A Case of Obstructed Hemivagina with Ectopic Ureter Leading to Severe Hydrocolpos and Contralateral Renal Outflow Tract Obstruction in a Neonate

Preoperative MRI presentations of Herlyn-Werner-Wunderlich syndrome

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare complex female urogenital anomaly, with diverse anatomical presentations. Due to obstruction, most patients with HWW syndrome need to be addressed surgically. The treatment strategy should be tailored to the different anatomical variants of each patient. Therefore, a detailed and comprehensive preoperative evaluation is needed. In this review, we describe the embryology and clinical manifestations of HWW syndrome and discuss and illustrate its diverse preoperative magnetic resonance imaging presentations to guide clinical treatment.

Proposal of the 3O (Obstruction, Ureteric Orifice, and Outcome) Subclassification System Associated with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA)

STUDY OBJECTIVE

To propose a "3O" (obstruction, ureteric orifice, and outcome) subclassification system associated with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA).

DESIGN

Retrospective case series.

SETTING

Xiangya Hospital, Central South University, Changsha, Hunan, China.

PARTICIPANTS

A total of 26 women with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) over a 9-year period.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

In all cases, the obstruction, ureteric orifice, outcome and surgical strategy were reviewed.

RESULTS

In our study, the "obstruction" category included 14 cases of blind hemivagina, 8 cases of buttonhole septum, 3 cases of cervical fistula, and 1 case of cervical atresia. A total of 25 patients with vaginal obstruction underwent resection of the vaginal septum. The patient with cervical atresia underwent a failed cervicoplasty, followed by hemi-hysterectomy. The "ureteric orifice" category included 24 cases of absent ureter with no orifice, as well as 2 cases of ureteric orifice emptying into the obstructed hemivagina. The 2 patients were treated with laparoscopic extirpation of the ectopic ureter and renal moiety. Regarding the "outcome" category, 5 patients with severe recurrent hematometra, hematosalpinx, and ovarian endometrioma underwent hemi-hysterectomy, salpingectomy, and cystectomy of the ovarian endometrioma. Both patients (1 with a septate uterus and 1 with a bicornuate uterus) who experienced recurrent abortion accepted uterine correction.

CONCLUSION

We provide new insights into the anatomical variants of this rare syndrome with the relevant surgical implications. Magnetic resonance imaging is the most useful tool in 3O diagnosis.

The value of surveying the kidneys during pelvic ultrasound examinations

INTRODUCTION

Pelvic ultrasounds are commonly performed for various clinical indications in female patients presenting to the hospital. A survey of the kidneys is routinely included as part of the examination, but there is limited justification for their inclusion in the assessment of every female presenting for a pelvic ultrasound.

METHOD

We examined the utility of surveying the kidney ultrasound during pelvic ultrasonography by reviewing the records of 1009 pelvic ultrasound examinations in 1000 women.

RESULTS

In total, 46 incidental findings were identified, but 91% of these were clinically inconsequential. Only four patients had incidental findings of high clinical priority requiring specialist treatment. Of these, two patients were symptomatic and had urinary tract obstruction due to stones. The other two patients harboured asymptomatic renal cell carcinomas. The overall incidence of renal incidental findings of high clinical priority in asymptomatic patients was two in 1009 examinations (1999 kidneys).

CONCLUSION

Indiscriminate uncritical screening of the kidneys in women presenting for pelvic ultrasound is not evidence-based and represents a low-yield examination with extremely low rate of incidental findings of clinical significance.