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Grant A, Carpenter CP, Li B, Kim SJ. Hydrometrocolpos: a Contemporary Review of the Last 5 Years. Curr Urol Rep 2023; 24:601-610. [PMID: 38038828 DOI: 10.1007/s11934-023-01191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to provide a comprehensive overview of hydrometrocolpos, covering disease etiology, pathophysiology, clinical presentation, and diagnostic and management techniques, and known outcomes. RECENT FINDINGS This narrative review presents the literature on hydrometrocolpos in the pediatric population from the past 5 years. We highlight the 69 reported cases of hydrometrocolpos and classify them based on type of obstruction or associated anomaly, discuss new diagnostic algorithms based on imaging, and present novel and underutilized surgical techniques for definitive management. Hydrometrocolpos, a condition characterized by retained fluid causing a distended vagina and uterus in the setting of a distal vaginal outflow obstruction, has a wide range of presentation severity based on the type of obstruction. Whether hydrometrocolpos is due to an isolated condition like imperforate hymen, a complex abnormality like cloacal malformation, or a part of a large congenital syndrome, the mainstay of treatment is decompression of the dilated vagina and surgical correction of the outflow obstruction. Imaging-based diagnostic algorithms and new treatment techniques reported in the literature, as well as longitudinal and patient-reported outcome research, can improve the lives of children affected by this condition.
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Affiliation(s)
- Allison Grant
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Christina P Carpenter
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Belinda Li
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Soo Jeong Kim
- Department of Pediatric Urology, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
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Lee SY, Jackson JE, Hassan AES, Kurzrock EA, McLennan A, Hirose S, Saadai P. Prenatal Rupture of Hydrocolpos in a Cloacal Malformation. Fetal Diagn Ther 2023; 50:158-164. [PMID: 37088075 DOI: 10.1159/000530438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/08/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Cloacal dysgenesis occurs from failure of embryological division of urogenital sinus and hindgut, leading to a single common perineal opening for genitourinary and gastrointestinal tracts. The prenatal diagnosis of cloacal malformation is imprecise, but the clinical correlation of postnatal findings to prenatal history can help reveal explanations for unusual pathological findings in patients with urogenital abnormalities. CASE PRESENTATION A 21-year-old woman was referred after her 20-week ultrasound demonstrated anhydramnios and concern for dilated fetal bowel. Fetal MRI confirmed anhydramnios and a dilated fetal colon, in addition to hydronephrosis and a pelvic cyst. Repeat ultrasound at 27 weeks showed unexpected complete resolution of her anhydramnios but new fetal ascites. The newborn girl was postnatally diagnosed with a cloacal malformation and an unusual near-complete fusion of her labia. She underwent proximal sigmoid colostomy and a tube vaginostomy at birth followed by cloacal reconstruction at 1.5 years old. CONCLUSION In female fetus with a pelvic cyst, one should have a high index of suspicion for cloacal anomaly and consider the possibility of urinary obstruction leading to alteration in amniotic fluid.
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Affiliation(s)
- Su Yeon Lee
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA,
| | - Jordan E Jackson
- Department of Surgery, University of San Francisco- East Bay, Oakland, California, USA
| | - Abd-Elrahman Said Hassan
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Eric A Kurzrock
- Department of Urologic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Amelia McLennan
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California, USA
| | - Shinjiro Hirose
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Payam Saadai
- Division of Pediatric General, Thoracic and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
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Tanitame K, Tanitame N, Urayama S, Ohtsu K. Congenital anomalies causing hemato/hydrocolpos: imaging findings, treatments, and outcomes. Jpn J Radiol 2021; 39:733-740. [PMID: 33840015 PMCID: PMC8338850 DOI: 10.1007/s11604-021-01115-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/30/2021] [Indexed: 12/28/2022]
Abstract
Hemato/hydrocolpos due to congenital urogenital anomalies are rare conditions discovered in neonatal, infant, and adolescent girls. Diagnosis is often missed or delayed owing to its rare incidence and nonspecific symptoms. If early correct diagnosis and treatment cannot be performed, late complications such as tubal adhesion, pelvic endometriosis, and infertility may develop. Congenital urogenital anomalies causing hemato/hydrocolpos are mainly of four types: imperforate hymen, distal vaginal agenesis, transverse vaginal septum, and obstructed hemivagina and ipsilateral renal anomaly, and clinicians should have adequate knowledge about these anomalies. This article aimed to review the diagnosis and treatment of these urogenital anomalies by describing embryology, clinical presentation, imaging findings, surgical management, and postoperative outcomes.
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Affiliation(s)
- Keizo Tanitame
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, Minami-ku, Ujinakanda, Hiroshima, 734-8530, Japan.
| | - Nobuko Tanitame
- Department of Radiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Saiko Urayama
- Department of Obstetrics and Gynecology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kazuhiro Ohtsu
- Department of Maternal and Child Health Research Center, Hiroshima Prefectural Hospital, Hiroshima, Japan
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Bischoff A, Alaniz VI, Trecartin A, Peña A. Vaginal reconstruction for distal vaginal atresia without anorectal malformation: is the approach different? Pediatr Surg Int 2019; 35:963-966. [PMID: 31256298 DOI: 10.1007/s00383-019-04512-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Distal vaginal atresia is a rare condition and treatment approaches are varied, usually driven by symptoms. METHODS A retrospective review was performed to identify patients with distal vaginal atresia without anorectal malformation. Data collected included age and symptoms at presentation, type and number of operations, and associated anomalies. RESULTS Eight patients were identified. Four presented at birth with a hydrocolpos and four presented with hematometrocolpos after 12 years of age. Number of operations per patient ranged from one to seven with an average of three. The vaginal reconstruction was achieved by perineal vaginal mobilization in four patients and abdomino-perineal approach in four patients. One patient, with a proximal vagina approximately 7 cm from the perineum, required partial vaginal replacement with colon. In addition, she had hematometrocolpos with an acute inflammation at the time of reconstruction despite menstrual suppression and drainage which may have contributed to the difficulty in mobilizing the vagina. In five patients, distal vaginal atresia was an isolated anomaly. In the other three cases, associated anomalies included: mild hydronephrosis that improved after hydrocolpos decompression (2), cardiac anomaly (2), and vertebral anomaly (1). CONCLUSION In this series, a distended upper vagina/uterus was a common presentation and the time of reconstruction was driven by the presence of symptoms. Drainage of the hydrocolpos/hydrometrocolpos with menstrual suppression in post-pubertal patients, followed by further work-up, and planned reconstruction is a good surgical strategy.
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Affiliation(s)
- Andrea Bischoff
- Department of Pediatric Surgery, Children's Hospital Colorado, International Center for Colorectal and Urogenital Care, University of Colorado, 13123 East 16th Avenue Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Veronica I Alaniz
- Division of Pediatric and Adolescent Gynecology, International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Andrew Trecartin
- Department of Pediatric Surgery, Children's Hospital Colorado, International Center for Colorectal and Urogenital Care, University of Colorado, 13123 East 16th Avenue Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Alberto Peña
- Department of Pediatric Surgery, Children's Hospital Colorado, International Center for Colorectal and Urogenital Care, University of Colorado, 13123 East 16th Avenue Box 323, Anschutz Medical Campus, Aurora, CO, 80045, USA
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Speck KE, Arnold MA, Ivancic V, Teitelbaum DH. Cloaca and hydrocolpos: laparoscopic-, cystoscopic- and colposcopic-assisted vaginostomy tube placement. J Pediatr Surg 2014; 49:1867-9. [PMID: 25487503 DOI: 10.1016/j.jpedsurg.2014.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 07/30/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022]
Abstract
Hydrocolpos presenting at birth in a neonate with a cloacal malformation may lead to massive distension, with compression of adjacent structures. At times, the hydrocolpos requires urgent drainage. Additionally, these neonates need a divided colostomy to divert their fecal stream and prevent genitourinary contamination. We present a novel approach by which these two procedures can be performed as a single operation guided by a combination of cystoscopy, colposcopy, and laparoscopy. This provides a minimally invasive technique with excellent outcome and potentially superior visualization of the necessary intra-abdominal structures.
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Affiliation(s)
- K Elizabeth Speck
- Section of Pediatric Surgery, Department of Surgery, University of Michigan
| | - Meghan A Arnold
- Section of Pediatric Surgery, Department of Surgery, University of Michigan
| | - Vesna Ivancic
- Section of Pediatric Urology, Department of Urology, University of Michigan
| | - Daniel H Teitelbaum
- Section of Pediatric Surgery, Department of Surgery, University of Michigan.
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Kedikova S, Shivachev H, Brankov O, Filipov E, Vazarova R. [Transversal vaginal septum in two months old patient--case report]. Akush Ginekol (Sofiia) 2012; 51:41-45. [PMID: 22639779] [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: 06/01/2023]
Abstract
The current publication describes a case of a two months old girl with a transverse vaginal septum presented. The clinical debut is with a large hydromucocolpos. It is concomitantly presented with a bilateral postaxial polydactyly of the upper limbs, typical for McKusick-Kaufmann syndrome.
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Zewdneh D, Shewarega Z. A case of McKusick-Kaufman Syndrome. Ethiop Med J 2011; 49:279-282. [PMID: 21991762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We are reporting a rare case of McKusick- Kaufman Syndrome in a ten-month old female infant from Addis Ababa with difficulty of urination often days duration. Clinical exam revealed supra-pubic mass with tenderness and had left hand postaxial polydactily. Ultrasound and CT scans showed the mass to be hydrometrocolpos posterior to the bladder. Intravenous urography revealed a lower abdomen-pelvic mass displacing and compressing the ureters with bilateral hydronephrosis. Further pelvic exam under anaesthesia revealed hydrometrocolpos with vaginal agenesis. This, to the best knowledge of the authors, is the first ever reported case of the syndrome in Ethiopia.
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Affiliation(s)
- Daniel Zewdneh
- Department of Radiology, School of Medicine, College of Health Sciences, Addis Ababa University
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Sonmez G, Aydinoz S, Mutlu H, Ozturk E, Sildiroglu O, Akyol I. Medical image. Hydrocolpos in a child. N Z Med J 2008; 121:115-116. [PMID: 18392068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Guner Sonmez
- Department of Pediatrics, GATA Haydarpasa Teaching Hospital, Uskudar, Istanbul, Turkey
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Subramanian S, Sharma R, Gamanagatti S, Agarwala S, Gupta P, Kumar S. Antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus. Pediatr Radiol 2006; 36:1086-9. [PMID: 16810498 DOI: 10.1007/s00247-006-0249-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 02/27/2006] [Revised: 04/05/2006] [Accepted: 05/01/2006] [Indexed: 10/24/2022]
Abstract
Hydrometrocolpos is cystic dilatation of the vagina and uterus due to congenital vaginal obstruction. It may be secretory or urinary in character and manifests in the neonatal period with abdominal distension. Urinary hydrometrocolpos occurs in patients with urogenital sinus or cloacal anomaly. A rare case of antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus is presented.
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Affiliation(s)
- Subramanian Subramanian
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Abstract
Congenital obstructing lesions of vagina, hydrometrocolpos, and hematocolpos, present at a variable time during early childhood and adolescence to different medical and surgical specialties. Twenty-six cases presenting over an 18-years period (1987-2005) were divided into three groups; Group A: neonates (6), Group B: adolescents (18), and Group C: adults (2). Common presentations in neonates (Group A) were abdominal mass (5), neonatal sepsis (3), and respiratory distress (2); whereas abdominal pain (18), voiding dysfunctions (13), and backache (7) were prevalent in adolescents (Group B). Adults (Group C) presented with inability to consummate and infertility (2). Four patients received erroneous treatment; exploratory laparotomy (1) and appendectomy (3). Urinary symptoms and associated urinary abnormalities were present in more than 50% of cases, especially those with complex anomalies. Management included excision of imperforate hymen (16) and transverse vaginal septum (8) through perineal (20) and abdominoperineal approach (4). Patients with urogenital sinus (1) and cloacal malformation (1) had staged reconstruction at 2.5 years of age following preliminary vesicostomy and colostomy at birth. On follow up (range 1-15 years; mean 7) more than 60% patients have menstrual irregularity (11), endometriosis (5), and infertility (4). In conclusion, rarity and variable presentation of congenital vaginal obstructions can lead to delayed diagnosis and erroneous management. A high index of suspicion and cross-sectional imaging help in early diagnosis and associated renal anomalies. A comprehensive management is imperative to preserve the reproductive potentials, as significant proportion of patients may experience sexual difficulties, menstrual irregularity, and infertility.
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Affiliation(s)
- Zafar Nazir
- Section of Pediatric Surgery, Department of Surgery, The Aga Khan University, P. O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
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Abstract
Imperforate hymen is most commonly an isolated finding and usually remains asymptomatic until puberty. Rarely, symptoms of imperforate hymen manifest antenatally as well as in the neonatal period, requiring surgical correction for life-threatening consequences. We report a 5-day-old infant with a large hydrometrocolpos causing severe renal compromise and abdominal ascites, successfully surgically treated in the neonatal period. Associated polydactyly suggested McKusick-Kaufman syndrome.
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Affiliation(s)
- A El-Messidi
- Department of Obstetrics and Gynecology, University of Ottawa, Ontario, Canada
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Abstract
McKusick-Kaufman syndrome is a rare, autosomal, recessive disorder characterized by hydrometrocolpos, post-axial polydactyly, and congenital heart disease. Less than one hundred cases have been reported in the English literature to date, mainly in the Amish population; sporadic cases have also been described. We present a case of an Arab Bedouin girl who presented with features resembling this syndrome.
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Affiliation(s)
- B Kawar
- Department of Pediatric Surgery, Ha'Emek Medical Center, Afula, Israel.
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Hayashi S, Sago H, Kashima K, Kitano Y, Kuroda T, Honna T, Nosaka S, Nakamura T, Ito Y, Kitagawa M, Natori M. Prenatal diagnosis of fetal hydrometrocolpos secondary to a cloacal anomaly by magnetic resonance imaging. Ultrasound Obstet Gynecol 2005; 26:577-9. [PMID: 16184505 DOI: 10.1002/uog.2584] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Fetal female urogenital anomalies are often difficult to evaluate by ultrasonography, especially in late gestation. We report a case of fetal hydrometrocolpos detected at 35 weeks of gestation. Ultrasonography revealed a large retrovesical septate hypoechogenic mass in the fetal abdomen, however the sonographic findings were inconclusive. Magnetic resonance imaging (MRI) confirmed that the abdominal mass was fluid-filled with a mid-plane septum in the midline posterior to the bladder, and showed a connection to the dilated uterus that was duplicated. These findings were consistent with a diagnosis of hydrometrocolpos with septate vagina and uterus didelphys. The neonate showed abdominal distension, ambiguous genitalia and anal atresia with a single perineal opening. Hydrometrocolpos was secondary to a urethral type of cloacal anomaly. Aspiration of the mass and a colostomy were performed on the first postnatal day, followed by anorectoplasty at 19 months of age. MRI is a useful complementary tool for assessing fetal urogenital anomalies when ultrasonography is inconclusive.
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Affiliation(s)
- S Hayashi
- Division of Fetal Medicine, National Center for Child Health and Development, Tokyo, Japan
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