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Lou S, Jensen AH, Vogel I, Trolle B, Herlin MK. Understanding the Diagnostic Odyssey of Women with Mayer-Rokitansky-Küster-Hauser ( MRKH) Syndrome in Denmark: A Qualitative Interview Study. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00189-X. [PMID: 38494126 DOI: 10.1016/j.jpag.2024.03.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
STUDY OBJECTIVE The diagnosis of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is often a lengthy process that typically occurs during late adolescence. To support optimized and patient-centered care, this study aimed to investigate how women with MRKH syndrome experience the diagnostic process. METHODS From January 2021 to March 2021, we conducted in-depth interviews with 18 Danish women (≥25 years) diagnosed with MRKH syndrome. The interviews lasted a median of 92 minutes (range: 67-117). Data were analyzed using thematic analysis. RESULTS As teenagers or young women at the time, all women had experienced the diagnostic process in the nonspecialized healthcare sector as deeply upsetting due to distressing gynecological examinations, use of inappropriate language, and considerable diagnostic delay. When reaching the specialized health care sector, questions could finally be answered, but this information and support did not significantly alter their feelings of being "deviant" or "flawed". The women continued their diagnostic odyssey beyond the health care system and found online communities that gave them valuable support in living with MRKH syndrome. CONCLUSION Women experience the diagnostic odyssey of MRKH syndrome as upsetting and potentially traumatizing beyond the diagnosis. Healthcare professionals can influence young women's understanding and experience of MRKH syndrome by using inclusive language (eg, avoiding "deformity") and addressing all that is normal and functioning (eg, external genitalia and potential for sexual pleasure). In nonurgent conditions, young women should be given the choice to delay a genital examination.
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Affiliation(s)
- Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, 8000 Aarhus, Denmark; DEFACTUM - Public Health Research, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark.
| | | | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, 8000 Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark; Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Birgitta Trolle
- Center of Sexology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Morten Krogh Herlin
- Department of Clinical Medicine, Health, Aarhus University, 8000 Aarhus, Denmark; Department of Clinical Genetics, Aarhus University Hospital, 8000 Aarhus, Denmark
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Gilfillan R, Carter P. Issues of identity, perceptions and isolation: An interpretative phenomenological analysis of women's experience of Mayer-Rokitansky-Küster-Hauser ( MRKH) syndrome. J Health Psychol 2024; 29:200-212. [PMID: 37771134 DOI: 10.1177/13591053231199253] [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] [Indexed: 09/30/2023] Open
Abstract
The objective of this study was to explore the personal experience of women with MRKH, a rare condition characterised by congenital abnormalities of the genital tract. There are very few qualitative studies into the lived experiences of women with MRKH. Interviews were conducted with 13 women with MRKH and analysed using interpretative phenomenological analysis. Four superordinate themes are discovered: maintaining a viable female identity; acceptance and coping; normality, secrecy and shame and the isolating impact of a lack of knowledge amongst the medical profession. This study also suggests that societal ideals of a 'normal woman' are influencing how MRKH impacts on the self-experienced psychological health. It is suggested that the psychological wellbeing of women with MRKH could be improved with continued multidisciplinary support beyond the initial diagnosis and alongside any vaginal correction.
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Roth LP, Yu LX, Johnson J, Qu'd D, McCracken K, Simpson BN, Pennesi CM. Müllerian Agenesis in a patient with Rubinstein-Taybi Syndrome: A Case Series and Review of the Overlapping Developmental Biologic Pathways. J Pediatr Adolesc Gynecol 2024; 37:67-71. [PMID: 37704034 DOI: 10.1016/j.jpag.2023.09.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Rubinstein-Taybi syndrome (RSTS) is a multi-system neurodevelopmental condition caused by deficiency of CREBBP (16p13.3) or EP300 (22q13.2). Müllerian agenesis, or Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, is defined as congenital agenesis of the uterus, cervix, and upper vagina without a definite genetic cause. INDEX CASE AND CASE SERIES We present a 14-year-old female with RSTS type 1 (CREBBP, c.4395-2A>C) and MRKH, the first documented in the literature. Following presentation to Gynecology for anticipatory guidance regarding future menstrual suppression and follow-up of previously diagnosed labial adhesions, exam under anesthesia revealed a single urogenital opening with cystoscopy demonstrating a normal urethra and bladder. Laboratory evaluation was consistent with peripubertal female gonadotropins and estradiol, 46,XX karyotype, and normal microarray, and a pelvic MRI confirmed Müllerian agenesis. Given this case, we assessed our cohort of females with RSTS and found that 4 of 12 individuals also had Müllerian anomalies. CONCLUSION Gynecologic evaluation should be a part of medical care for females with RSTS, particularly in individuals with delayed menarche or abnormal menstrual history, on the basis of the observed association between RSTS and Müllerian anomalies in this case series. Although several candidate genes and copy number variants are associated with MRKH, no candidate genes in close proximity to the 16p13.3 region have been identified to explain both RSTS and MRKH in the index patient. Due to the regulatory nature of CREBBP during embryonic development, we theorize that CREBBP may play a role in the migration of Müllerian structures during embryogenesis.
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Affiliation(s)
- Lauryn P Roth
- Cincinnati Children's Hospital Medical Center, Division of Pediatric and Adolescent Gynecology, Cincinnati, Ohio.
| | - Lissa X Yu
- Cincinnati Children's Hospital Medical Center, Division of Pediatric and Adolescent Gynecology, Cincinnati, Ohio; University of Washington, Division of Pediatric and Adolescent Gynecology, Seattle, Washington
| | - Jodie Johnson
- Cincinnati Children's Hospital Medical Center, Division of Human Genetics, Cincinnati, Ohio
| | - Dima Qu'd
- Cincinnati Children's Hospital Medical Center, Division of Human Genetics, Cincinnati, Ohio
| | - Kyle McCracken
- Cincinnati Children's Hospital Medical Center, Division of Nephrology, Cincinnati, Ohio
| | - Brittany N Simpson
- Cincinnati Children's Hospital Medical Center, Division of Human Genetics, Cincinnati, Ohio
| | - Christine M Pennesi
- Cincinnati Children's Hospital Medical Center, Division of Pediatric and Adolescent Gynecology, Cincinnati, Ohio
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Pennesi CM, Berkeley J, Lossie AC, Quint EH, Zieman KD, Carroll S. International Experiences with Vaginal Lengthening Treatment Among Individuals with Müllerian Agenesis: A Mixed-Methods Study. J Pediatr Adolesc Gynecol 2023; 36:476-483. [PMID: 37182810 DOI: 10.1016/j.jpag.2023.05.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
STUDY OBJECTIVE To understand variations and experiences of vaginal lengthening internationally in individuals with congenital underdevelopment of the uterus, cervix, and upper vagina or Müllerian agenesis METHODS: In this study, we used a cross-sectional mixed-methods design incorporating quantitative and qualitative questionnaires. Adults with Müllerian agenesis completed questionnaires with quantitative and open-ended qualitative questions about their vaginal lengthening experiences. Data were analyzed using descriptive statistics and inductive thematic analysis. RESULTS Of 616 respondents meeting inclusion criteria (representing 40 countries), 46% (n = 284) reported no vaginal lengthening intervention. Vaginal lengthening was commonly reported by participants from North America and Europe (59%) and less commonly by participants from Africa, Asia, and South America (16%). Of those who had undergone vaginal lengthening, 72% reported dilator use, 34% coital dilation, and 39% surgery. Four major themes were identified in response to the open-ended vaginal lengthening experience question: (1) difficult physical symptoms, (2) practical and psychosocial challenges, (3) intimate relationships and sexual satisfaction, and (4) impact of experiences with healthcare providers. CONCLUSION This study highlights vaginal lengthening practices internationally and shared themes related to significant challenges and positive experiences. The findings show room for improvement in the counseling and care surrounding vaginal lengthening. Future research should investigate factors that influence decision-making about vaginal lengthening and work toward international consensus on best care practices in Müllerian agenesis.
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Affiliation(s)
- Christine M Pennesi
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, Michigan; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Jane Berkeley
- Beautiful You MRKH Foundation, Silver Spring, Maryland
| | - Amy C Lossie
- Beautiful You MRKH Foundation, Silver Spring, Maryland
| | - Elisabeth H Quint
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, Michigan
| | | | - Susan Carroll
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom of Great Britain and Northern Ireland, United Kingdom; King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom of Great Britain and Northern Ireland, United Kingdom
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Vali S, Jones BP, Sheikh S, Saso S, Quiroga I, Smith JR. Attitudes, knowledge, and perceptions among women toward uterus transplantation and donation in the United Kingdom. Front Med (Lausanne) 2023; 10:1223228. [PMID: 37654655 PMCID: PMC10467283 DOI: 10.3389/fmed.2023.1223228] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Objective To assess the motivations and perceptions of the general public in the United Kingdom toward donating their uterus for Uterus Transplantation after death (UTx). Design A cross sectional study. Setting A 32-item electronic questionnaire. Population One hundred fifty nine females over the age of 16 living in the United Kingdom, consented and took part in the study. Main outcome measures The motivations and perceptions toward UTx among the general public including the willingness to donate and barriers preventing donation. Results One hundred fifty nine women completed the questionnaire. The majority had never heard of UTx (n = 107, 71%) and most were not aware the uterus could be donated after death (n = 130, 92%). 43% of the cohort were willing to donate their uterus after death (n = 57). 8% stated they wished to donate their organs but not their uterus (n = 10). 30% of women (n = 42) believed the child born following UTx would have genetic links to the donor. Over half of the respondents (n = 65, 51%) strongly agreed or agreed they would feel joy in the knowledge that donation would lead to bringing a new life into the world. A quarter of respondents strongly agreed or agreed (n = 45, 25%) that the use of their uterus by another woman would feel like an extension of life. Conclusion The findings indicate a favorable opinion toward UTx and a positive attitude toward donation of the uterus after death among the general public in the United Kingdom. The findings also highlight the need for education around UTx now this therapeutic option is available.
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Affiliation(s)
- Saaliha Vali
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Cutrale Perioperative and Ageing Group, Sir Michael Uren Hub, Imperial College London, London, United Kingdom
| | - Benjamin P. Jones
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Sairah Sheikh
- Queen Mary University of London, London, United Kingdom
| | - Srdjan Saso
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Isabel Quiroga
- The Oxford Transplant Centre, The Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - J. Richard Smith
- West London Gynaecological Cancer Centre, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
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Georgevsky D, Ying L, Krishnan S, Laurence J, Robinson D, Campbell N, Wyburn K, Marinelli T, Davis R, Narayan R, Lutz T, Chan A, Heaney SA, Kitzing YX, Anderson L, Liyanagama K, Robson J, Carter J, Testa G, Johannesson L, Marren A. First uterine transplant case at the Royal Prince Alfred Hospital. Aust N Z J Obstet Gynaecol 2023; 63:599-602. [PMID: 37200477 DOI: 10.1111/ajo.13700] [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: 03/21/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
Uterine transplantation (UT) is an emerging medical treatment for women affected by absolute uterine factor infertility (AUFI). To date there have been over 90 documented cases of UT performed worldwide, with over 50 live births. UT allows women affected by AUFI the opportunity to carry and deliver a childd. The Royal Prince Alfred Hospital (RPAH) introduced a UT study in 2019; however, due to the impacts of the COVID pandemic the study was placed on hold for two years. In February 2023, RPAH performed the centre's first UT from a living unrelated donor to a 25-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome. The donor and recipient surgeries were uncomplicated and both are recovering well in the early post-operative period.
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Affiliation(s)
- Dana Georgevsky
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Li Ying
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Surya Krishnan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jerome Laurence
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - David Robinson
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Neil Campbell
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate Wyburn
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Tina Marinelli
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rebecca Davis
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rajit Narayan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Tracey Lutz
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Agnes Chan
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sally-Ann Heaney
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Yu Xuan Kitzing
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lyndal Anderson
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Keith Liyanagama
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | - Jonathan Carter
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Centre, Dallas, Texas, USA
| | - Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute at Baylor University Medical Centre, Dallas, Texas, USA
| | - Anthony Marren
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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La Maida GA, Della Valle A, Gallazzi E, Ferraro M, Cecconi D, Cicatelli A, Priano D, La Verde L, Misaggi B. Paraparesis and congenital severe hyperkyphosis in Mayer-Rokitansky-Küster-Hauser ( MRKH) syndrome: A rare deformity management during the Sars-Cov-2 pandemic. Brain Spine 2023; 3:101753. [PMID: 37197562 PMCID: PMC10154059 DOI: 10.1016/j.bas.2023.101753] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/07/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
Introduction Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) syndrome can be classified into two types: type I (isolated) without extragenital abnormalities; type II (associated) with the presence of extragenital dimorphisms. Skeletal abnormalities are the second most frequent extragenital manifestations. Research question Association between MRKH and congenital scoliosis has been described; on the contrary, hyperkyphosis is very rare and sparsely described in the medical literature. Here we report our experience in the management of thoracolumbar hyperkyphosis in 16-year-old patient diagnosed with MRKH syndrome with an acute neurological impairment due to T11-T12 disc herniation. Material and methods Clinical and radiological images of the case were retrieved from the medical notes, operative records and imaging system. Results Posterior surgical correction was proposed to treat the severe spinal deformity; however, surgery was delayed because of SARS-CoV2 pandemic outbreak. During the pandemic, the patient had a major clinical and radiological deterioration with development of paraparesis. Complete clinical resolution of the paraparesis and restoration of balance was achieved with a two stage surgical approach, with a first anterior stage followed by a delayed posterior approach aimed at deformity correction. Discussion Congenital kyphosis are rare deformities that can progress rapidly leading to severe neurological deficits and worsening of the deformity. When patient has neurological deficit the surgical strategy to address the neurological problem first and plan the more complex and demanding corrective surgery remains a valid strategy that must be consider. Conclusion This is the first reported case of hyperkyphosis in Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) syndrome surgically treated.
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Affiliation(s)
- Giovanni Andrea La Maida
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Andrea Della Valle
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Enrico Gallazzi
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Marcello Ferraro
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Davide Cecconi
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Alfonso Cicatelli
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Daniele Priano
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
| | - Luca La Verde
- Dipartimento di Scienze Biomediche per La Salute, Università Degli Studi di Milano, Milano, Italy
| | - Bernardo Misaggi
- U.O. Ortopedia e Traumatologia per le Patologie Della Colonna Vertebrale, ASST G. Pini - CTO, Milano, Italy
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Meutia AP, Kouwagam AD, Djusad S, Hakim S, Priyatini T, Harzif AK. Laparoscopic proximal neovaginoplasty using autologous peritoneal graft to correct short vagina. Int J Surg Case Rep 2023; 106:108157. [PMID: 37099989 PMCID: PMC10164880 DOI: 10.1016/j.ijscr.2023.108157] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare condition characterized by congenital aplasia of the uterus and upper two-third vagina with normal secondary characteristics. Treatment of this condition consists of non-surgical and surgical management. After nonsurgical Frank method, neovaginal canal may be formed but sometimes the vaginal length may not be adequate to facilitate normal sexual intercourse. PRESENTATION OF CASE A 27-year-old woman, sexually active, complained about the difficulty of sexual intercouse. The patient was diagnosed with vaginal agenesis and uterine dysgenesis with normal secondary sexual characteristics and chromosome (46, XX). The patient has had nonsurgical treatment by Frank method for 6 years and as a result we found a 5 cm-vaginal indentation but she still complaint of pain and discomfort during intercourse. Laparoscopy proximal neovaginoplasty using autologous peritoneal graft was performed to add the proximal vaginal length. DISCUSSION In our case, the patient may have a short vagina as the result from inadequate Frank method dilatation. This may cause dyspareunia and discomfort to her sexual partner. Therefore, laparoscopic proximal neovaginaplasty and uterine band excision were carried out to correct the anatomical restriction and improve her sexual function. CONCLUSION Laparoscopic proximal neovaginoplasty is a surgical method to increase proximal vaginal length by using autologous peritoneal graft which shows excellent result. This procedure should be considered in MRKH syndrome patients with unsatisactory nonsurgical treatment result.
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Affiliation(s)
- Alfa Putri Meutia
- Division of Urogynecology, Reconstruction and Aesthetic Surgery Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Anggrainy Dwifitriana Kouwagam
- Division of Urogynecology, Reconstruction and Aesthetic Surgery Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Suskhan Djusad
- Division of Urogynecology, Reconstruction and Aesthetic Surgery Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Surahman Hakim
- Division of Urogynecology, Reconstruction and Aesthetic Surgery Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tyas Priyatini
- Division of Urogynecology, Reconstruction and Aesthetic Surgery Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Achmad Kemal Harzif
- Division of Reproductive Immunoendocrinology Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia/ Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Oppelt P, Binder H, Birraux J, Brucker S, Dingeldein I, Draths R, Eckoldt F, Füllers U, Hiort O, Hoffmann D, Hoopmann M, Hucke J, Korell M, Kühnert M, Ludwikowski B, Mentzel HJ, Mon OʼDey D, Rall K, Riccabona M, Rimbach S, Schäffeler N, Shavit S, Stein R, Utsch B, Wenzl R, Wieacker P, Zeino M. Diagnosis and Therapy of Female Genital Malformations (Part 1). Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/052, May 2019). Geburtshilfe Frauenheilkd 2021; 81:1307-1328. [PMID: 34899045 DOI: 10.1055/a-1471-4781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 10/19/2022] Open
Abstract
Objectives Female genital malformations may take the form of individual entities, they may involve neighboring organs or they may occur in the context of complex syndromes. Given the anatomical structures of the vulva, vagina, uterus and adnexa, the clinical picture of malformations may vary greatly. Depending on the extent of the malformation, organs of the urinary system or associated malformations may also be involved. Methods This S2k-guideline was developed by representative members from different medical specialties and professions as part of the guidelines program of the DGGG, SGGG and OEGGG. The recommendations and statements were developed using a structured consensus process with neutral moderation and voted on. Recommendations The guideline is the first comprehensive presentation of the symptoms, diagnosis and treatment options for female genital malformations. Additional chapters on classifications and transition were included.
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Affiliation(s)
- Peter Oppelt
- Universitätsklinik für Gynäkologie, Geburtshilfe & gynäkologische Endokrinologie, Kepler Universitätsklinikum Linz, Austria
| | - Helge Binder
- Universitätsklinik für Gynäkologie, Geburtshilfe & gynäkologische Endokrinologie, Kepler Universitätsklinikum Linz, Austria
| | - Jacques Birraux
- Klinik für Kinderchirurgie, Universitätsklinikum Genf, Genf, Switzerland
| | | | - Irene Dingeldein
- Universitätsklinik für Frauenheilkunde, Insel Spital, Bern, Switzerland
| | | | - Felicitas Eckoldt
- Klinik für Kinderchirurgie, Universitätsklinikum Jena, Jena, Germany
| | | | - Olaf Hiort
- Hormonzentrum für Kinder und Jugendliche - Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Dorit Hoffmann
- Klinik für Kinder- und Jugendmedizin, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Jürgen Hucke
- Klinik für Frauenheilkunde und Geburtshilfe, Agaplesion Bethesda Krankenhaus, Wuppertal, Germany
| | - Matthias Korell
- Klinik für Gynäkologie und Geburtshilfe, Johanna Etienne Krankenhaus, Neuss, Germany
| | - Maritta Kühnert
- Klinik für Geburtshilfe und Perinatalmedizin, Universitätsklinikum Marburg, Marburg, Germany
| | - Barbara Ludwikowski
- Klinik für Kinderchirurgie und -urologie, Kinder- und Jugendkrankenhaus auf der Bult, Hannover, Germany
| | - Hans-Joachim Mentzel
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Germany
| | - Dan Mon OʼDey
- Klinik für Plastische, Rekonstruktive und Ästhestische Chirurgie und Handchirurgie, Luisenspital Aachen, Aachen, Germany
| | | | - Michael Riccabona
- Klinische Abteilung für Kinderradiologie, Universitätsklinikum Graz, Graz, Austria
| | - Stefan Rimbach
- Abteilung für Gynäkologie und Geburtshilfe, Krankenhaus Agatharied, Hausham, Germany
| | - Norbert Schäffeler
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Sandra Shavit
- Klinik für Kinderchirurgie, Luzerner Kantonsspital, Luzern, Switzerland
| | - Raimund Stein
- Zentrum für Kinder-, Jugend- und Rekonstruktive Urologie, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Boris Utsch
- Abteilung für Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum Gießen/Marburg, Gießen, Germany
| | - Rene Wenzl
- Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien, Wien, Austria
| | - Peter Wieacker
- Institut für Humangenetik, Universitätsklinikum Münster, Münster, Germany
| | - Mazen Zeino
- Universitätsklinik für Kinderchirurgie, Insel Spital, Bern, Switzerland
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11
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Tsitoura A, Michala L. The Sexuality of Adolescents and Young Women With MRKH Syndrome: A Qualitative Study. J Sex Med 2021; 18:2012-2019. [PMID: 34649813 DOI: 10.1016/j.jsxm.2021.09.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vaginal agenesis, most commonly referred as Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome, is mostly diagnosed as primary amenorrhea in teenage girls; although there is plenty of literature concerning the formation of a neovagina, limited research has focused on the psychological burden of this diagnosis to the girls. AIM To enlighten health providers into the finer aspects of sexuality through the own words and experiences of girls with MRKH under our care. METHODS Women currently undergoing vaginal dilation or who had completed vaginal dilation within the past year were recruited from February 2019 to January 2020. A gynecologist with training in Sexual Medicine conducted a semistructured interview, which was recorded and then transcribed to identify common themes among interviewees. OUTCOMES The main outcome explored was the narrative experiences of women with MRKH. RESULTS 7 women participated, with a mean age of 19.7 (range 17-22 years). None of the girls felt stigmatized, however one reported significant distress at diagnosis, stemming from the attitude of health care professionals and exacerbated by an earlier age at disclosure. All girls accepted that VDT was successful, when it was initiated after they had felt sexual interest and arousal. Exact quantification of the vaginal length at onset, worried 4 as they felt pressurized to achieve a specific length. A few girls reported anxiety over sharing the diagnosis with an intimate partner. All of them pretended at some point to have menses. Childbearing was an important issue for most of the interviewees, but it did not concern them for the time being. All girls had supporting families. However, 5 did not want to share information about VDT with them. One girl reported that openness in discussing genital anatomy, VDT and sexuality, helped her both in completing treatment and adapting in a sexual relationship. CLINICAL IMPLICATIONS A multidisciplinary team should aim for age-appropriate disclosure and consultation and guide women through VDT and their sexual relations. STRENGTHS AND LIMITATIONS This is a thorough account of women's perceptions regarding VDT and sexuality in MRKH. However, our conclusions may be limited by the small number of participants. CONCLUSION Gradual provision of information at disclosure and adjusted timing at VDT may reduce stress in girls with MRKH. Tsitoura A, Michala L. The Sexuality of Adolescents and Young Women With MRKH Syndrome: A Qualitative Study. J Sex Med 2021;XX:XXX-XXX.
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Affiliation(s)
- Anastasia Tsitoura
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece.
| | - Lina Michala
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
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12
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Ufuk F. A 17-year-old girl with primary amenorrhea: Answers. Pediatr Nephrol 2021; 36:2093-2094. [PMID: 33496850 DOI: 10.1007/s00467-021-04943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Furkan Ufuk
- Department of Radiology, University of Pamukkale, Kinikli, 20100, Denizli, Turkey.
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13
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Ibidapo-Obe O, Okudo J, Filani O. Incidental Finding of Leiomyoma in Mayer-Rokitansky-Kuster-Hauser Syndrome. J Investig Med High Impact Case Rep 2021; 9:23247096211014690. [PMID: 33985356 PMCID: PMC8127750 DOI: 10.1177/23247096211014690] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a sexual developmental disorder. In this disorder, there is a congenital absence of the uterus and vagina with normal external genitalia. The etiology is not well understood. Variations of this condition exist that may include congenital abnormalities and psychological problems. In this article, we discuss the case of a 47-year-old African American female who presented with acute renal failure, solitary right kidney, and a pelvic mass extending from the pelvis to the right hypochondrium determined to be a fibroid. The patient was managed by a multidisciplinary team, dialyzed, and planned for removal of the mass. While understanding the low probability of having fibroids without a uterus, fibroids should not be excluded from such patients. It is also important to consider the emotional and psychological well-being of such patients.
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14
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Hatim H, Zainuddin AA, Anizah A, Kalok A, Daud TIM, Ismail A, Nurazurah AG, Grover S. The Missing Uterus, the Missed Diagnosis, and the Missing Care. Mayer-Rokitansky-Küster-Hauser Syndrome in the Lives of Women in Malaysia. J Pediatr Adolesc Gynecol 2021; 34:161-167. [PMID: 33189898 DOI: 10.1016/j.jpag.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/18/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To explore the effect of the diagnosis of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome on affected Malaysian women. DESIGN Qualitative study with a quantitative component. SETTING Pediatric and adolescent gynecology unit at Universiti Kebangsaan Malaysia Medical Centre, Malaysia. PARTICIPANTS Twelve women with MRKH. INTERVENTIONS Face-to-face interview and short questionnaire. MAIN OUTCOME MEASURES Thematic analysis was used to understand participants' experiences. RESULTS There were 7 themes identified: (1) delayed diagnoses; (2) doctors' roles and attitudes; (3) gender identity; (4) family and society's response; (5) reaction toward infertility; (6) managing sexual intimacy; and (7) coping mechanisms. Several participants consulted their physicians regarding their primary amenorrhea at an opportunistic setting. When they were referred to the gynecologists, they were dismayed at the lack of information given. The term, "MRKH" plays an important role to ease information-seeking. Participants felt that the doctors were insensitive toward them. Mental illness is a significant complication of MRKH. All participants acknowledged that infertility was the hardest part of the condition. The importance of blood lineage affects their outlook on childbearing options. Some were afraid of sexual intimacy and worried that they would not be able to satisfy their partners. Participants gained support and bonded with their counterparts in the MRKH support group. CONCLUSION A multidisciplinary approach including medical, psychological, and social support is essential for the management of MRKH. Adequate information and sexual education plays the utmost importance in preventing social-related complications of MRKH.
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Affiliation(s)
- H Hatim
- Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - A A Zainuddin
- Paediatric Adolescent Gynaecology Unit, Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A Anizah
- Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A Kalok
- Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - T I Mohd Daud
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A Ismail
- Department of Public Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - A G Nurazurah
- Paediatric Adolescent Gynaecology Unit, Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - S Grover
- Department of Gynaecology, Royal Children Hospital Melbourne, Melbourne, Australia
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15
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Fischer N, Xun H, Lossie A, Fadavi D, Darrach H, Yesantharao P, Kraenzlin F, Singh B, Sacks JM, Segars JH. Perspectives of 281 patients with Mayer-Rokitansky-Küster-Hauser Syndrome on uterine transplantation. Fertil Steril 2021; 115:1074-83. [PMID: 33468312 DOI: 10.1016/j.fertnstert.2020.10.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To investigate the personal, ethical, and financial perspectives of individuals with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), a congenital uterine factor infertility condition, regarding uterine transplantation (UTx). DESIGN Cross-sectional, quantitative survey. SETTING A 60-item anonymous electronic questionnaire was disseminated via social media sites. PATIENTS International members of the Beautiful You MRKH Foundation. INTERVENTIONS None. MAIN OUTCOME MEASURES The survey contained UTx educational materials followed by questions assessing participants' baseline knowledge, global perceptions, financial concerns, and ethical considerations regarding UTx. RESULTS We received 281 responses, with a mean participant age of 28.2 ± 9.8 years. After reviewing the education material, most participants considered receiving a UTx (73%), believed that it should be an option for all women with uterine factor infertility (86%), and believed that it should be covered by health insurance (78%). Respondents perceived the benefits of the procedure to outweigh the risks (67%) and considered it to be an ethical procedure (82%). Almost one-half (49%) were willing to spend more than $10,000 out of pocket to receive the procedure. When asked to rank the risk of UTx to self, donor, and fetus in order of personal importance, 21% ranked their own safety last. CONCLUSION There is a profound desire in the MRKH community for UTx to become more widely available and affordable. MRKH patients may represent a vulnerable population requiring special considerations for informed consent and rigorous evaluation for UTx. Providers caring for MRKH patients should be prepared to provide education about UTx and to thoughtfully engage with news and media outlets to communicate evidence-supported information.
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16
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Carroll S, Laufer MR, Thomas-Kowal P, Lossie AC, Moss-Morris R. From Engulfment to Enrichment: Associations Between Illness Representations, Self-Concept, and Psychological Adjustment in Mayer-Rokitansky-Küster-Hauser Syndrome. J Pediatr Adolesc Gynecol 2020; 33:639-648. [PMID: 32688051 DOI: 10.1016/j.jpag.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/07/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a female reproductive disorder characterized by the absence or underdevelopment of the uterus, cervix and vagina. Limited research has examined factors related to psychological adjustment in MRKH. This study aimed to explore associations among illness representations, self-concept, psychological distress, and self-esteem in MRKH. DESIGN Cross-sectional. SETTING Participants were recruited globally online and from patient meetings. PARTICIPANTS A total of 263 patients with MRKH (age 16.1-74.4 years; mean = 31.7 years) completed questionnaires. INTERVENTION None. MAIN OUTCOME MEASURES Validated self-reported measures of psychological distress and self-esteem (outcomes) and illness representations, self-concept, social support-seeking, and positive affect (hypothesized correlates) were explored in correlation and hierarchical regression analyses, alongside demographic and clinical variables. RESULTS Younger age and shorter time since diagnosis was associated with higher distress and lower self-esteem. Patients with MRKH reported significantly higher distress and lower self-esteem than the general population. Higher distress and lower self-esteem were associated with higher reported engulfment (defining one's identity or feeling consumed by MRKH) and beliefs about the serious consequences of MRKH, and lower reported MRKH coherence, enrichment (positive changes to self-identity because of MRKH) and positive affect. CONCLUSIONS Findings suggest that the impact of MRKH on identity plays an important role in adjustment. High perceived coherence and maintenance of positive affect may play a protective role in psychological adjustment. A 12-month follow-up study is planned to examine associations among these variables longitudinally. Baseline data suggest that early availability of psychological support would be beneficial, and interventions focused on identity and psychoeducation about MRKH would be valuable.
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Affiliation(s)
- Susan Carroll
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK.
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA; Center for Young Women's Health and Division of Gynecology, Boston Children's Hospital, Boston, MA
| | - Phaedra Thomas-Kowal
- Center for Young Women's Health and Division of Gynecology, Boston Children's Hospital, Boston, MA
| | - Amy C Lossie
- Beautiful You MRKH Foundation, Silver Spring, MD; The Global MRKH Consortium, Silver Spring, MD
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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17
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Liang G, Xia W, Liang Y, Zhu Q, Zou L, Zhang J, Jiang H. Mayer-Rokitansky-Küster-Hauser syndrome with rare findings of inferior crossed-fused renal ectopia and Gartner's duct cyst: a video case report. Fertil Steril 2021; 115:525-7. [PMID: 33069370 DOI: 10.1016/j.fertnstert.2020.08.1433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the treatments of a patient using the laparoscopic Davydov's method for Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and ureteral reimplantation for hydronephrosis and hydroureter. DESIGN Surgical video article. A consent form from the patient was obtained as appropriate; the nature of the study did not necessitate ethics committee approval. There were no conflicts of interest. SETTING University hospital. PATIENT(S) A 28-year-old woman who presented at our gynecology department with the symptoms of primary amenorrhea and difficult intercourse. She had repaired congenital rectovestibular fistula and imperforate anus at the age of 8. At physical examination, she had a phenotypically normal vulva with a vaginal small pouch (0.5 cm). Magnetic resonance imaging of the pelvis revealed normal ovaries, a primordial uterus, absence of vaginal canal, and a 4.0 × 4.2 × 4.0 cm cystic structure posterior to the bladder. Magnetic resonance urography showed right to left renal crossed-ectopia with inferior fusion, and hydronephrosis and hydroureter from the superior kidney with Grade Ⅳ vesicoureteral reflux. Karyotype was 46, XX. INTERVENTION(S) Saline solution 300 mL was injected into the rectovesical space with an infusion of diluted adrenaline (1:200,000). The goal of this injection was to aid in the identification of tissue planes and reduce blood loss. The space between urethra/bladder and rectum progressively was dissected. Blunt dissection was performed initially with digital separation of tissues. Then, an 8-cm-long neovaginal vault of about 3 cm in diameter was created. The mobilized peritoneum was pulled downward with eight Vicryl sutures and connected to the vaginal epithelium. By cystoscope, we found the left orifice but could not find the right orifice of the hydroureter. Then we ligated the hydroureter by 2-0 absorbable suture near the cyst and cut off the hydroureter, and then incised of all the layers at the top of the bladder to make a bladder flap. We placed the 5 Fr double J stent in the hydroureter and the bladder and anastomozed with the ureteral stump (3-0 Vicryl). Then we removed the cyst laparoscopically. We performed a purse-string stitch to create the apex of the neovagina by taking posterior serosa of the bladder, the pelvic peritoneum between the ovary and rectum, primordial uterus, and anterior rectal serosa. MAIN OUTCOME MEASURE(S) Measurement of the final canal length, sexual function (Female Sexual Function Index), and degree of hydronephrosis. RESULT(S) Three days later, we started to change the vaginal mold and the patient was advised to wear it day and night for the first postoperative month. The vaginal mold had to be worn each night until normal sexual intercourse was possible. Findings confirmed the cyst was Gartner's duct cyst. One year after the surgery, the final canal length was 9 cm and Female Sexual Function Index score was 28. The ultrasound showed that the degree of hydronephrosis of upper moiety was mild. CONCLUSION(S) The distal Wolffian ducts in the female are absorbed but may persist as vestigial remnants (Gartner's duct cysts). A few cases of the combined urogenital-Wolffian anomalies are reported; most of them are associated with the anomalies of müllerian duct fusion, such as Herlyn-Werner-Wunderlich syndrome (uterus didelphys, obstructed hemivagina, and mesonephric duct anomalies). The embryogenesis of the combined anomalies is not completely understood. With comprehensive preoperative assessments, laparoscopic surgery could be a safe and effective treatment to these cases.
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18
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Hentrich T, Koch A, Weber N, Kilzheimer A, Maia A, Burkhardt S, Rall K, Casadei N, Kohlbacher O, Riess O, Schulze-Hentrich JM, Brucker SY. The Endometrial Transcription Landscape of MRKH Syndrome. Front Cell Dev Biol 2020; 8:572281. [PMID: 33072755 PMCID: PMC7542331 DOI: 10.3389/fcell.2020.572281] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome (OMIM 277000) is characterized by agenesis of the uterus and upper part of the vagina in females with normal ovarian function. While genetic causes have been identified for a small subset of patients and epigenetic mechanisms presumably contribute to the pathogenic unfolding, too, the etiology of the syndrome has remained largely enigmatic. A comprehensive understanding of gene activity in the context of the disease is crucial to identify etiological components and their potential interplay. So far, this understanding is lacking, primarily due to the scarcity of samples and suitable tissue. In order to close this gap, we profiled endometrial tissue of uterus rudiments in a large cohort of MRKH patients using RNA-seq and thereby provide a genome-wide view on the altered transcription landscape of the MRKH syndrome. Differential and co-expression analyses of the data identified cellular processes and candidate genes that converge on a core network of interconnected regulators that emerge as pivotal for the perturbed expression space. With these results and browsable access to the rich data through an online tool we seek to accelerate research to unravel the underlying biology of the syndrome.
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Affiliation(s)
- Thomas Hentrich
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - André Koch
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Nico Weber
- Applied Bioinformatics, Department of Computer Science, University of Tübingen, Tübingen, Germany.,Institute for Bioinformatics and Medical Informatics, University of Tübingen, Tübingen, Germany
| | - Alexander Kilzheimer
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Ana Maia
- Division of Molecular Genome Analysis, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simone Burkhardt
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Katharina Rall
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany.,Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Nicolas Casadei
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,NGS Competence Center Tübingen (NCCT), Tübingen, Germany
| | - Oliver Kohlbacher
- Applied Bioinformatics, Department of Computer Science, University of Tübingen, Tübingen, Germany.,Institute for Bioinformatics and Medical Informatics, University of Tübingen, Tübingen, Germany.,Institute for Translational Bioinformatics, University Hospital Tübingen, Tübingen, Germany.,Biomolecular Interactions, Max Planck Institute for Developmental Biology, Tübingen, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany.,NGS Competence Center Tübingen (NCCT), Tübingen, Germany
| | | | - Sara Yvonne Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany.,NGS Competence Center Tübingen (NCCT), Tübingen, Germany
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19
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Jokimaa V, Virtanen J, Kujari H, Ala-Nissilä S, Rantanen V. A Mayer-Rokitansky-Kuster-Hauser patient with leiomyoma and dysplasia of neovagina: a case report. BMC Womens Health 2020; 20:157. [PMID: 32723331 PMCID: PMC7388509 DOI: 10.1186/s12905-020-01026-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/19/2020] [Indexed: 12/22/2022]
Abstract
Background Most patients with congenital uterus and vaginal aplasia (i.e., Mayer–Rokitansky–Kuster–Hauser [MRKH] syndrome) have rudimentary pelvic uterine structures that contain smooth muscle. Although leiomyomas and dysplasia of vaginal mucosa are relatively common in the general population, they are rare in MRKH patients. Data on the vulnerability of neovaginas to HPV-associated dysplasia are limited. Case presentation A rare case of an MRKH patient with two gynaecological conditions detected during long-term gynaecological follow-up is presented. At the age of 21, the patient was treated for HPV-associated neovaginal dysplasia. At the age of 47, a pelvic leiomyoma was detected with transvaginal ultrasound and confirmed with magnetic resonance imaging. Conclusion A Pap smear or human papillomavirus testing is indicated in sexually active MRKH women. Uterine rudiments contain smooth muscle, which facilitates the development of oestrogen-dependent diseases, such as leiomyomas and adenomyosis. Although magnetic resonance imaging is recommended in cases of a pelvic mass, easily attainable and cost-efficient transvaginal ultrasound offers high diagnostic accuracy in patients with a surgically created neovagina and is suitable for the patients’ follow-up. Guidelines for the gynaecological follow-up of MRKH patients are warranted.
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Affiliation(s)
- Varpu Jokimaa
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland.
| | - Johanna Virtanen
- Department of Radiology, Turku University Hospital and University of Turku, 20521, Turku, Finland
| | - Harry Kujari
- Institute of Biomedicine, Research Center for Cancer, Infections and Immunity, University of Turku, 20014, Turku, Finland.,Department of Pathology, Turku University Hospital, 20521, Turku, Finland
| | - Seija Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
| | - Virpi Rantanen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
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Anant M, Raj N, Yadav N, Prasad A, Kumar S, Saxena AK. Two Distinctively Rare Syndromes in a Case of Primary Amenorrhea: 18p Deletion and Mayer-Rokitansky-Kuster-Hauser Syndromes. J Pediatr Genet 2019; 9:193-197. [PMID: 32714621 DOI: 10.1055/s-0039-1700577] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome and 18p deletion syndrome, two genetic disorders having distinct genetic etiologies, have an exceedingly rare likelihood of coexistence. Vaginal agenesis or MRKH syndrome, the developmental failure of Mullerian ductal system-derived structures in a genotypic female fetus (46, XX), leads to congenital absence of uterus and vagina in variable degree. The 18p deletion syndrome is a rare chromosomal disorder, characterized by dysmorphic features, stunted growth, and mental retardation, which is caused by deletion of a part or all of the short arm of chromosome 18. A detailed evaluation of primary amenorrhea in a 16-year-old girl yielded both MRKH syndrome and 18p deletion syndrome. Extensive literature search could not identify any reported case bearing this combination of syndromes. This case presentation and review emphasizes on the importance of karyotyping in MRKH patients having atypical features.
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Affiliation(s)
- Monika Anant
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Nutan Raj
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Neelu Yadav
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Arun Prasad
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Subhash Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ajit K Saxena
- Department of Pathology/Laboratory medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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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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Chmel R, Pastor Z, Mužík M, Brtnický T, Nováčková M. Syndrome Mayer-Rokitansky-Küster-Hauser - uterine and vaginal agenesis: current knowledge and therapeutic options. Ceska Gynekol 2019; 84:386-392. [PMID: 31826637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Evaluation of existing knowledge of etiopathogenesis, clinical manifestations and treatment options to increase quality of life in women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH). DESIGN Review article. SETTING Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague. METHODS Literature search using the Web of Science, Google Scholar and Medline databases with keywords (absolute uterine infertility factor, AUFI, Mayer-Rokitansky-Küster-Hauser syndrome, MRKH, uterine transplantation) and analysis of articles published in impact and reviewed journals. RESULTS MRKH syndrome is defined as congenital agenesis of the upper two-thirds of vagina and uterus in women with normal secondary sexual characteristics and female karyotype (46, XX). The incidence of the syndrome is 1 : 4500 births of female sex children. It is the second most common cause of primary amenorrhea. Recent research has focused on elucidating the genetic origin of the disease, focusing on the research of candidate genes that could be participating in the genesis of Müllerian ducts and their derivatives. CONCLUSION MRKH syndrome now appears as a multifactorial congenital developmental defect based on a combination of genetic predisposition and environmental factors. Modern medicine can help girls with MRKH syndrome to a quality sexual life. It is also able to offer different possibilities of achieving motherhood. In the future, however, further research is needed, in particular on the etiology and pathogenesis of this syndrome to detect a possible genetic basis of the disease.
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Chmel R, Novackova M, Pastor Z, Fronek J. The Interest of Women with Mayer-Rokitansky-Küster-Hauser Syndrome and Laparoscopic Vecchietti Neovagina in Uterus Transplantation. J Pediatr Adolesc Gynecol 2018; 31:480-484. [PMID: 29751094 DOI: 10.1016/j.jpag.2018.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/19/2017] [Revised: 02/21/2018] [Accepted: 04/30/2018] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE The goal of this study was to assess a group of women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with surgically created neovaginas in the interest of uterus transplantation (UTx) and to recruit the first group of applicants for a UTx trial. DESIGN AND SETTING This was an original prospective study using semistructured interviews. PARTICIPANTS A study group of 50 women with MRKH syndrome with Vecchietti neovaginas was recruited via letter of invitation. INTERVENTIONS AND MAIN OUTCOME MEASURES Interest of MRKH women in obtaining experimental UTx for the treatment of absolute uterine factor infertility. RESULTS A total of 50 women responded via e-mail and 31 (62% [31 of 50] of the study group) expressed serious interest in UTx after complete information about its risks and benefits was provided during the first semistructured interview. They subsequently agreed to participate in additional interviews and further examinations. Because of various reasons, only 9 women were prepared to enter our UTx trial (18% [9 of 50] of the study group). Three recipients/donors were accepted into the living donor arm and 6 into the deceased brain donor arm of the trial. CONCLUSION Nearly two-thirds of our MRKH syndrome study group women with surgically created neovaginas were interested in UTx and motivated to undergo this method of absolute uterine factor infertility treatment. Therefore, this group of women might be approached to participate in ongoing and future UTx trials. Future studies of women with MRKH syndrome might confirm or disprove the results of our survey.
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Affiliation(s)
- Roman Chmel
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
| | - Marta Novackova
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Zlatko Pastor
- Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jiri Fronek
- Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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AlSubaihin A, VanderMeulen J, Harris K, Duck J, McCready E. Müllerian Agenesis in Cat Eye Syndrome and 22q11 Chromosome Abnormalities: A Case Report and Literature Review. J Pediatr Adolesc Gynecol 2018; 31:158-161. [PMID: 28919146 DOI: 10.1016/j.jpag.2017.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/04/2017] [Accepted: 09/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although Müllerian agenesis is the second most common cause of primary amenorrhea the underlying etiology in most cases is unknown. Müllerian agenesis has been reported as a rare finding associated with chromosomal aberrations of the 22q11 chromosomal region including at least 1 individual with cat eye syndrome (CES) and 10 individuals with deletions or duplications of the 22q11.2 region. However, a potential link between 22q11 abnormalities and uterine malformations has been difficult to adequately ascertain because of the limited case reports in the literature. CASE We report a second case of Müllerian agenesis in a girl with CES. A 16-year-old girl presented with bilateral colobomata, primary amenorrhea, and absence of the uterus and upper vagina on pelvic magnetic resonance imaging. Microarray analysis showed tetrasomy of the pericentromeric region of chromosome 22 diagnostic of CES. SUMMARY AND CONCLUSION Müllerian aplasia/hypoplasia might represent a rare feature in CES and should be considered in the investigation of young girls with this syndrome. An increasing number of cases with 22q11 chromosome abnormalities and Müllerian agenesis further highlights the possibility of a gene within the 22q11 region that might mediate normal Müllerian development in girls.
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Affiliation(s)
- Abdulmajeed AlSubaihin
- Division of Endocrinology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, King Saud University Hospital, Riyadh, Saudi Arabia.
| | - John VanderMeulen
- Division of Endocrinology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kate Harris
- Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - John Duck
- Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Elizabeth McCready
- Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada; Department Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Verma R, Shah R, Anand S, Vaja C, Gaikwad K. Mayer-Rockitansky-Kuster-Hauser Syndrome Presenting as Irreducible Inguinal Hernia. Indian J Surg 2018; 80:93-95. [PMID: 29581694 DOI: 10.1007/s12262-017-1673-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/29/2017] [Indexed: 11/29/2022] Open
Abstract
Inguinal hernia is the most common type of hernia experienced in the surgical OPD due to the muscular anatomy of the region being weak along with the natural weaknesses like deep ring with indirect hernia being more common than direct. Inguinal hernias may have varying unusual sac contents, a case presentation of rudimentary uterus and ovaries as contents of inguinal hernia in an adult female with Mayer-Rokitansky-Kuster-Hauser (MRKH) type II syndrome. This syndrome may be attributed to abnormal development of blastema of cervicothoracic somites and pronephriducts.
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Affiliation(s)
- Radha Verma
- Department of Surgery at K.J. Somaiya Medical College, Mumbai, India
| | - Rajul Shah
- Department of Surgery at K.J. Somaiya Medical College, Mumbai, India
| | - Swarup Anand
- Department of Surgery at K.J. Somaiya Medical College, Mumbai, India
| | - Chirag Vaja
- Department of Surgery at K.J. Somaiya Medical College, Mumbai, India
| | - Kiran Gaikwad
- Department of Surgery at K.J. Somaiya Medical College, Mumbai, India
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Abstract
The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome [MIM 277000] is characterised by the absence of a uterus and vagina in otherwise phenotypically normal women with karyotype 46,XX. Clinically, the MRKH can be subdivided into two subtypes: an isolated or type I form can be delineated from a type II form, which is characterised by extragenital malformations. The so-called Müllerian hypoplasia, renal agenesis, cervicothoracic somite dysplasia (MURCS) association can be seen as the most severe phenotypic outcome. The MRKH syndrome affects at least 1 in 4000 to 5000 female new-borns. Although most of the cases are sporadic, familial clustering has also been described, indicating a genetic cause of the disease. However, the mode of inheritance is autosomal-dominant inheritance with reduced penetrance. High-resolution array-CGH and MLPA analysis revealed recurrent aberrations in different chromosomal regions such as TAR susceptibility locus in 1q21.1, chromosomal regions 16p11.2, and 17q12 and 22q11.21 microduplication and -deletion regions in patients with MRKH. Sequential analysis of the genes LHX1, TBX6 and RBM8A, which are located in chromosomal regions 17q12, 16p11.2 and 1q21.1, yielded in the detection of MRKH-associated mutations. In a subgroup of patients with signs of hyperandrogenaemia mutations of WNT4 have been found to be causative. Analysis of another member of the WNT family, WNT9B, resulted in the detection of some causative mutations in MRKH patients.
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Affiliation(s)
- Susanne Ledig
- Institute of Human Genetics, Westfälische Wilhelms-Universität, Vesaliusweg 12–14, 48149 Münster, Germany
| | - Peter Wieacker
- Institute of Human Genetics, Westfälische Wilhelms-Universität, Vesaliusweg 12–14, 48149 Münster, Germany
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Demir Eksi D, Shen Y, Erman M, Chorich LP, Sullivan ME, Bilekdemir M, Yılmaz E, Luleci G, Kim HG, Alper OM, Layman LC. Copy number variation and regions of homozygosity analysis in patients with MÜLLERIAN aplasia. Mol Cytogenet 2018; 11:13. [PMID: 29434669 PMCID: PMC5797403 DOI: 10.1186/s13039-018-0359-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/16/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Little is known about the genetic contribution to Müllerian aplasia, better known to patients as Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Mutations in two genes (WNT4 and HNF1B) account for a small number of patients, but heterozygous copy number variants (CNVs) have been described. However, the significance of these CNVs in the pathogenesis of MRKH is unknown, but suggests possible autosomal dominant inheritance. We are not aware of CNV studies in consanguineous patients, which could pinpoint genes important in autosomal recessive MRKH. We therefore utilized SNP/CGH microarrays to identify CNVs and define regions of homozygosity (ROH) in Anatolian Turkish MRKH patients. RESULTS Five different CNVs were detected in 4/19 patients (21%), one of which is a previously reported 16p11.2 deletion containing 32 genes, while four involved smaller regions each containing only one gene. Fourteen of 19 (74%) of patients had parents that were third degree relatives or closer. There were 42 regions of homozygosity shared by at least two MRKH patients which was spread throughout most chromosomes. Of interest, eight candidate genes suggested by human or animal studies (RBM8A, CMTM7, CCR4, TRIM71, CNOT10, TP63, EMX2, and CFTR) reside within these ROH. CONCLUSIONS CNVs were found in about 20% of Turkish MRKH patients, and as in other studies, proof of causation is lacking. The 16p11.2 deletion seen in mixed populations is also identified in Turkish MRKH patients. Turkish MRKH patients have a higher likelihood of being consanguineous than the general Anatolian Turkish population. Although identified single gene mutations and heterozygous CNVs suggest autosomal dominant inheritance for MRKH in much of the western world, regions of homozygosity, which could contain shared mutant alleles, make it more likely that autosomal recessively inherited causes will be manifested in Turkish women with MRKH.
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Affiliation(s)
- Durkadin Demir Eksi
- Department of Medical Biology, Alanya Alaaddin Keykubat University, Faculty of Medicine, Antalya, Turkey
| | - Yiping Shen
- Guangxi Maternal and Child Health Hospital, Nanning, China
- Department of Pathology, Harvard Medical School, Boston, MA 02115 USA
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115 USA
- Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127 China
| | - Munire Erman
- Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Lynn P. Chorich
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
| | - Megan E. Sullivan
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
| | - Meric Bilekdemir
- Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Elanur Yılmaz
- Department of Medical Biology and Genetics, Akdeniz University, Faculty of Medicine, 07058 Antalya, Turkey
| | - Guven Luleci
- Department of Medical Biology and Genetics, Akdeniz University, Faculty of Medicine, 07058 Antalya, Turkey
| | - Hyung-Goo Kim
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
| | - Ozgul M. Alper
- Department of Medical Biology and Genetics, Akdeniz University, Faculty of Medicine, 07058 Antalya, Turkey
| | - Lawrence C. Layman
- Section of Reproductive Endocrinology, Infertility, & Genetics, Department of Obstetrics & Gynecology Medical College of Georgia at Augusta University, Augusta, GA USA
- Department of Neuroscience & Regenerative Medicine, Medical College of Georgia at Augusta University, 1120 15th Street, CA2041, Augusta, GA 30912 USA
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Adeyemi-Fowode OA, Dietrich JE. Assessing the Experience of Vaginal Dilator Use and Potential Barriers to Ongoing Use among a Focus Group of Women with Mayer-Rokitansky-Küster-Hauser Syndrome. J Pediatr Adolesc Gynecol 2017; 30:491-4. [PMID: 28216131 DOI: 10.1016/j.jpag.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/21/2017] [Accepted: 02/09/2017] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To assess the experience of dilator use for neovagina creation in women diagnosed with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and identify barriers affecting patient compliance with dilator use. DESIGN AND SETTING This was a qualitative study using a structured questionnaire to investigate perception and identify barriers regarding vaginal dilator use. A questionnaire was administered after participants viewed a 2-minute patient educational video to additionally examine the usefulness of a patient education video tool as an adjunct to counseling in clinic on vaginal dilator use. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES We enrolled 13 adolescent girls and women diagnosed with MRKH, aged 14-48 years, recruited from clinic and during a conference geared toward women affected by MRKH. RESULTS The mean age of participants was 26 (±11.4) years with most diagnosed between the ages of 12 and 18 years. Of all participants, 69% (9/13) reported ever being sexually active with a mean age of coitarche of 16 (±2.6) years. Seventy-seven percent (10/13) reported current or past use of vaginal dilators, and most had some previous education on dilator use. Only 15% (2/13) reported no previous exposure to an educational tool. After viewing the 2-minute educational video, all participants rated it very helpful using a Likert scale (strongly agree to strongly disagree). Major themes that emerged as perceived barriers to dilator use included viewing dilation as a negative experience, uncertainty about success, and lack of motivation. CONCLUSION Education is an integral part of improving compliance with vaginal dilator use among adolescent girls and women affected by MRKH. Technology can be used to reinforce face-to-face counseling in the clinic. To our knowledge, this is the first study to specifically investigate patient experience with dilator use and opinion regarding the use of video technology to demonstrate self-directed neovagina creation in an MRKH population. The barriers identified in this study provide new insights to inform future research and clinical management of dilator use.
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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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Vatsa R, Bharti J, Roy KK, Kumar S, Sharma JB, Singh N, Singhal S, Meena J. Evaluation of amnion in creation of neovagina in women with Mayer-Rokitansky-Kuster-Hauser syndrome. Fertil Steril 2017. [PMID: 28624115 DOI: 10.1016/j.fertnstert.2017.05.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the outcome of amnion vaginoplasty in cases of vaginal agenesis due to Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome managed at the authors' institution. DESIGN Retrospective study. SETTING Tertiary care hospital. PATIENT(S) Fifty women with MRKH who underwent neovaginoplasty. INTERVENTION(S) Modified McIndoe's vaginoplasty was done in all the patients, using human amnion graft. MAIN OUTCOME MEASURE(S) Functional status assessed by Female Sexual Function Index, anatomic status (length and width of neovagina), and epithelialization of vagina. RESULT(S) Mean (±SD) vaginal length after surgery was 8.2 ± 1 cm. Mean vaginal length at 6-month follow-up in sexually active patients was significantly longer as compared with the patients who were not sexually active after surgery (8.4 ± 1.04 cm vs. 6.6 ± 2.4 cm). Mean Female Sexual Function Index score was 30.8 ± 2.1. Vaginal biopsy showed complete epithelialization of vaginal mucosa. CONCLUSION(S) In a developing nation like India, McIndoe's method with amnion graft seems to be a promising option owing to its low cost, easy availability, and safety, ease of the procedure not requiring any special instrument, physiologic outcome with respect to epithelialization of the vagina without hair growth, and satisfying functional outcome.
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Affiliation(s)
- Richa Vatsa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Kallol Kumar Roy
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunesh Kumar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Kuessel L, Wenzl R, Marschalek ML, Slavka G, Doerfler D, Husslein H. Using the Wharton-Sheares-George method to create a neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a step-by-step video tutorial. Fertil Steril 2016; 106:e20-e21. [PMID: 27678038 DOI: 10.1016/j.fertnstert.2016.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To provide a review of the literature regarding this technique as well as a step-by-step description with the goal of increasing its use as a safe surgical option. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by vaginal agenesis and a variety of mullerian duct anomalies. To date, a variety of procedures have been described for creating a neovagina, but the best treatment remains debated. The Wharton-Sheares-George method, a minimally invasive surgical approach for the creation of a neovagina, is remarkably simple to perform. DESIGN Surgical video tutorial. SETTING University hospital and referral center for pediatric and adolescent gynecology. PATIENT(S) A 20-year-old woman with MRKH syndrome who underwent Wharton-Sheares-George neovaginoplasty. INTERVENTION(S) With the Wharton-Sheares-George neovaginoplasty the rudimentary müllerian ducts are dilated incrementally by pushing Hegar dilators in the direction of the pelvic axis, and the resulting median raphe is then intersected using diathermy. Subsequently a vaginal mold is inserted into the newly created cavity and held in position by two sutures. MAIN OUTCOME MEASURE(S) Discussion of the surgical steps according to the Wharton-Sheares-George method and review of the anatomic and functional results. RESULTS Reviewing the existing literature shows that a mean vaginal length and width of 8.3 and 3.3 cm, respectively, can be achieved, and so far no major intraoperative or postoperative complications or prolapse of the neovagina has been reported. Patients can achieve a high degree of general well-being as well as sexual and psychosocial functioning. However, as with most other methods, the presented method requires diligent patient compliance due to the lifelong need to actively avoid contraction of the neovagina. Also, as revealed by vaginal cultures and biopsies, the neovaginas remarkably resemble natural vaginas with regard to type of bacterial colonization and structure of epithelium. The process of spontaneous epithelialization of the neovagina is not fully understood, but has been observed to begin at the vaginal orifice and take several months to reach the apex. This leads to the assumption that the nonkeratinizing, stratified squamous epithelium originates from the preexisting vaginal epithelium of the vaginal dimple and migrates in a cranial direction. Alternatively, epithelialization might arise from pluripotent stem cells located in the obliterated müllerian ducts. CONCLUSION(S) The creation of a neovagina using the Wharton-Sheares-George method does not require allogenic or autologous transplants, nor does it require traction devices or specialized surgical equipment. Furthermore, the procedure is comparatively simple to perform and easy to learn. By following our step-by-step description of this technique, surgeons can offer a minimally invasive, quick, and safe surgical option that provides long-term results that are both functionally and anatomically satisfying. We believe that this technique represents a valuable alternative for the creation of a neovagina in patients with MRKH syndrome and thus should be investigated on a broader scale in the future.
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Affiliation(s)
- Lorenz Kuessel
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - René Wenzl
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria.
| | | | - Georg Slavka
- Department of Laboratory Medicine, Wilhelminen Hospital, Vienna, Austria
| | - Daniela Doerfler
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Heinrich Husslein
- Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
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Ernst ME, Sandberg DE, Keegan C, Quint EH, Lossie AC, Yashar BM. The Lived Experience of MRKH: Sharing Health Information with Peers. J Pediatr Adolesc Gynecol 2016; 29:154-8. [PMID: 26453829 DOI: 10.1016/j.jpag.2015.09.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To examine the process and emotional effect of disclosing a personal diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) to peers during adolescence and young adulthood. DESIGN AND SETTING Qualitative study using semistructured telephone interviews. PARTICIPANTS Nine women diagnosed with MRKH, aged 21-31 years, recruited via patient support groups. INTERVENTIONS AND MAIN OUTCOME MEASURES Motivators and barriers to self-disclosure of a diagnosis of MRKH to peers and partners. RESULTS Motivators to tell peers about a diagnosis included significant trust in the relationship (whether platonic or romantic), needing to unload the experienced burden of diagnosis, and a sense of responsibility to be forthcoming if a long-term romantic future was desired. The most common barrier to telling others was fear of rejection or being labeled a "freak." Although most participants did not receive guidance from a health care provider regarding approaches to sharing diagnostic information with others, almost all participants reported wishing they had received such counseling. CONCLUSION A diagnosis of MRKH elicits recurring anxieties about disclosure and the effect on relationships that are inadequately addressed by health care providers. Guidance and support on disclosure to friends and romantic partners should be provided whenever possible.
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Affiliation(s)
- Michelle E Ernst
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan.
| | - David E Sandberg
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Catherine Keegan
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Amy C Lossie
- Department of Animal Sciences, Purdue University, Lafayette, Indiana
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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Abstract
The congenital aplasia or severe hypoplasia of mullerian structures is infrequent. However, the features of normal female endocrine function paired with the absence of a functional uterus and vagina makes it a fascinating entity. The diagnosis and work-up in these patients has become very efficient, thanks to the use of imaging, and there are multiple successful procedures for the creation of a neovagina. In recent years, infertility treatment options through in vitro fertilization have also become available as part of the long-term care of these patients.
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Affiliation(s)
- Laura Londra
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Farah S Chuong
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa Kolp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
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Friedler S, Grin L, Liberti G, Saar-Ryss B, Rabinson Y, Meltzer S. The reproductive potential of patients with Mayer-Rokitansky-Küster-Hauser syndrome using gestational surrogacy: a systematic review. Reprod Biomed Online 2015; 32:54-61. [PMID: 26626805 DOI: 10.1016/j.rbmo.2015.09.006] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 01/16/2023]
Abstract
Women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome may reproduce after uterine transplantation or IVF using a gestational surrogate. As uterine transplantation is still an experimental procedure, data on their clinical outcome using assisted reproduction techniques are imperative to allow evidence-based counselling. For this purpose, a systematic non-restricted electronic literature search was conducted. The 14 studies included in this review were published between 1988 and 2011. From a cohort of 140 patients with MRKH syndrome, mostly from the the USA and Israel, only four studies contained data on more than 10 patients; the others were case reports or small series. In the studies reviewed, 125 patients underwent 369 cycles of IVF with gestational surrogacy, and delivered 71 newborns. The reporting of outcome of patients with MRKH syndrome undergoing assisted reproduction techniques in the available literature is less than optimal and is characterized by bias of publication, inconsistent reports, including few patients, treated over a long time span, and lacking systematic reports from large IVF centres. None of the national registries contain specific outcome data on patients with MRKH syndrome. The paucity of data limits the possibility to draw firm conclusions but substantiates the need for a systematic multicentre reporting system.
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Affiliation(s)
- Shevach Friedler
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Leonti Grin
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gad Liberti
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Buzhena Saar-Ryss
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaakov Rabinson
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Semion Meltzer
- Barzilai Medical Center, Askelon, Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gauthier T, Garnault D, Therme JF, Piver P, Essig M, Pichon N, Marquet P, Aubard Y. [Uterine transplantation: is there a real demand?]. ACTA ACUST UNITED AC 2015; 43:133-8. [PMID: 25595943 DOI: 10.1016/j.gyobfe.2014.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/17/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the demand there is for uterus transplantation (UTx). PATIENTS AND METHODS Recent media coverage of developments in UTx prompted associations of patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and of women suffering from UI to contact us. We sent them anonymous questionnaires devised to sound out their attitude towards UTx and towards adoption and gestational surrogacy (GS). A clinical psychologist also carried out a qualitative discourse analysis. RESULTS Sixty patients answered the questionnaire. Thirty-eight patients were married or living with a male partner. Seven patients had had a hysterectomy. Fifty-one patients had uterine agenesis. Of the 60 patients, 19 and 21, respectively, had ruled out the option of adoption or GS, and 11 would not envisage either possibility. Thirty-five patients were willing to take part in a clinical study into UTx despite the uncertainty of the outcome and the potential risks involved. Of these 35 volunteers, 23 were in a heterosexual relationship and aged ≤35 years. DISCUSSION AND CONCLUSION For women with UI the condition is all the more distressing because there is no medical solution for it. UTx could hold out hope for some of these patients despite the complexity of the procedure and the attendant risks. Because of the feelings of vulnerability engendered by UI, any UTx programme should provide full information to patients and ensure they are carefully screened and selected.
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Delaine M, Ohl J. [Sexual activity and quality of life in patients with Mayer-Rokitansky-Kuster-Hauser syndrome]. ACTA ACUST UNITED AC 2014; 42:865-71. [PMID: 25456491 DOI: 10.1016/j.gyobfe.2014.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 10/14/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study evaluated the sexual activity and the quality of life in patients with a Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. PATIENTS AND METHODS The study is based on a series of patients hospitalized for the treatment of MRKH syndrome in CMCO between 1997 and 2010. Through the medical reports, we recovered information about the pathology, the treatment given and the psychological support proposed to or wished by the patients. The patients also had to answer a questionnary concerning the quality of the informations they received about the treatment, the different types of supports proposed and wanted, their life as a couple and how they communicated about their disease. RESULTS Eleven medical reports have been reviewed. The patients were aged 21 in average at the moment of the treatment. Three patients had some associated malformations. Different methods of treatment were represented (Frank's method, Vecchietti's technique, sigmoid vaginoplasty, McIndoe's technique). Sexual intercourse was assessed as satisfactory by 4 patients. In 8 cases, the partner accepted well the pathology. Only 4 out of the eleven medical reports mentioned a psychological support. Nine out of the eleven patients accepted to answer the questionnary. DISCUSSION AND CONCLUSION The review of the literature and our own results show that the patients with MRKH syndrome have a real need for psychological support. They are able to have sexual intercourse that is satisfactory in the domains of excitation, lubrification and desire, especially after treatment. The main problem is the inability to bear children, a problem which might by solved by the future researches about uterus graft and the evolution of the laws concerning gestational surrogacy.
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Affiliation(s)
- M Delaine
- Service de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67100 Strasbourg, France.
| | - J Ohl
- Service de gynécologie-obstétrique, CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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Johannesson L, Kvarnström N, Mölne J, Dahm-Kähler P, Enskog A, Diaz-Garcia C, Olausson M, Brännström M. Uterus transplantation trial: 1-year outcome. Fertil Steril 2014; 103:199-204. [PMID: 25439846 DOI: 10.1016/j.fertnstert.2014.09.024] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/20/2014] [Accepted: 09/16/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report the 12-month outcome of seven patients with viable uteri after uterus transplantation (UTx). DESIGN Prospective observational study. SETTING University hospital. PATIENT(S) Seven patients with absolute uterine infertility and viable uteri for 12 months after live-donor UTx. INTERVENTION(S) Predetermined immunosuppression was with tacrolimus and mychophenolate mofetil (MMF) during 6 months, whereupon MMF should be withdrawn. Frequent ultrasound examinations were performed to assess uterine appearance and uterine artery blood flow. Cervical biopsies (for histological detection of rejection) were obtained at preset time points, with temporary adjustments of immunosuppression if there were signs of rejection. Menstruations were systematically recorded. MAIN OUTCOME MEASURE(S) Menstruation, uterine artery blood flow, histology of cervical biopsies, and blood levels of tacrolimus. RESULT(S) All patients showed regular menses after 1-2 months. Uterine artery blood flow was unchanged, with a median pulsatility index of 1.9 (range, 0.5-5.4). Blood levels of tacrolimus were approximately 10, 9, and 8 (μg/L) during months 2, 9, and 12, respectively. Four recipients showed mild inflammation in biopsies after MMF withdrawal and were treated with corticosteroids and azathioprine during the remainder of the 12 months. Subclinical rejection episodes were detected on ectocervical biopsies in five recipients. Histology showed apoptotic bodies and occasional spongiosis in the squamous epithelium. Moderate infiltration of lymphocytes and neutrophils was seen in the epithelial/stromal interface. All rejection episodes were successfully treated for 2 weeks with corticosteroids or dose increments of tacrolimus. CONCLUSION(S) We demonstrate long-term uterine viability after UTx, with continued menstruation and unaltered uterine artery blood flow. Subclinical rejection episodes were effectively reversed by temporary increase of immunosuppression. CLINICAL TRIAL REGISTRATION NUMBER NCT01844362.
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Affiliation(s)
- Liza Johannesson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Niclas Kvarnström
- Department of Transplantation, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Johan Mölne
- Department of Clinical Pathology and Genetics, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Anders Enskog
- Department of Anesthesiology and Intensive Care, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Cesar Diaz-Garcia
- Department of Gynecology and Obstetrics, La Fe University Hospital, University of Valencia, Valencia, Spain
| | - Michael Olausson
- Department of Transplantation, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden; Stockholm IVF, Stockholm, Sweden.
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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.
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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
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Will MA, Marsh CA, Smorgick N, Smith YR, Quint EH. Surgical pearls: laparoscopic removal of uterine remnants in patients with Mayer-Rokitansky-Küster-Hauser syndrome. J Pediatr Adolesc Gynecol 2013; 26:224-7. [PMID: 23889918 DOI: 10.1016/j.jpag.2013.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/06/2013] [Accepted: 03/14/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Females with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome may require surgical removal of uterine remnant(s) which can be accomplished with a laparoscopic approach, described in this case series. CASES Nine females with MRKH and pelvic pain were treated with laparoscopic resection of uterine remnants without major complication. The following management recommendations are offered: (1) preoperative evaluation for urinary tract anomalies and postoperative cystoscopy; (2) medial traction of the remnant to allow adequate exposure of the pelvic sidewall; (3) awareness of possible anomalous vascular supply to uterine remnant; (4) individualized management of associated endometriosis; (5) careful use of surgical terminology, avoiding use of the word hysterectomy. SUMMARY AND CONCLUSION Laparoscopic removal of uterine remnant(s) is safe and effective.
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Affiliation(s)
- Matthew A Will
- Department of Obstetrics and Gynecology, School of Medicine, University of Michigan Health System, Ann Arbor, MI 48109, USA
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