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Schall K, Parks M, Nemivant S, Hernandez J, Weidler EM. Pelvic pain in patients with complex mullerian anomalies including Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH), obstructed hemi-vagina ipsilateral renal anomaly (OHVIRA), and complex cloaca. Semin Pediatr Surg 2019; 28:150842. [PMID: 31668297 PMCID: PMC6936264 DOI: 10.1016/j.sempedsurg.2019.150842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Caring for patients with congenital pelvic anomalies can be challenging in many ways but one crucial aspect is providing longitudinal into adulthood. Newborns with urinary, intestinal or vaginal obstruction require urgent operations to relieve obstruction followed by multiple reconstructive procedures involving the perineum. Openings are created in the pelvic floor musculature that did not exist in development. Adolescence presents further challenges for these postoperative patients while other diagnoses present for the first time in the peri-pubertal teenage years. Young adults can have new symptoms when they become sexually active and are faced with reproductive decisions. During all of these time periods, optimization of function is of paramount importance and patients who are suffering are not able to participate in school, sports or work. This study evaluates the prevalence of pelvic pain in newborns and adolescents with complex congenital pelvic anomalies, associated factors and possible treatment options.
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Affiliation(s)
- Kathy Schall
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, United States
| | - Melissa Parks
- Division of Pediatric and Adolescent Gynecology, Phoenix Children's Hospital, Phoenix, AZ, United States
| | | | - Janett Hernandez
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, United States
| | - Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ 85016, United States.
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Williams LS, Demir Eksi D, Shen Y, Lossie AC, Chorich LP, Sullivan ME, Phillips JA, Erman M, Kim HG, Alper OM, Layman LC. Genetic analysis of Mayer-Rokitansky-Kuster-Hauser syndrome in a large cohort of families. Fertil Steril 2017; 108:145-151.e2. [PMID: 28600106 PMCID: PMC5770980 DOI: 10.1016/j.fertnstert.2017.05.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To study the genetic cause of Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH). Although a few candidate genes and genomic domains for have been reported for MRKH, the genetic underpinnings remain largely unknown. Some of the top candidate genes are WNT4, HNF1B, and LHX1. The goals of this study were to: 1) determine the prevalence of WNT4, HNF1B, and LHX1 point mutations, as well as new copy number variants (CNVs) in people with MRKH; and 2) identify and characterize MRKH cohorts. DESIGN Laboratory- and community-based study. SETTING Academic medical centers. PATIENT(S) A total of 147 MRKH probands and available family members. INTERVENTIONS(S) DNA sequencing of WNT4, HNF1B, and LHX1 in 100 MRKH patients, chromosomal microarray analysis in 31 North American MRKH patients, and characterization and sample collection of 147 North American and Turkish MRKH probands and their families. MAIN OUTCOME MEASURE(S) DNA sequence variants and CNVs; pedigree structural analysis. RESULT(S) We report finding CNVs in 6/31 people (∼19%) with MRKH, but no point mutations or small indels in WNT4, HNF1B, or LHX1 in 100 MRKH patients. Our MRKH families included 43 quads, 26 trios, and 30 duos. Of our MRKH probands, 87/147 (59%) had MRKH type 1 and 60/147 (41%) had type 2 with additional anomalies. CONCLUSION(S) Although the prevalence of WNT4, HNF1B, and LHX1 point mutations is low in people with MRKH, the prevalence of CNVs was ∼19%. Further analysis of our large familial cohort of patients will facilitate gene discovery to better understand the complex etiology of MRKH.
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Affiliation(s)
- Lacey S Williams
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Durkadin Demir Eksi
- Department of Medical Biology and Genetics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Yiping Shen
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts; Guangxi Maternal and Child Health Hospital, Nanning, People's Republic of China; Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Amy C Lossie
- Beautiful You MRKH Foundation, Silver Spring, Maryland
| | - Lynn P Chorich
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Megan E Sullivan
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - John A Phillips
- Division of Medical Genetics and Genomic Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Munire Erman
- Department of Obstetrics and Gynecology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Hyung-Goo Kim
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Ozgul M Alper
- Department of Medical Biology and Genetics, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Lawrence C Layman
- Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia; Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia; Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia.
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Sirakov M, Tomova E. [CONSERVATIVE TREATMENT OF MAYER-ROKITANSKY-KÜSTER-HAUSER SYNDROME. REVIEW OF LITERATURE AND OUR EXPERIENCE]. Akush Ginekol (Sofiia) 2016; 55:51-58. [PMID: 27514132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Mayer-Rokitansky-Küster-Hauser syndrome is a part of the group of abnormalities known as "Anomalies of the fusion of the Müllerian ducts". It is characterized by normal development of breasts and hairs, normal appearance of external genitalia, normal feminine genotype (46XX), normal FSH, LH, E₂ and Test. levels, normal ovaries and congenital absence of uterus and the whole or the upper two thirds of the vagina. It is observed in about 15% of the cases with primary amenorrhea and the incidence is about 1:4500-6000. Etiologycal factors such as lack of estrogen/gestagen receptors, deletions or mutations of genes that stop the fusion, as well as the activation of anti-Müllerian hormone (AMH), are considered. The etiology is being explored but there is no consensus yet. The diagnosis is confirmed during a clinical examination, which takes place because of a primary amenorrhea (often happening at the age of 16), and the absence of a uterus and vagina is proved. The therapy should be handled by a multidisciplinary team including obstetrician, trained midwife, psychologist, specialist in imaging and psycho-sexual counseling. The idea for surgical creation of vagina (neovagina) dates many years ago. The first known documents date back to 1817 and over the years a variety of methods are offered usage of amnion, dura mater, peritoneum, skin grafts, different parts of the intestine, cellulose, etc. The first method of non-surgical treatment is offered by the Czech gynecologist Frank. His ambition was to build a vagina by gradual dilatation of the tissue while applying dilatators with successively increasing length and thickness. The method was further developed by Ingram (1981) and nowadays by Edmonds (2012). He reported about 245 patients treated during the last 12 years by his team. 232 of them had a success in anatomic aspect (95%), 13 did not complete the treatment due to psychological or cultural problems. The experts from American College of Obstetricians and Gynecologists include in their "Committee Opinion" from May 2013 the following lines: "Non-surgical creation of the vagina is the appropriate first line approach in most patients". Briefly is presented our experience in this field--14 girls at the age of 16-18, successfully treated with dilatation in the III Gynecology Clinic in University hospital "Maichin dom", Sofia, Bulgaria.
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Amaral RC, Inacio M, Brito VN, Bachega TASS, Domenice S, Arnhold IJP, Madureira G, Gomes L, Costa EMF, Mendonca BB. Quality of life of patients with 46,XX and 46,XY disorders of sex development. Clin Endocrinol (Oxf) 2015; 82:159-64. [PMID: 25040878 DOI: 10.1111/cen.12561] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/30/2014] [Accepted: 07/16/2014] [Indexed: 12/22/2022]
Abstract
Disorders of sex development (DSD) result from abnormalities in the complex process of sex determination and differentiation. An important consideration to guide the assignment of social sex in newborns with ambiguous genitalia is the quality of life (QoL) of these patients in adulthood. The rarity of most DSD conditions makes it difficult to conduct a long-term follow-up of affected patients through adulthood. This review of papers on the QoL of DSD patients evaluated in developing and developed countries by qualitative and quantitative instruments revealed a large spectrum of QoL, ranging from very poor to similar to, or even better than, the normal population. A more adequate QoL was found in patients from tertiary centres, indicating that the medical care of DSD patients should be multidisciplinary and carried out by specialized teams.
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MESH Headings
- 46, XX Disorders of Sex Development/epidemiology
- 46, XX Disorders of Sex Development/physiopathology
- 46, XX Disorders of Sex Development/psychology
- Adrenal Hyperplasia, Congenital/epidemiology
- Adrenal Hyperplasia, Congenital/physiopathology
- Adrenal Hyperplasia, Congenital/psychology
- Adult
- Disorder of Sex Development, 46,XY/epidemiology
- Disorder of Sex Development, 46,XY/physiopathology
- Disorder of Sex Development, 46,XY/psychology
- Disorders of Sex Development/epidemiology
- Disorders of Sex Development/physiopathology
- Disorders of Sex Development/psychology
- Female
- Humans
- Male
- Quality of Life
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Affiliation(s)
- Rita Cassia Amaral
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Cassia Amaral R, Inacio M, Brito VN, Bachega TASS, Oliveira AA, Domenice S, Denes FT, Sircili MH, Arnhold IJP, Madureira G, Gomes L, Costa EMF, Mendonca BB. Quality of life in a large cohort of adult Brazilian patients with 46,XX and 46,XY disorders of sex development from a single tertiary centre. Clin Endocrinol (Oxf) 2015; 82:274-9. [PMID: 25074426 DOI: 10.1111/cen.12572] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 07/02/2014] [Accepted: 07/22/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Few studies have focused on the quality of life (QoL) of patients with disorders of sex development (DSD). Our aim was to evaluate QoL in DSD patients with defined diagnoses followed until adulthood in a single tertiary centre. PATIENTS AND METHODS Adult patients with DSD (56 patients with 46,XX DSD - 49 with female social sex and 7 with male social sex as well as 88 patients with 46,XY DSD - 54 with female social sex and 34 with male social sex). MEASUREMENTS QoL using WHOQOL-Bref questionnaire. RESULTS Both patients with 46,XX DSD and patients with 46,XY DSD had similar QoL scores on the WHOQOL-Bref, comparable to the scores of the Brazilian general population. The chronological age at the start of treatment was negatively and significantly associated with general QoL score. Patients with male social sex DSD had better scores on the psychological domain than patients with female social sex DSD, as found in the Brazilian general population. In addition, among the 46,XY DSD group, the male social sex patients had better QoL compared with the female social sex patients. There was a positive and significant correlation between sexual performance and general QoL, although it explained only 4% of the variability of the general QoL score. The most influencing variables were general health, positive feelings and spirituality, religion and personal beliefs, each of them contributing with 18% of the variability of the general QoL score. CONCLUSION Our large cohort of adult patients with DSD, which was followed by a multidisciplinary team in a single tertiary centre, had good QoL in adulthood; in addition, late treatment compromised the QoL of patients with DSD, whereas sexual performance has little influence on QoL.
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Affiliation(s)
- Rita Cassia Amaral
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular LIM/42, Disciplina de Endocrinologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Simoes E, Kronenthaler A, Emrich C, Rieger MA, Rall KK, Schäffeler N, Hiltner H, Ueding E, Brucker SY. Development of a provisional model to improve transitional care for female adolescents with a rare genital malformation as an example for orphan diseases. Biomed Res Int 2014; 2014:913842. [PMID: 25544945 PMCID: PMC4269155 DOI: 10.1155/2014/913842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 11/23/2014] [Accepted: 11/23/2014] [Indexed: 11/18/2022]
Abstract
Deficits of care exist during the transitional period, when young people with ongoing needs of support to achieve their physical, social, and psychological potential are entering adulthood. This study aims to develop a patient oriented, structured provisional model to improve transitional care for adolescents with Mayer-Rokitansky-Kuester-Hauser-Syndrome as an example for orphan diseases, where problems of access and continuity are even more complex. The study is funded by the German Federal Ministry of Education and Research (BMBF-Funding Code 01GY1125). The target patient group are young females with this disorder, treated at the Centre for Rare Genital Malformations in Women (ZSGF), University Hospital of Tuebingen. The study comprises five phases: an appraisal of literature, assessment of patients (n = 25), parents', partners', and health and social care providers' (n = 24) needs and experienced deficits in care and support in a qualitative approach, construction of a provisional model via scenario technique, followed by communicative validation (including interested public, n = 100), preference finding, and identification of patient-oriented quality aims for follow-up. Quantitative data from questionnaires and chart review (as sociodemographic data, nonresponder analysis, and preference rating) are worked up for descriptive statistics. The results provide a platform for the development of future multidisciplinary transitional intervention programs in orphan diseases.
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Affiliation(s)
- Elisabeth Simoes
- Centre of Women's Health, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Women's Health Research Institute, 72076 Tuebingen, Germany
- Social Medicine Staff Unit, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Andrea Kronenthaler
- Institute of General Practice, University of Tuebingen, 72074 Tuebingen, Germany
| | - Christine Emrich
- Institute of Occupational and Social Medicine and Health Services Research, 72074 Tuebingen, Germany
| | - Monika A. Rieger
- Institute of Occupational and Social Medicine and Health Services Research, 72074 Tuebingen, Germany
| | | | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Hanna Hiltner
- Institute of General Practice, University of Tuebingen, 72074 Tuebingen, Germany
| | - Esther Ueding
- Women's Health Research Institute, 72076 Tuebingen, Germany
| | - Sara Y. Brucker
- Centre of Women's Health, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Women's Health Research Institute, 72076 Tuebingen, Germany
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Rall K, Conzelmann G, Schäffeler N, Henes M, Wallwiener D, Möhrle M, Brucker SY. Acne and PCOS are less frequent in women with Mayer-Rokitansky-Küster-Hauser syndrome despite a high rate of hyperandrogenemia: a cross-sectional study. Reprod Biol Endocrinol 2014; 12:23. [PMID: 24641817 PMCID: PMC4003801 DOI: 10.1186/1477-7827-12-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/06/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Acne is a very common skin condition during adolescence and adulthood. Patients with uterovaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome, MRKH) treated at the Tübingen University Center for Rare Female Genital Malformations, however, clinically appeared to be less frequently affected by acne. The etiology of MRKH syndrome remains unknown. The only known MRKH-associated mutations are located within the WNT4 gene and lead to an atypical form of MRKH syndrome associated with clinical and biochemical hyperandrogenism. Our study aimed to assess the frequency, severity, and self-evaluation of acne in MRKH patients and to correlate the clinical findings with hormone analyses. METHODS As part of a cross-sectional longterm follow-up study after laparoscopic assisted creation of a neovagina a questionnaire was sent to 149 MRKH patients aged 16-44 years comprising 26 items concerning prevalence and self-evaluation of acne, and the effects of acne on quality of life. The questionnaire was derived from one used in a former epidemiological study of acne in 4,000 women. Blood for hormone analyses was collected routinely during the clinical visit. RESULTS Fully completed, evaluable questionnaires were returned by 69/149 (46%) women. Of these respondents, 42 (60.1%) showed hyperandrogenemia without other clinical signs of virilization but only 17 (24.6%) reported acne (8 (11.6%) had physiological acne and 9 (13.0%) clinical acne) and only 10 (14.5%) reported receiving medical treatment for their acne. Effects of acne on quality of life were minor. Only 4 patients (5.8%) with PCOS were identified, among them one with physiological acne, the other three within the acne-free group. CONCLUSIONS Although hyperandrogenemia is common, acne is significantly less frequent in women with MRKH than reported in the literature for non-MRKH women, and is seldom treated medically. Patients in this study appeared resistant to acne to some extent, possibly due to the sebaceous glands in the acne regions being less sensitive to androgens compared to the normal population. A WNT4 mutation is unlikely to be the main cause of MRKH syndrome in our hyperandrogenemic patients.
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Affiliation(s)
- Katharina Rall
- Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstrasse 7, 72076 Tübingen, Germany
| | - Gabriele Conzelmann
- Department of Dermatology, Tübingen University Hospital, Liebermeisterstrasse 25, 72076 Tübingen, Germany
| | - Norbert Schäffeler
- Division of Psychosomatic Medicine and Psychotherapy, Department of Internal Medicine VI, Tübingen University Hospital, Osianderstrasse 5, 72076 Tübingen, Germany
| | - Melanie Henes
- Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstrasse 7, 72076 Tübingen, Germany
| | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstrasse 7, 72076 Tübingen, Germany
| | - Matthias Möhrle
- Department of Dermatology, Tübingen University Hospital, Liebermeisterstrasse 25, 72076 Tübingen, Germany
- Praxisklinik Tübingen Haut und Venen, Europaplatz 2, 72072 Tübingen, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, Tübingen University Hospital, Calwerstrasse 7, 72076 Tübingen, Germany
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