Diagnosis and management of hydrometrocolpos in infancy

Ultrasound-guided fluid aspiration and prenatal diagnosis of duplicated hydrometrocolpos with uterus didelphys and septate vagina

We report on a case of duplicated hydrometrocolpos with uterus didelphys, a septate vagina, lower vaginal atresia, a persistent urogenital sinus, left ear agenesis, a single umbilical artery, and an imperforate anus, but without the associated features of McKusick-Kaufman syndrome such as polydactyly and congenital heart defects. Ultrasound-guided fluid aspiration of the fetal intrapelvic cystic mass helped to decompress the distended genital organs, decrease the severity of the urinary tract obstruction, delineate the ultrasonographic image of duplicated hydrometrocolpos to differentiate it from other intrapelvic cystic masses, and obtain fluid for cytological analysis.

Uterus didelphys and vaginal duplication with unilateral obstruction presenting as a newborn abdominal mass

Vaginal duplication with uterus didelphys is a rare anomaly in which unilateral obstruction of either vaginal orifice may result in hydrocolpos but with normal-appearing external genitalia in the female newborn. We recently treated 2 female infants with this anomaly who presented with a lower abdominal mass that persisted after bladder drainage. Both infants had evidence of urological abnormalities on the side ipsilateral to the obstructed vagina. One infant had renal agenesis and 1 had severe renal dysplasia. Owing to the high incidence of associated renal abnormalities excretory urography, voiding cystourethrography and abdominal ultrasound are essential to the evaluation. Precise diagnosis and careful evaluation are mandatory to avoid unnecessary loss of essential normal müllerian structures.

Urometrocolpos associated with retroiliac ureter

We report on an 8-year-old girl who presented clinically with an acute abdomen. Examination revealed a left hypoplastic kidney with its ureter draining into the lower segment of the vagina, which was closed by an imperforate hymen. Initially, we thought that pressure by the urometrocolpos on the right ureter caused right hydronephrosis. Subsequently, it was found that the right ureter followed a retroiliac course and was compressed by a U-shaped iliac artery loop at the ureteral crossing. The iliac artery extended to the level of the second lumbar vertebra.