosis and management. NARRA J 2023; 3:e223. [PMID: 38450268 PMCID: PMC10914055 DOI: 10.52225/narra.v3i2.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/23/2023] [Indexed: 03/08/2024]
Abstract
Herlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) is a complex congenital malformation characterized by a triad including uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis. In this case report, we present a case of HWWS along with the challenges in diagnosis and multi-step treatment processes. A 25-year-old woman presented to Dr. Zainoel Abidin Hospital in Banda Aceh, Indonesia with a chief complaint of lower back pain for the past six months (two months after the marriage). The patient also complained of late menstruation, followed by thick yellow vaginal discharge resembling malodorous pus occurring after menstruation. Additionally, a history of fever and pain during intercourse was reported. Vaginal examination revealed purulent fluid emerging from a pinpoint hole on the right vaginal wall. Vaginal palpation revealed a two-branched uterus, along with a palpable cystic mass on the right vaginal wall. Ultrasound examination indicated the presence of the right and left hemi-uteri, measuring 4.7x1.35 cm and 5.7x1.26 cm in size, respectively with both ovaries appearing normal. Fluid accumulation was observed in the right hemivagina, while the left kidney exhibited normal features, and the right kidney showed signs of hypoplasia. The patient was diagnosed with uterus didelphys, fluid accumulation in the hemivagina, and right kidney hypoplasia. Magnetic resonance imaging (MRI) confirmed uterus didelphys and revealed narrowing of the right hemivagina, suggestive of HWWS. Hysteroscopy was performed to resect the vaginal septum with laparoscopic guidance, along with drainage of hematocolpos, pyocolpos and placement of an intracervical mold. Despite HWWs having conservative gradual management, it was opted to perform vaginal septum resection, hematocolpos and pyocolpos drainage and placement of an intracervical mould in this case, in order to relieve symptoms and restore the reproductive and sexual functions.
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Affiliation(s)
- Roziana Roziana
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Hilwah Nora
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Cut R. Maharani
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Cut M. Yeni
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Tengku P. Dewi
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Rusnaidi Rusnaidi
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Ima Indirayani
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Rizka Aditya
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | | | - Siti D. Haryani
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Departement of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
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Moufawad G, Giannini A, D’Oria O, Laganà AS, Chiantera V, Khazzaka A, Maziad G, Nasr E, Geagea V, Jardali MA, Sleiman Z. Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome: A Systematic Review about Diagnosis and Surgical Management. Gynecol Minim Invasive Ther 2023; 12:123-129. [PMID: 37807996 PMCID: PMC10553600 DOI: 10.4103/gmit.gmit_103_22] [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: 09/12/2022] [Revised: 10/03/2022] [Accepted: 11/15/2022] [Indexed: 10/10/2023] Open
Abstract
Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare congenital defect of the Müllerian ducts characterized by uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. The aim of this systematic review is to summarize the main symptoms and presentation of the OHVIRA syndrome, as well as the different types of management, fertility, and obstetrical outcomes. A comprehensive search was performed in PubMed, EMBASE, SCOPUS, and Web of Science databases since inception to May 1, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. After duplicate records removed, the search strategy retrieved 103 articles. The full texts of 73 articles further were assessed for eligibility, and 44 studies were finally included in the systematic review. The mainstay surgical treatment of OHVIRA syndrome is usually a minimally invasive vaginal approach to remove the septum. Ultrasound-guided hysteroscopic resection and laparoscopic resection of the septum have been described as alternatives. Considering the feasibility of minimally invasive approach for the management of the syndrome, laparotomy should be avoided as much as possible and considered only in selected cases.
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Affiliation(s)
- Graziella Moufawad
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Ottavia D’Oria
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Aline Khazzaka
- Department of Obstetrics and Gynaecology, Laboratory of Science and Research, Saint Joseph University, Beirut, Lebanon
| | - Ghida Maziad
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Elena Nasr
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Vanessa Geagea
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Marwa Al Jardali
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Zaki Sleiman
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
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Niu G, Zhai Y, Meng L, Zhao L, Liu N, Xing X, Wen X, Chen J. Laparoscopy combined with transvaginal surgery for Herlyn-Werner-Wunderlich syndrome: A case report. Medicine (Baltimore) 2022; 101:e32264. [PMID: 36626531 PMCID: PMC9750648 DOI: 10.1097/md.0000000000032264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital Mullerian duct anomaly disease that is characterized by a triad of symptoms, didelphys uterus, blind hemivagina, and ipsilateral renal agenesis. Herein, we reported a case from China. CASE PRESENTATION An 11-year-old patient presented to our hospital with lower abdominal pain and frequent urination. Computed tomography and magnetic resonance imaging revealed hematocolpos, uterine hemorrhage, didelphys uterus, and renal agenesis on the right side. Thus, the patient was diagnosed with HWW syndrome. Laparoscopic combined with transvaginal surgery to remove the vaginal septum, the symptoms of the lesion disappeared after the blood was discharged. CONCLUSION Abnormal urination and other symptoms should be carefully examined in adolescent girls with abdominal pain not menarche, since they may be related to reproductive organ development disorders and other diseases. We recommend laparoscopy combined with transvaginal surgery to remove the oblique septum in HWW syndrome, which is rarely reported.
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Affiliation(s)
- Gaoli Niu
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People’s Hospital of Jiaozuo), Jiaozuo, China
| | - Yanhong Zhai
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People’s Hospital of Jiaozuo), Jiaozuo, China
- *Correspondence: Yanhong Zhai, Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People’s Hospital of Jiaozuo), Jiaozuo, 454000, China (e-mail: )
| | - Luhong Meng
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People’s Hospital of Jiaozuo), Jiaozuo, China
| | - Lingli Zhao
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People’s Hospital of Jiaozuo), Jiaozuo, China
| | - Nannan Liu
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People’s Hospital of Jiaozuo), Jiaozuo, China
| | - Xuejiao Xing
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People’s Hospital of Jiaozuo), Jiaozuo, China
| | - Xin Wen
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People’s Hospital of Jiaozuo), Jiaozuo, China
| | - Jingjing Chen
- Department of Gynecologic Oncology, The First Affiliated Hospital of Henan Polytechnic University (The Second People’s Hospital of Jiaozuo), Jiaozuo, China
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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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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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