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Elshetry ASF, Assy MM, Zaid NA, El-Fawakry RM, Radwan MHSS, Hamed EM. Reproducibility of MRI Diagnosis of Female Genital Anomalies. Can Assoc Radiol J 2024:8465371241252793. [PMID: 38795028 DOI: 10.1177/08465371241252793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2024] Open
Abstract
Purpose: To assess and compare intrareader and interreader reproducibility of magnetic resonance imaging (MRI) diagnosis of female genital anomalies (FGAs) using the American Society for Reproductive Medicine-Mullerian anomalies classification 2021 (ASRM-MAC 2021) and European Society of Human Reproduction and Embryology-European Society for Gynecological Endoscopy (ESHRE-ESGE) 2016 classification. Methods: In this retrospective study, we searched our electronic MRI database from April 2021 to September 2023, selecting MRI studies with FGAs. Seventy-six consecutive studies were included and reviewed by 4 independent radiologists using both classifications. Studies were re-evaluated after 1 month. Reproducibility was assessed using kappa (κ) scores with 95% confidence intervals (CI). Results: Intrareader agreement for MRI diagnosis of FGAs was substantial to excellent, with κ scores ranging from 0.684 (95% CI, 0.534-0.834) to 0.985 (95% CI, 0.963-1.01) using the ASRM-MAC 2021 and from 0.743 (95% CI, 0.621-0.865) to 0.846 (95% CI, 0.719-0.973) using the ESHRE-ESGE 2016 classification. Pairwise interreader agreement was higher with the ASRM-MAC 2021, ranging from moderate (κ = 0.491; 95% CI, 0.341-0.642) to substantial (κ = 0.709; 95% CI, 0.597-0.821), compared to the ESHRE-ESGE 2016 classification, with weak (κ = 0.080; 95% CI, 0.068-0.228) to moderate (κ = 0.511; 95% CI, 0.344-0.678) agreement. Overall interreader agreement was moderate for both classifications (κ = 0.599; 95% CI, 0.562-0.638 for ASRM-MAC 2021 and κ = 0.429; 95% CI, 0.396-0.463 for ESHRE-ESGE 2016 classification), but with significant differences (non-overlapping CIs). Conclusion: The intrareader reproducibility was high for both classifications, whereas the interreader reproducibility was higher using the ASRM-MAC 2021, highlighting the impact of classification criteria on the reproducibility of MRI diagnosis of FGAs.
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Affiliation(s)
| | - Mostafa Mohamad Assy
- Radio-diagnosis Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nesma Adel Zaid
- Radio-diagnosis Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Enas Mahmoud Hamed
- Radio-diagnosis Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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Navarro V, Acién M, Acién P. Applicability and Suitability of the Embryological-Clinical Classification of Female Genital Malformations: A Systematic Review. J Clin Med 2024; 13:2988. [PMID: 38792529 PMCID: PMC11121905 DOI: 10.3390/jcm13102988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Complex urogenital malformations are clinically highly relevant; thus, they must be appropriately diagnosed and classified before initiating treatment. Background/Objectives: This study aimed to evaluate the applicability and suitability of the embryological-clinical classification of female genital malformations. Methods: A systematic review of cases of genital malformations reported in the literature from 2000 to 2020 was conducted. Case reports and series with the following combinations: "female genital tract" AND (malformation OR anomaly OR müllerian anomaly OR uterine anomaly OR cervical anomaly OR vaginal anomaly OR cloacal anomaly OR urogenital sinus); and "female genital tract" AND (renal agenesis OR ectopic ureter) were searched. A total of 3124 articles were identified, of which 824 cases of genital malformation were extracted. The characteristics of each malformation were included in a database for further analyses. Results: Using the embryological-clinical classification, 89.9% of the published cases and 86.5% of the 52 cases defined as unclassifiable by their authors have been classified in this review. In 73 cases (72.2%), the classification of the malformation using the AFS system was incomplete because although the type of uterine anomaly of the AFS classification matched that of the embryological-clinical classification, characteristics of the urinary system or the vagina were overlooked when using the AFS system. Following a dispersion matrix, we have been able to show that the embryological-clinical classification system is able to classify and subclassify the genitourinary malformations more accurately. Conclusions: The applicability of the embryological-clinical classification has been confirmed after classifying most of the cases of genital malformation previously published. This system also provides a more complete and accurate classification than other classifying systems exclusively based on Müllerian duct development or uterovaginal parameters, demonstrating its suitability.
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Affiliation(s)
- Victoria Navarro
- Obstetrics and Gynecology Service, Elda University Hospital, 03600 Elda, Alicante, Spain;
- Reproductive Biopathologies Mixed Research Unit FISABIO-UA-UMH, 03550 San Juan, Alicante, Spain
| | - Maribel Acién
- Reproductive Biopathologies Mixed Research Unit FISABIO-UA-UMH, 03550 San Juan, Alicante, Spain
- Obstetrics and Gynecology Service, San Juan University Hospital, 03550 San Juan, Alicante, Spain
- Division of Gynecology, Miguel Hernández University, Campus of San Juan, 03550 San Juan, Alicante, Spain;
- Grant Next Generation EU-EGA Institute for Women’s Health, University College London, London WC1E 6DE, UK
| | - Pedro Acién
- Division of Gynecology, Miguel Hernández University, Campus of San Juan, 03550 San Juan, Alicante, Spain;
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Kiblboeck S, Oppelt P, Oppelt P, Stein R, Ommer S, Pavlik R, Rall K, Kongrtay K, Wagner H, Hermann P, Trautner PS. Can Classifications Adequately Represent Genital Malformations?: EVA Study ( E SHRE/ESGE | V CUAM | A FS) - A Prospective Multicenter Study to Evaluate the Current Female Genital Malformation Classifications. Geburtshilfe Frauenheilkd 2023; 83:827-834. [PMID: 37564897 PMCID: PMC10410643 DOI: 10.1055/a-2043-9982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/20/2023] [Indexed: 03/31/2023] Open
Abstract
Introduction Genital malformations are a common clinical occurrence that can be represented using different classifications. Reproducibility is an essential quality characteristic for a classification, and it plays an important role, especially in consultations and the treatment of infertile patients and in obstetric management. The aim of this study is to demonstrate the reproducibility and clinical practicality of three commonly used classifications: the ESHRE/ESGE (European Society of Human Reproduction and Embryology/ European Society for Gynecological Endoscopy), VCUAM (Vagina Cervix Uterus Adnex-associated Malformation), and AFS (American Fertility Society) classifications. Materials and Methods Sixty-five patients with female genital malformations were included in this prospective, multicenter, exploratory, observational study. All participants underwent a clinical examination and a medical interview. The investigators were instructed to classify the presenting malformations according to the ESHRE/ESGE, VCUAM, and AFS classifications using a structured questionnaire. Investigators were asked whether the malformation could be reproducibly classified (yes/no) and about the grade (grade 1-5 from "very good" to "deficient") they would assign to each classification. Classification assessment was queried for vagina, cervix, uterus, adnexa, and associated malformations and was scored from 1 to 5. Results Reproducibility was rated as 80% (n = 52/65), 92.3% (n = 60/65), and 56.9% (n = 37/65) for the ESHRE/ESGE, VCUAM, and AFS classification, respectively. ESHRE/ESGE, VCUAM and AFS were rated as "very good" or "good" for 83.3%, 89.2%, and 10.8% of vaginal malformations; for 75.8%, 87.5%, and 24.2% of cervical malformations; and for 89.7%, 89.5%, and 86.2% of uterine malformations, respectively. VCUAM was rated as "very good" or "good" for 77.8% and 69.6% of adnexal malformations and associated malformations, respectively. ESHRE/ESGE and AFS were rated as "sufficient" or "deficient" for 100% and 75% of adnexal malformations and for 77.3% and 69.6% of associated malformations, respectively. Conclusion The prospective multicenter EVA ( E SHRE/ESGE | V CUAM | A FS) study revealed that the organ-based ESHRE/ESGE and VCUAM classifications of female genital malformations perform better in terms of reproducibility as well as in the assessment of individual compartments than the non-organ-based AFS classification.
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Affiliation(s)
- Stephanie Kiblboeck
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Johannes Kepler Universität Linz, Linz, Austria
| | - Peter Oppelt
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Johannes Kepler Universität Linz, Linz, Austria
| | - Patricia Oppelt
- Department of Gynecology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim,
Germany
| | - Stefanie Ommer
- Department of Pediatric Surgery, University Hospital Jena, Jena, Germany
| | | | - Katharina Rall
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany
| | - Kuralay Kongrtay
- Clinical Academic Department of Women’s Health, Corporate fund “University Medical Center”, Astana, Kazakhstan
| | - Helga Wagner
- Department of Applied Statistics, Johannes Kepler University Linz, Linz, Austria
- Center for Clinical Studies (CCS Linz), Johannes Kepler University Linz, Linz, Austria
| | - Philipp Hermann
- Center for Clinical Studies (CCS Linz), Johannes Kepler University Linz, Linz, Austria
| | - Philip Sebastian Trautner
- Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital Linz, Johannes Kepler Universität Linz, Linz, Austria
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Brandão P, Ceschin N, Romero JL, Ferro J. Incidental Finding of a Müllerian Malformation on Two-dimensional Ultrasound: What Now? J Med Ultrasound 2023; 31:162-164. [PMID: 37576426 PMCID: PMC10413391 DOI: 10.4103/jmu.jmu_118_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/06/2021] [Accepted: 09/17/2021] [Indexed: 08/15/2023] Open
Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, IVIRMA Valencia, Valencia, Spain
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nathan Ceschin
- Department of Reproductive Medicine, IVIRMA Valencia, Valencia, Spain
| | | | - Jaime Ferro
- Department of Reproductive Surgery, IVIRMA Valencia, Valencia, Spain
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Alcázar JL, Carriles I, Cajas MB, Costa S, Fabra S, Cabrero M, Castro E, Tomaizeh A, Laza MV, Monroy A, Martinez I, Aguilar MI, Hernani E, Castellet C, Oliva A, Pascual MÁ, Guerriero S. Diagnostic Performance of Two-Dimensional Ultrasound, Two-Dimensional Sonohysterography and Three-Dimensional Ultrasound in the Diagnosis of Septate Uterus-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13040807. [PMID: 36832295 PMCID: PMC9955687 DOI: 10.3390/diagnostics13040807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The septate uterus is the most common congenital uterine anomaly, and hysteroscopy is the gold standard for diagnosing it. The goal of this meta-analysis is to perform a pooled analysis of the diagnostic performance of two-dimensional transvaginal ultrasonography, two-dimensional transvaginal sonohysterography, three-dimensional transvaginal ultrasound, and three-dimensional transvaginal sonohysterography for the diagnosis of the septate uterus. METHODS Studies published between 1990 and 2022 were searched in PubMed, Scopus, and Web of Science. From 897 citations, we selected eighteen studies to include in this meta-analysis. RESULTS The mean prevalence of uterine septum in this meta-analysis was 27.8%. Pooled sensitivity and specificity were 83% and 99% for two-dimensional transvaginal ultrasonography (ten studies), 94% and 100% for two-dimensional transvaginal sonohysterography (eight studies), and 98% and 100% for three-dimensional transvaginal ultrasound (seven articles), respectively. The diagnostic accuracy of three-dimensional transvaginal sonohysterography was only described in two studies, and we did not calculate the pooled sensitivity and specificity for this method. CONCLUSION Three-dimensional transvaginal ultrasound has the best performance capacity for the diagnosis of the septate uterus.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - Isabel Carriles
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, 31008 Pamplona, Spain
| | - María Belén Cajas
- Department of Obstetrics and Gynecology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain
| | - Susana Costa
- Department Obstetrics and Gynecology, Centro Hospitalar e Universitário de São João, 4200-319 Porto, Portugal
| | - Sofia Fabra
- Department of Obstetrics and Gynecology, Hospital Universitario Infanta Sofia, 28702 Madrid, Spain
| | - Maria Cabrero
- Department of Obstetrics and Gynecology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain
| | - Elena Castro
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Aida Tomaizeh
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain
| | - María Victoria Laza
- Department of Obstetrics and Gynecology, Hospital Universitario Materno-Infantil, 06010 Badajoz, Spain
| | - Alba Monroy
- Department of Obstetrics and Gynecology, Hospital Universitario Materno-Infantil, 06010 Badajoz, Spain
| | - Irene Martinez
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain
| | - Maria Isabel Aguilar
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de Valme, 41701 Sevilla, Spain
| | - Elena Hernani
- Department of Obstetrics and Gynecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain
| | - Cristina Castellet
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain
| | - Agustin Oliva
- Department of Obstetrics and Gynecology, Hospital Universitario San Carlos, 28040 Madrid, Spain
| | - María Ángela Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain
| | - Stefano Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, 09042 Cagliari, Italy
- Dipartimento di Scienze Chirurgiche, University of Cagliari, 09124 Cagliari, Italy
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Panwar A, Lata K, Kriplani I, Sharma S, Kriplani A. Role of Laparoscopic Transillumination Guidance During Hysteroscopic Metroplasty in Simplifying Surgical Management of Type II Robert's Uterus. J Obstet Gynaecol India 2022; 72:421-424. [PMID: 36457422 PMCID: PMC9701275 DOI: 10.1007/s13224-021-01609-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022] Open
Abstract
Robert's uterus is a rare variant of septate uterus with an asymmetrical septum which divides the uterine cavity into a noncommunicating hemiuterus causing hematometra and other communicating hemiuterus with a single cervix and a normal fundal contour (U2bC3V4 ESHRE classification). It is a cause of severe dysmenorrhea in young girls. However, there is a type of Robert uterus (Type II) which does not have collection in the blind cavity and causes symptoms later, similar to our case. We describe a case of hysteroscopic septum resection (metroplasty) with laparoscopic guidance by transillumination in a case of Type II Robert's uterus in a 25-year-old nulliparous woman. Thick muscular septum posed a surgical challenge which was supplemented by astutely utilizing laparoscopic transillumination.
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Affiliation(s)
- Akshita Panwar
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Kusum Lata
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences New Delhi, Room No 3076, Third floor, New Delhi, India
| | - Isha Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Seema Sharma
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
| | - Alka Kriplani
- Department of Minimally Invasive Gynaecology, Paras Hospitals, Gurugram, India
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Al Najar MS, Al Ryalat NT, Sadaqah JS, Husami RY, Alzoubi KH. MRI Evaluation of Mullerian Duct Anomalies: Practical Classification by the New ASRM System. J Multidiscip Healthc 2022; 15:2579-2589. [PMID: 36388626 PMCID: PMC9659481 DOI: 10.2147/jmdh.s386936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Objective To describe variable mullerian duct anomalies using magnetic resonance imaging (MRI) and to classify these anomalies according to the available classification systems, namely the American Fertility Society (AFS) system, the European Society of Human Reproduction and Embryology (ESHRE) system, and the new American Society for Reproductive Medicine (ASRM) system. Design Retrospective chart review. Subjects The pelvic MRI studies and the clinical records of 64 females with mullerian congenital anomalies were retrospectively reviewed between January 2010 and December 2021. The mean age was 22 years (age range 2–63 years). Main Outcome Measures Detailed imaging findings were recorded, and the resulting mullerian anomalies were then classified according to the three classification systems of interest. Results Variable mullerian anomalies were found among patients with multiple frequencies. Mullerian agenesis and hypoplasia were found in 12 patients (19%) and 16 patients (25%), respectively. Uterus didelphys was found in 5 patients (8%). Twelve (19%) patients had septate uterus, while 8 (12.5%) had a bicornuate anomaly. Unicornuate uterus was present in 7 patients (11%). Isolated vaginal anomaly was diagnosed in 4 patients (6%). Renal/urinary tract imaging was available for 27 (42%) patients, and accompanying urinary tract anomalies were noted in 10 of them (37%). Few ovarian and other extra-renal anomalies were observed. Conclusion MRI could efficiently delineate the mullerian anomalies regardless of their complexity. Most of these anomalies were more efficaciously categorized by the ESHRE and the new ASRM systems, compared to the originally widely used AFS system. The new ASRM classification was found to be more practical as it is a modification of the original AFS system, using drawings with clear descriptions instead of symbols. This is particularly helpful in the radiological era, saving time and effort.
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Affiliation(s)
- Mahasen S Al Najar
- Department of Diagnostic Radiology, The University of Jordan Hospital, Amman, Jordan
| | - Nosaiba T Al Ryalat
- Department of Diagnostic Radiology, The University of Jordan Hospital, Amman, Jordan
| | - Jaffer S Sadaqah
- Department of Diagnostic Radiology, The University of Jordan Hospital, Amman, Jordan
| | - Rawand Y Husami
- Department of Diagnostic Radiology, The University of Jordan Hospital, Amman, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Liu Y, Hou C, Zhou Y. Ultrasound combined with hysteroscopy for optimum treatment of Robert’s uterus: a case report and a review. BMC Womens Health 2022; 22:334. [PMID: 35934693 PMCID: PMC9358804 DOI: 10.1186/s12905-022-01903-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Rbert’s uterus, also known as asymmetric septate uterus, is a rare genital malformation first reported by Dr. Robert in 1970. Robert’s uterus is characterized by a septate uterus with a blind hemicavity and an intact external fundus. According to some reports, Robert’s uterus was typically managed by laparoscopic uterine resection of a hemicavity, laparoscopic endometrectomy, and even hysterectomy. Considering that fertility preservation is important in young patients, we recommend ultrasound-guided hysteroscopic septum resection as an optimum treatment for Robert’s uterus. Case presentation Herein is described a clinical case of Robert’s uterus in a 15-year-old girl who was misdiagnosed for primary dysmenorrhea in the beginning. Magnetic resonance imaging (MRI) and 3-dimensional (3D) ultrasound identified an asymmetrical uterine septum. The patient was treated using ultrasound-guided hysteroscopic treatment without laparoscopy. The surgical procedure lasted less than an hour, and the symptoms of dysmenorrhea were relieved during a six months follow-up. Conclusions Ultrasound-guided hysteroscopic septum resection is the preferred treatment for Robert’s uterus.
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Magnetic resonance imaging of Müllerian anomalies in girls: concepts and controversies. Pediatr Radiol 2022; 52:200-216. [PMID: 34152437 DOI: 10.1007/s00247-021-05089-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Female Müllerian anomalies are the result of failure of formation, fusion or resorption of the Müllerian ducts and are relatively common, with a prevalence of 5.5-7.0% in the general population. While some of these anomalies are asymptomatic, those presenting with obstruction require accurate identification for optimal clinical management including potential surgical treatment. MRI is a useful adjunct to sonography in the evaluation of Müllerian anomalies, typically allowing a more complete characterization of the malformation. Technical aspects, embryologic concepts and controversies regarding classification systems are highlighted in this review. Several Müllerian anomalies are discussed and illustrated in more detail utilizing various cases with pelvic MRI studies.
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Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification: A Systematic Review and Meta-analysis. Obstet Gynecol 2022; 139:138-148. [PMID: 34856567 DOI: 10.1097/aog.0000000000004627] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3 [bicorporeal], U4 [hemi-uterus]), based on the 2013 classification by the ESHRE (European Society of Human Reproduction and Embryology) and the ESGE (European Society for Gynaecological Endoscopy). DATA SOURCES MEDLINE, Scopus, and ClinicalTrials.gov were searched from inception until January 2021. The reference list of all included articles and previous systematic reviews were also screened to identify potential additional articles. METHODS OF STUDY SELECTION Comparative and noncomparative studies that investigated the obstetric outcomes of women with any type of known congenital uterine anomaly were considered eligible for inclusion. Screening and eligibility assessment was performed independently by two reviewers. TABULATION, INTEGRATION, AND RESULTS Forty-seven studies were included. The quality of included comparative studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs), pooled proportions of each obstetric outcome, and 95% CIs were calculated in RevMan and Stata accordingly, using random effects models. Congenital uterine anomalies were associated with increased risk of preterm birth (OR 3.89, 95% CI 3.11-4.88); cervical insufficiency (OR 15.13, 95% CI 11.74-19.50); prelabor rupture of membranes (OR 2.48, 95% CI 1.38-4.48); fetal malpresentation (OR 11.11, 95% CI 5.74-21.49); fetal growth restriction (OR 3.75, 95% CI 1.88-7.46); placental abruption (OR 5.21, 95% CI 3.34-8.13); placenta previa (OR 4.00, 95% CI 1.87-8.56); placental retention (OR 1.71, 95% CI 1.16-2.52); and cesarean birth (OR 4.52, 95% CI 2.19-9.31); when compared with those without anomalies. Pooled estimated risks were 25% for preterm birth, 40% for fetal malpresentation, 64% for cesarean birth, 12% for prelabor rupture of membranes, 15% for fetal growth restriction, 4% for placental abruption, 5% for preeclampsia, 13% for cervical insufficiency, and 2% for placenta previa. Classes U2 (septate), U3 (bicorporeal), and U4 (hemi-uterus) were also associated independently with preterm birth, fetal malpresentation, cesarean birth, and placental abruption. CONCLUSION Congenital uterine anomalies are associated with obstetric complications across all examined ESHRE and ESGE classifications. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021244487.
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Harshitha B, Mohite S, Sharma S, Gupta K. Pregnancies in anomalous uterus: series of three cases. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Venkatesh M, Awal SS. Hemiuterus with functional non-communicating horn in a young female. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mullerian duct anomalies are a broad spectrum of congenital anomalies of the female genital tract presenting with variable symptoms like infertility, amenorrhoea, dysmenorrhea, pelvic endometriosis, and poor obstetric outcomes. Unicornuate uterus or hemiuterus occurs as a result of abnormal formation or failure of formation of the contralateral part.
Case presentation
We present a rare case report of hemiuterus with functional non-communicating horn along with hematometra in a 15-year-old female who presented with severe dysmenorrhoea since her menarche. Pelvic Ultrasonography demonstrated inconclusive findings of a heterogenous lesion in the right pelvic cavity adjacent to the uterus. Further, pelvic MRI revealed a hemiuterus on the left side with a normal endometrial cavity and a well-defined functional non-communicating horn on right side. The diagnosis of European Society of Human Reproduction (ESHRE) Classification U4a uterine anomaly (left hemiuterus with functional non-communicating horn on right side) was established.
Conclusions
ESHRE Class U4a comprises of hemiuterus with a functional rudimentary horn. This is considered clinically significant as it may lead to further complications, such as hematometra or ectopic pregnancy in the rudimentary horn. Hence, the correct identification of this entity is essential as laparoscopic removal is the current recommended management.
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Said MR, Afaneh H, Zaghmout O, Moses K, Young OJ, Abuzeid MI. Minimally invasive management of juvenile cystic adenomyoma: report of three cases. Facts Views Vis Obgyn 2021; 13:267-272. [PMID: 34555881 PMCID: PMC8823274 DOI: 10.52054/fvvo.13.3.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Juvenile cystic adenomyosis (JCA) represents a rare form of focal adenomyosis in young women. Objectives To determine safety and effectiveness of minimally invasive surgery (MIS for JCA). Materials and Methods Three patients aged 16-30 years old presented with chronic pelvic pain [2016 - 2019]. Hormonal treatment failed in two cases. Cystic lesions in the myometrium (n=2), and the broad ligament (n=1) was detected on transvaginal 2D ultrasound (TV 2D US) and/or magnetic resonance imaging (MRI). The cyst was separate from the endometrium in all the cases, within the myometrium in two patients and in the right broad ligament in one case. The cystic lesions were confirmed on laparoscopy; and laparoscopic excision of the cysts with adequate repair of the myometrial beds were performed in all cases with fertility preservation. Robotic assistance was chosen in one case in an attempt to avoid injury of the fallopian tube based on the cyst location during a previous laparoscopy. The endometrial cavity was entered in one case. Main outcome measures Absence of intraoperative complications and relief of presenting symptoms postoperatively. Results Pathology report confirmed the diagnosis of JCA is all cases. There were no intraoperative complications. All three patients reported relief of their symptoms 6 to 8 months after surgery. No recurrence of the JCA was reported using TV 2D US in all cases. Conclusions MIS could be the treatment of choice for patients with JCA. The technique described in our study is safe, effective, and easy to master in experienced hands. What is new? Value of MIS in treatment of patients with JCA.
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Ballabh S, Simon B, Ebenezer ED, John RA, Chandramohan A. Imaging features of Robert's uterus: Case series of a rare Mullerian duct anomaly. Trop Doct 2021; 51:553-560. [PMID: 34313499 DOI: 10.1177/00494755211034061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The diagnosis of Mullerian duct anomaly is crucial because of strong association with infertility, endometriosis and miscarriage. Robert's uterus is a rare variant of septate uterus. Patients present with recurrent abdominal pain and severe dysmenorrhoea. Magnetic resonance imaging is the investigation of choice. In this case series, we present the imaging features of four such cases.
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Affiliation(s)
- Saket Ballabh
- Assistant Professor, Department of Radiology, Christian Medical College, Vellore, India
| | - Betty Simon
- Professor, Department of Radiology, Christian Medical College, Vellore, India
| | - Emily Divya Ebenezer
- Associate Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India
| | - Reetu A John
- Associate Professor, Department of Radiology, Christian Medical College, Vellore, India
| | - A Chandramohan
- Professor, Department of Radiology, Christian Medical College, Vellore, India
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15
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Zhang J, Zhou W, Tang Y, Tan S, Qiao L. Robert's uterus with delayed diagnosis and potential consequences: a case report. J Int Med Res 2021; 49:300060521999531. [PMID: 33752443 PMCID: PMC7995457 DOI: 10.1177/0300060521999531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 24-year-old woman who wished to become pregnant presented to our hospital with an enlarged ovarian endometrioma and developmental abnormality of the uterus. Robert’s uterus complicated by hematosalpinx, ovarian endometrioma, and endometriosis were finally identified 1 year after previously being diagnosed with a cyst and uterine abnormality at a local hospital. The function of the salpinx and the pelvic environment were damaged because of the delayed diagnosis and operation. Gynecologists and sonologists should be aware of and alert to this rare entity while evaluating and managing cases of uterine abnormalities and endometriosis. Prompt early diagnosis and proper management of Robert’s uterus are important for avoiding future morbidity because these are major factors in protecting fertility.
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Affiliation(s)
- Jing Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases, Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Weili Zhou
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Tang
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shiqiao Tan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases, Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Lin Qiao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases, Women and Children Ministry of Education, Sichuan University, Chengdu, Sichuan, China
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16
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Deenadayal M, Günther V, Alkatout I, Freytag D, Deenadayal-Mettler A, Deenadayal Tolani A, Sinha R, Mettler L. Critical Role of 3D ultrasound in the diagnosis and management of Robert's uterus: a single-centre case series and a review. Facts Views Vis Obgyn 2021; 13:41-49. [PMID: 33889860 PMCID: PMC8051191 DOI: 10.52054/fvvo.13.1.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A septate uterus with a non-communicating hemicavity was first described by Robert in 1969/70 as a specific malformation of the uterus. The condition is commonly associated with a blind uterine hemicavity, unilateral haematometra, a contralateral unicornuate uterine cavity and a normal external uterine fundus. The main symptoms are repetitive attacks of pain at four-weekly intervals around menarche, repeated dysmenorrhea, recurrent pregnancy loss and infertility. In this report, we review the disease, its diagnosis and treatment, and describe five cases of Robert's uterus. Three dimensional (3D) ultrasound (US) imaging was performed by the transvaginal route in four cases. In the fifth case of a 13-year-old girl, we avoided the vaginal route and magnetic resonance imaging (MRI) and 3D transrectal US yielded the correct diagnosis. The following treatment procedures were undertaken: laparoscopic endometrectomy, hysteroscopic septum resection, laparoscopic uterine hemicavity resection and total laparoscopic hysterectomy (TLH). The diagnosis and optimum treatment of Robert's uterus remains difficult for clinicians because of its rarity. A detailed and careful assessment by 3D US should be performed, followed by hysteroscopy in combination with laparoscopy, to confirm the diagnosis.
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Affiliation(s)
- M Deenadayal
- Mamata Fertility Hospital, 9-1-192, St Marys Rd, Telangana 500003, Hyderabad, India
| | - V Günther
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - I Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - D Freytag
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - A Deenadayal-Mettler
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - A Deenadayal Tolani
- Mamata Fertility Hospital, 9-1-192, St Marys Rd, Telangana 500003, Hyderabad, India
| | - R Sinha
- Apollo Health City, Gynaecology, Road No 72, Hyderabad, Telangana 500033, Hyderabad, India
| | - L Mettler
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
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17
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Shah N, Joshi A, Bansode S, Bansode V. Accessory Cavitated Uterine Mass: An Emerging Differential Diagnosis of Dysmenorrhea in Adolescents. J Minim Invasive Gynecol 2020; 28:1131-1132. [PMID: 33359290 DOI: 10.1016/j.jmig.2020.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Nitin Shah
- Department of Obstetrics and Gynaecology, Vardann Multispeciality Hospital, Mumbai, Maharashtra, India (all authors)
| | - Aditi Joshi
- Department of Obstetrics and Gynaecology, Vardann Multispeciality Hospital, Mumbai, Maharashtra, India (all authors)..
| | - Shrikant Bansode
- Department of Obstetrics and Gynaecology, Vardann Multispeciality Hospital, Mumbai, Maharashtra, India (all authors)
| | - Vaishali Bansode
- Department of Obstetrics and Gynaecology, Vardann Multispeciality Hospital, Mumbai, Maharashtra, India (all authors)
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18
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Wu CQ, Childress KJ, Traore EJ, Smith EA. A Review of Mullerian Anomalies and Their Urologic Associations. Urology 2020; 151:98-106. [PMID: 32387292 DOI: 10.1016/j.urology.2020.04.088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
Structural anomalies of the female reproductive tract, known as Mullerian anomalies, can occur in isolation or in association with anomalies of other organ systems. Due to shared embryology, the most common association in up to 40% of patients is with renal, ureteral, and bladder anomalies. Affected girls can have a wide range of genitourinary symptoms with urologists playing an integral role in their diagnosis and treatment. To facilitate the recognition and management of these conditions, we provide a review of Mullerian anomalies including the embryology, classifications, syndromes, evaluation, and treatments with attention to their urologic applicability.
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Affiliation(s)
- Charlotte Q Wu
- Division of Pediatric Urology, Children's Healthcare of Atlanta; Emory University School of Medicine, Atlanta, GA.
| | - Krista J Childress
- Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Emory University School of Medicine; Divisions of Pediatric Surgery and Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Elizabeth J Traore
- Division of Pediatric Urology, Children's Healthcare of Atlanta; Emory University School of Medicine, Atlanta, GA
| | - Edwin A Smith
- Division of Pediatric Urology, Children's Healthcare of Atlanta; Emory University School of Medicine, Atlanta, GA
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19
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Maciel C, Bharwani N, Kubik-Huch RA, Manganaro L, Otero-Garcia M, Nougaret S, Alt CD, Cunha TM, Forstner R. MRI of female genital tract congenital anomalies: European Society of Urogenital Radiology (ESUR) guidelines. Eur Radiol 2020; 30:4272-4283. [PMID: 32221681 PMCID: PMC7338830 DOI: 10.1007/s00330-020-06750-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/22/2020] [Accepted: 02/04/2020] [Indexed: 11/24/2022]
Abstract
Objective To develop imaging guidelines for the MR work-up of female genital tract congenital anomalies (FGTCA). Methods These guidelines were prepared based on a questionnaire sent to all members of the European Society of Urogenital Radiology (ESUR) Female Pelvic Imaging Working Group (FPI-WG), critical review of the literature and expert consensus decision. Results The returned questionnaires from 17 different institutions have shown reasonable homogeneity of practice. Recommendations with focus on patient preparation and MR protocol are proposed, as these are key to optimised examinations. Details on MR sequences and planning of uterus-orientated sequences are provided. Conclusions The multiplanar capabilities and soft tissue resolution of MRI provide superb characterisation of the wide spectrum of findings in FGTCA. A standardised imaging protocol and method of reporting ensures that the salient features are recognised, contributing to a correct diagnosis and classification of FGTCA, associated anomalies and complications. These imaging guidelines are based on current practice among expert radiologists in the field and incorporate up to date information regarding MR protocols and essentials of recently published classification systems. Key Points • MRI allows comprehensive evaluation of female genital tract congenital anomalies, in a single examination. • A dedicated MRI protocol comprises uterus-orientated sequences and vaginal and renal evaluation. • Integration of classification systems and structured reporting helps in successful communication of the imaging findings. Electronic supplementary material The online version of this article (10.1007/s00330-020-06750-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cristina Maciel
- Serviço de Imagiologia, CHVNG/E, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
- Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Nishat Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1 NY, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rahel A Kubik-Huch
- Institut für Radiologie, Kantonsspital Baden AG, CH-5404, Baden-Dättwil, Switzerland
| | - Lucia Manganaro
- Dipartimento di Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Sapienza Università di Roma, Vle Regina Elena 324, 00161, Rome, Italy
| | - Milagros Otero-Garcia
- Department of Radiology, Hospital Universitario de Vigo, Planta 3 Vela A, Vigo, Spain
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France
| | - Celine D Alt
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Duesseldorf, Germany
| | - Teresa Margarida Cunha
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal
| | - Rosemarie Forstner
- Department of Radiology, Universitätsklinikum Salzburg, PMU, Müllner-Hauptstr. 48, A-5020, Salzburg, Austria.
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20
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Müllerian Duct Anomalies- Diagnostic Imaging in Pediatric and Adolescent Population. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Müllerian duct anomalies (MDAs) are congenital entities that result from the non-development, defective vertical or lateral fusion, or the resorption failure of the Müllerian (paramesonephric) ducts. MDAs represent a more frequent entity than previously believed. Few recent meta-analyses reported a prevalence of 5.5 - 6.7%. MDAs are commonly associated with other anomalies, specially kidneys, so identification of both kidneys is important. In pediatric and adolescent population MDAs are discovered incidentally at patients observed for some other reason or because of the primary amenorrhea and low abdominal pain related to hematometra (colpos). Imaging is essential for a diagnosis, management, and reproductive counseling in patients with MDA. Patients suspected of having the MDA are often initially referred to pelvic ultrasonography (US). Field-of-view restrictions with US, patient body habitus and artifact from bowel gas may result in a request for the further MagneticRresonance Iimaging (MRI). Also US cannot help identify the type of the MDA. MRI is the imaging standard of reference because it is non-invasive, does not involve ionizing radiation, has a multiplanar capability, allows an excellent soft-tissue characterization, detailed delineation of the uterovaginal anatomy and accurate classification of the type of anomaly. This is especially true for young female patients, in whom the use of vaginal US probes is avoided. Establishing an accurate diagnosis is essential for planning treatment and management strategies. The surgical management of MDAs is specific to the type of malformation and may vary in a specific group.
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21
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Reproductive surgery for müllerian anomalies: a review of progress in the last decade. Fertil Steril 2019; 112:408-416. [DOI: 10.1016/j.fertnstert.2019.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/21/2022]
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22
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Xu S, Zhang J, Wang S, Yang L, Qian J, Yue S, Zhu D, Yang L, Zhao L, Yang A, Li Y, Xue Q. MRI features and differential diagnoses of congenital vaginal atresia. Gynecol Endocrinol 2019; 35:777-781. [PMID: 30982355 DOI: 10.1080/09513590.2019.1588875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To investigate the MRI manifestations of congenital vaginal atresia, analyze its imaging features, and improve the understanding of the disease. Methods: MRI findings and clinical data of 12 patients with congenital vaginal atresia confirmed by hysteroscopy and laparoscopic surgery were retrospectively analyzed. Vaginal atresia was classified according to vaginal dysplasia in AFS female genital malformation classification system. Results: In this study, 12 cases of congenital vaginal atresia were diagnosed by combined preoperative MRI with operative diagnosis. Among them, 10 patients all had type-I congenital vaginal atresia, and their uterus and cervix were normal (1 patient had ectopic renal malformation combined with left ovarian endometriosis cyst and 1 patient with uterine empyema). The other two cases were diagnosed congenital vaginal atresia type II (1 case merged with residual uterus, 1 case with cervical dysplasia). MRI mainly manifested as dilatation and hemorrhage in the uterine cavity, cervical canal and vaginal upper segment. T1WI showed high signal, T2WI showed slightly lower and slightly higher signal. The dilated vagina was above the perineal level. Conclusion: MRI features of congenital vaginal atresia have certain characteristics. MRI cannot only accurately assess the type of vaginal dysplasia and its associated complications, but also make objective evaluation and diagnosis, so it can be used as the best effective preoperative image evaluation.
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Affiliation(s)
- Shengfang Xu
- a Medical Imaging Center, Gansu Provincial Maternity and Child-care Hospital , Lanzhou , China
| | - Jinlong Zhang
- b Department of Respiratory Medicine, The 940th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army (Former Lanzhou General Hospital of Lanzhou Military Region) , Lanzhou , China
| | - Suyang Wang
- c Otolaryngology Head and Neck Surgery, Gansu Provincial Maternity and Child-care Hospital , Lanzhou , China
| | - Lei Yang
- d Functional Examination Department, Gansu Provincial Maternity and Child-care Hospital , Lanzhou , China
| | - Jifang Qian
- a Medical Imaging Center, Gansu Provincial Maternity and Child-care Hospital , Lanzhou , China
| | - Songhong Yue
- e Nuclear Magnetic Resonance Chamber, Lanzhou University Second Hospital , Lanzhou , China
| | - Dalin Zhu
- a Medical Imaging Center, Gansu Provincial Maternity and Child-care Hospital , Lanzhou , China
| | - Laihu Yang
- a Medical Imaging Center, Gansu Provincial Maternity and Child-care Hospital , Lanzhou , China
| | - Li Zhao
- a Medical Imaging Center, Gansu Provincial Maternity and Child-care Hospital , Lanzhou , China
| | - Aiping Yang
- a Medical Imaging Center, Gansu Provincial Maternity and Child-care Hospital , Lanzhou , China
| | - Yunzhi Li
- a Medical Imaging Center, Gansu Provincial Maternity and Child-care Hospital , Lanzhou , China
| | - Qinliang Xue
- b Department of Respiratory Medicine, The 940th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army (Former Lanzhou General Hospital of Lanzhou Military Region) , Lanzhou , China
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Three-dimensional ultrasound in the diagnosis and the classification of congenital uterine anomalies using the ESHRE/ESGE classification: a diagnostic accuracy study. Arch Gynecol Obstet 2019; 299:779-789. [DOI: 10.1007/s00404-019-05050-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
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Crimì F, Camporese G, Lacognata C, Fanelli G, Cecchin D, Zoccarato M. Ovarian Teratoma or Uterine Malformation? PET/MRI as a Novel Useful Tool in NMDAR Encephalitis. In Vivo 2018; 32:1231-1233. [PMID: 30150449 DOI: 10.21873/invivo.11369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/27/2018] [Accepted: 05/30/2018] [Indexed: 01/05/2023]
Abstract
This is a case report of a 17-year-old girl affected by N-methyl-D-aspartate-receptor (NMDAR) encephalitis suspected for a paraneoplastic syndrome. Ultrasound (US) and computed tomography (CT) imaging identified an ovarian lesion compatible with teratoma. 18F-fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI), performed to evaluate metabolic activity of the brain and of the ovarian mass, correctly changed the diagnosis to uterine malformation that was later histologically proven.
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Affiliation(s)
- Filippo Crimì
- Radiology Unit, Department of Medicine - DIMED, University-Hospital Padua, Padua, Italy
| | | | - Carmelo Lacognata
- Radiology Unit, Department of Medicine - DIMED, University-Hospital Padua, Padua, Italy
| | - Giuseppe Fanelli
- Surgical Pathology & Cytopathology Unit, Department of Medicine - DIMED, University-Hospital of Padua, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital Padua, Padua, Italy
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Jóźwik M, Jóźwik M, Zaręba K, Semczuk A, Modzelewska B, Jóźwik M. Congenital vesicouterine fistulas-A PRISMA-compliant systematic review. Neurourol Urodyn 2018; 37:2361-2367. [PMID: 30106189 DOI: 10.1002/nau.23795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/08/2018] [Indexed: 11/07/2022]
Abstract
AIMS Vesicouterine fistulas (VUFs) are infrequent abnormal connections between the bladder and the uterine cavity or cervical canal, being mainly sequelae of repeat Cesarean sections. Exceedingly rare are congenital VUFs. This is a systematic review of available world data aimed to characterize congenital VUFs and better understand the mechanism(s) of their formation. METHODS The PubMed® database via MEDLINE® search engine was explored from its inception to March 2018. Relevant studies were identified using selected Medical Subject Heading-based terms. This was further supplemented by cross-referencing and handsearching. Retrieved literature was evaluated in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines. RESULTS A total of 6561 articles were identified of which 10 were analyzed. Three VUFs accompanied broader syndromes of congenital defects. A lack of patency at the level of the vagina was present in all assessed cases. Unilateral renal agenesis was confirmed in four of eight (50%) verified patients. Hence, unilateral kidney agenesis was related to a lesser degree (P = 0.0186) than vaginal atresia to VUF. The principal features of these fistulas were as follows: partial or complete vaginal atresia resulting in primary amenorrhea, menouria present since menarche, and urinary continence. CONCLUSIONS This review provides the first systematic evidence that congenital VUFs are chiefly associated with concomitant vaginal atresia. The symptomatology of such VUFs is consistent with that of type I acquired fistulas.
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Affiliation(s)
- Maciej Jóźwik
- Department of Gynecology and Gynecologic Oncology, Medical University of Białystok, Białystok, Poland
| | - Marcin Jóźwik
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Kamil Zaręba
- Department of Gynecology and Gynecologic Oncology, Medical University of Białystok, Białystok, Poland
| | - Andrzej Semczuk
- IIND Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Beata Modzelewska
- Department of Biophysics, Medical University of Białystok, Białystok, Poland
| | - Michał Jóźwik
- Chair of Clinical Sciences, Faculty of Health Sciences, State Higher School of Computer Science and Business Administration, Łomża, Poland
- Department of Reproductive Health, National Research Institute of Mother and Child, Warsaw, Poland
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Ferro J, Labarta E, Sanz C, Montoya P, Remohi J. Reproductive outcomes after hysteroscopic metroplasty for women with dysmorphic uterus and recurrent implantation failure. Facts Views Vis Obgyn 2018; 10:63-68. [PMID: 31110644 PMCID: PMC6516190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the reproductive outcomes of women with recurrent implantation failure (RIF) after hysteroscopic metroplasty for dysmorphic uteri. METHODS This retrospective observational study included 190 women with a diagnosis of RIF. These patients were eligible for hysteroscopic metroplasty for dysmorphic uteri, including T-shaped uteri, between January 2008 and September 2015 at the Instituto Valenciano de Infertilidad (IVI) in Valencia, Spain. RESULTS The total clinical pregnancy rate, the live birth rate, and the abortion rate were 80.0% (152/190), 77.9% (147/190) and 8.9%, respectively. At 12 months, the clinical pregnancy rate was 76.3% (145/190) and at 6 months 50.5% (96/190). After the metroplasty, approximately 76% of all gravidities, were achieved during the first 12 months of follow-up. Within the first IVF cycle, pregnancy and live birth rates were 77.8% and 86.1%, respectively. The mean time to pregnancy was 6.5 months. CONCLUSION This study demonstrates that hysteroscopic metroplasty improves pregnancy and live birth rates for women with a history of recurrent implantation failure and dysmorphic uterus. However, conclusions must be taken carefully as this is an observational study. A prospective, randomized and controlled study is necessary to support these results.
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Affiliation(s)
- J Ferro
- Director of Surgery of Instituito Valenciano de Infertilidad “IVI”, Plaza de la Policía Local, 3. 46015. Valencia, Spain
| | - E Labarta
- Especialist in Reproductive Medicine of Instituito Valenciano de Infertilidad “IVI”
| | - C Sanz
- Fellows in Reproductive Medicine of Instituito Valenciano de Infertilidad “IVI”
| | - P Montoya
- Fellows in Reproductive Medicine of Instituito Valenciano de Infertilidad “IVI”
| | - J Remohi
- Director of Instituto Valenciano de Infertilidad “IVI
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Jegannathan D, Indiran V. Magnetic resonance imaging of classified and unclassified Müllerian duct anomalies: Comparison of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology classifications. SA J Radiol 2018; 22:1259. [PMID: 31754489 PMCID: PMC6837830 DOI: 10.4102/sajr.v22i1.1259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
Magnetic resonance imaging (MRI), due to its optimal delineation of anatomy, has become the mainstay in imaging for diagnosing Müllerian duct anomalies (MDA). Pelvic MRI is requested for various conditions such as primary amenorrhoea, infertility or poor obstetric history with regard to MDA, as identifying the exact aetiology for these conditions is vital. Knowledge regarding the classification of MDA is important, as the treatment varies with respect to the different classes. As all the lesions do not fit within the classification of the American Society for Reproductive Medicine, a new anatomy-based classification was established by the European Society of Human Reproduction and Embryology and the European Society for Gynecological Endoscopy, to fulfil the needs of experts. We aim to discuss various classes of classified and unclassified MDA with regard to both the above-mentioned classifications and illustrate some of them using various cases based on pelvic MRI studies.
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Affiliation(s)
| | - Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, India
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Female genital tract congenital malformations and the applicability of the ESHRE/ESGE classification: a systematic retrospective analysis of 920 patients. Arch Gynecol Obstet 2018; 297:1473-1481. [PMID: 29549434 DOI: 10.1007/s00404-018-4749-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Several classification systems for female genital tract anomalies exist but are of limited use in clinical practice. We, therefore, assessed the applicability and ease of use of the new ESHRE/ESGE classification, using only patient records. METHODS This retrospective, single-center, proof-of-principle study systematically analyzed the surgical reports and other hospital records of 920 inpatients and outpatients treated for confirmed female genital tract congenital malformations at a major German university hospital during 2003-2013. Using only this information, a non-expert (medical student) assigned patients to an ESHRE/ESGE class, rating ease of classification based on the time and the number of additional medical records required. Results were verified by an expert gynecologist, who also classified any malformations previously left unclassified. Data analysis used descriptive statistics. RESULTS The non-expert successfully classified 859/920 patients (93.4%), rating classification as "easy" for 836/859 (90.9%) and "moderately difficult" for 23/859 (2.5%) patients. The expert gynecologist successfully classified 60 (60/920, 6.5%) of the remaining 61 patients rated as "difficult" by the non-expert, but was unable to accurately subclassify 1 patient (1/920, 0.1%) because the operative report lacked the relevant details. 251/920 (27.3%) patients had associated non-Müllerian anomalies, most frequently renal (20.9%) and skeletal (9.1%) malformations. CONCLUSIONS The ESHRE/ESGE classification provides a generally applicable, comprehensive, and adequately specific classification of female genital tract congenital malformations. It offers an efficient basis for communication between non-experts and experts in the field and is, therefore, useful in clinical management and treatment planning.
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A Case of Haematometra Secondary to Cervical Stenosis after Vesicle Vaginal Fistula Surgical Repair. Case Rep Obstet Gynecol 2017; 2017:2303840. [PMID: 29130005 PMCID: PMC5654339 DOI: 10.1155/2017/2303840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022] Open
Abstract
Background. Haematometra is a rare postobstetrics fistula surgical repair outcome complication; however the condition can be misinterpreted especially in limited resource areas that lack routine ultrasound guidance and with a slowly progressed increase in size of abdomen accompanied with a history of amenorrhoea together with a history of having unprotective sexual intercourse which may increase the possibility of being controversial to full-term gravid uterus. The causes of haematometra might be either due to congenital abnormality of the vaginal canal or acquired iatrogenically. However, any other cause that involved vaginal canal can be a predisposing factor of haematometra. We present a case of a 32-year-old female patient, who had obstetric fistula which was successfully repaired over the past two years. She presented with one-year-and-two-month history of an amenorrhoea that was progressive accompanied with distended abdomen to the extent of looking typically as the gravid uterus. Explorative laparotomy was performed successfully and surgical incision managed by hysterotomy and salpingotomy, whereby approximately ten liters of serosanguinous blood fluid mixed with blood clots was completely suctioned. Despite being a rare condition after vesicle vaginal fistula repair complication outcome, haematometra remains to be relatively common gynaecological condition among female adolescence during postpubertal period.
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Bermejo C, Martínez-Ten P, Ruíz-López L, Estévez M, Gil MM. Classification of Uterine Anomalies by 3-Dimensional Ultrasonography Using ESHRE/ESGE Criteria: Interobserver Variability. Reprod Sci 2017; 25:740-747. [DOI: 10.1177/1933719117725825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- C. Bermejo
- Delta Ecografía, Centro de Diagnóstico por la Imagen en Obstetricia, Ginecología y Mama, Madrid, Spain
| | - P. Martínez-Ten
- Delta Ecografía, Centro de Diagnóstico por la Imagen en Obstetricia, Ginecología y Mama, Madrid, Spain
| | - L. Ruíz-López
- Gerencia de Atención Primaria de Toledo, SESCAM, Toledo, Spain
| | - M. Estévez
- Delta Ecografía, Centro de Diagnóstico por la Imagen en Obstetricia, Ginecología y Mama, Madrid, Spain
| | - M. M. Gil
- Delta Ecografía, Centro de Diagnóstico por la Imagen en Obstetricia, Ginecología y Mama, Madrid, Spain
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Universidad Francisco de Vitoria, Carretera de Pozuelo a Majadahonda Km 1800, Pozuelo de Alarcón, Madrid, Spain
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Misdiagnosed Roberts Uterus Leading to Surgical Misadventures. J Pediatr Adolesc Gynecol 2017; 30:508-510. [PMID: 28108213 DOI: 10.1016/j.jpag.2017.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Developmental anomalies of the Müllerian duct system are some of the most intriguing and challenging disorders that gynecologists and surgeons encounter in their practice. CASE We report on a 16-year-old adolescent girl with regular menstrual cycles, who presented with recurrent cyclical abdominal pain for which she had undergone 2 unsuccessful surgeries. When correctly diagnosed with the rare condition of "Robert's uterus," she underwent successful metroplasty and is completely asymptomatic at 2-year follow-up. SUMMARY AND CONCLUSION To avoid inappropriate management, gynecologists and surgeons should be aware of this rare entity while evaluating cases of severe dysmenorrhoea in previously normal menstruating young girls.
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Wang GH, Zhu L, Liu AM, Xu T, Lang JH. Clinical Characteristics of Patients Who Underwent Surgery for Genital Tract Malformations at Peking Union Medical College Hospital across 31 Years. Chin Med J (Engl) 2016; 129:2441-2444. [PMID: 27748336 PMCID: PMC5072256 DOI: 10.4103/0366-6999.191762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Female genital malformations represent miscellaneous deviations from normal anatomy. This study aimed to explore the clinical characteristics of patients who underwent surgery for genital tract malformations at Peking Union Medical College Hospital (PUMCH) during a 31-year period. Methods: We retrospectively reviewed surgical cases of congenital malformation of the female genital tract at PUMCH for a 31-year period, analyzed the clinical characteristics of 1634 hospitalized patients, and investigated their general condition, diagnosis, and treatment process. Results: The average patient age was 27.6 ± 9.9 years. The average ages of patients who underwent surgery for uterine malformation and vaginal malformation were 31.9 ± 8.8 years and 24.7 ± 9.0 years, respectively; these ages differed significantly (P < 0.01). Among patients with genital tract malformation, the percentages of vaginal malformation, uterine malformation, vulva malformation, cervical malformation, and other malformations were 43.9%, 43.5%, 7.4%, 2.3%, and 2.8%, respectively. Among patients with uterine malformation, 34.5% underwent surgery for the genital tract malformation, whereas in patients with vaginal malformation, the proportion is 70.6%; the difference between the two groups was statistically significant (P < 0.01). The percentage of complications of the urinary system in patients with vaginal malformations was 10.2%, which was statistically significantly higher than that (5.3%) in patients with uterine malformations (P < 0.01). Conclusions: Compared to patients with uterine malformations, patients with vaginal malformations displayed more severe clinical symptoms, a younger surgical age, and a greater need for attention, early diagnosis, and treatment. Patients with genital tract malformations, particularly vaginal malformations, tend to have more complications of the urinary system and other malformations than patients with uterine malformations.
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Affiliation(s)
- Guang-Han Wang
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Lan Zhu
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Ai-Ming Liu
- Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Tao Xu
- Department of Statistics, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Jing-He Lang
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100005, China
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Ludwin A, Ludwin I, Martins WP. Robert's uterus: modern imaging techniques and ultrasound-guided hysteroscopic treatment without laparoscopy or laparotomy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:526-529. [PMID: 27240758 DOI: 10.1002/uog.15976] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/07/2016] [Accepted: 05/24/2016] [Indexed: 06/05/2023]
Abstract
Robert's uterus is a unique malformation, described as a septate uterus with a non-communicating hemicavity, consisting of a blind uterine horn usually with unilateral hematometra, a contralateral unicornuate uterine cavity and a normally shaped external uterine fundus. The main symptom in affected young women is pelvic pain that becomes intensified near menses. We describe the case of a 22-year-old woman who was referred for diagnostic assessment and treatment of a congenital uterine anomaly. We used three-dimensional sonohysterography with volume-contrast imaging, HDLive rendering mode and automatic volume calculation (SonoHysteroAVC) for the diagnosis, surgical planning and postoperative evaluation. These imaging techniques provided a complete understanding of the internal and external uterine structures, enabling us to perform a minimally invasive hysteroscopic metroplasty, guided by transrectal ultrasound, and therefore avoiding the need for laparotomy/laparoscopy. The outcome of treatment was considered satisfactory; menstruation ceased to be painful and, after two hysteroscopic procedures, the communicating 0.3-cm3 hemicavity was visualized as a 3.6-cm3 normalized uterine cavity using the same imaging techniques. The findings of this case report raise questions about the embryological origin of Robert's uterus, the suitability of current classification systems, and the role of more invasive approaches (laparoscopy/laparotomy) and surgical procedures (horn resection/endometrectomy) that do not aim to improve uterine cavity shape and volume in women with this condition. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland.
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland.
| | - I Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
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Heinonen PK. Distribution of female genital tract anomalies in two classifications. Eur J Obstet Gynecol Reprod Biol 2016; 206:141-146. [PMID: 27693935 DOI: 10.1016/j.ejogrb.2016.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/22/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study assessed the distribution of Müllerian duct anomalies in two verified classifications of female genital tract malformations, and the presence of associated renal defects. STUDY DESIGN 621 women with confirmed female genital tract anomalies were retrospectively grouped under the European (ESHRE/ESGE) and the American (AFS) classification. The diagnosis of uterine malformation was based on findings in hysterosalpingography, two-dimensional ultrasonography, endoscopies, laparotomy, cesarean section and magnetic resonance imaging in 97.3% of cases. Renal status was determined in 378 patients, including 5 with normal uterus and vagina. RESULTS The European classification covered all 621 women studied. Uterine anomalies without cervical or vaginal anomaly were found in 302 (48.6%) patients. Uterine anomaly was associated with vaginal anomaly in 45.2%, and vaginal anomaly alone was found in 26 (4.2%) cases. Septate uterus was the most common (49.1%) of all genital tract anomalies, followed by bicorporeal uteri (18.2%). The American classification covered 590 (95%) out of the 621 women with genital tract anomalies. The American system did not take into account vaginal anomalies in 170 (34.7%) and cervical anomalies in 174 (35.5%) out of 490 cases with uterine malformations. Renal abnormalities were found in 71 (18.8%) out of 378 women, unilateral renal agenesis being the most common defect (12.2%), also found in 4 women without Müllerian duct anomaly. CONCLUSIONS The European classification sufficiently covered uterine and vaginal abnormalities. The distribution of the main uterine anomalies was equal in both classifications. The American system missed cervical and vaginal anomalies associated with uterine anomalies. Evaluation of renal system is recommended for all patients with genital tract anomalies.
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Affiliation(s)
- Pentti K Heinonen
- School of Medicine, University of Tampere, Tampere, Finland; Department of Obstetrics and Gynecology, University Hospital of Tampere, Tampere, Finland.
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Is Hysteroscopy Better than Ultrasonography for Uterine Cavity Evaluation? An Evidence-Based and Patient-Oriented Approach. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Evaluation of the uterine cavity is an important part of the gynecological check, especially in symptomatic women and, over the last few decades, a number of technical and technological advancements has allowed a superb investigation of this organ. Traditionally, transvaginal ultrasound (TVUS) has been the first-line diagnostic tool for evaluating uterine diseases, also considering that gynecologists are familiar with the technique since it is included in the basic training in obstetrics and gynecology. Nevertheless, to date “office hysteroscopy” received growing attention since the development of smaller-diameter hysteroscopes which has made it possible to easily perform the hysteroscopy in ambulatory settings, obviating the need for anesthesia and dilatation of the cervical canal. According to our overview, none of the available methods for endometrial evaluation are ideal and each one has pros and cons. TVUS allows assessment of both the myometrium and the endometrium and typically offers greater patient comfort, but it has a higher false-negative rate in diagnosing focal intrauterine pathology. On the other hand, office hysteroscopy has the advantage of providing (most of the time) a real-time diagnosis avoiding anxiety, inconvenience and costs associated with follow-up appointments. The main advantage of the office hysteroscopy on the TVUS is the possibility to perform an operative phase if necessary during the examination itself. In fact, the modern smaller-diameter hysteroscopes have a working channel through which operative miniaturized instruments (mechanical instruments or bipolar electrodes) can be introduced, allowing the performance of target-eye biopsies and the “instant” treatment of most of uterine diseases in outpatient settings.
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Grechukhina O, English DP, Miller D, Ratner E. Challenging Case of Postmenopausal Bleeding and Complete Urogenital Duplication. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:331-6. [PMID: 27180733 PMCID: PMC4913742 DOI: 10.12659/ajcr.897080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Müllerian duct anomalies represent a wide spectrum of congenital abnormalities ranging from simple uterine anomalies to more complex multisystem derangements. Complete duplication of uterus, cervix, and vagina may be associated with urologic and caudal gastrointestinal malformations. CASE REPORT We present a case report detailing the management of a morbidly obese patient with postmenopausal bleeding and thickened endometrial stripe who had a very rare condition of pelvic organ duplication, including 2 hemiuteri, 2 vaginas, 2 hemibladders, and 2 each of ovaries, fallopian tubes, kidneys, and ureters. Laparoscopic hysterectomy was complicated by difficulties understanding urinary system anatomy requiring intraoperative urology consultation and imaging. CONCLUSIONS Management of patients with urogenital duplication and abnormal uterine bleeding requires a thorough understanding of possible associated malformations. Thorough preoperative evaluation, careful surgical exploration, and multidisciplinary approach may be necessary to avoid urologic injury in such patients.
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Affiliation(s)
- Olga Grechukhina
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Diana P English
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Devin Miller
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Elena Ratner
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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Li Y, Yang L, Tian Y, Li D, Luo S. Successful term delivery of spontaneous twin pregnancy in a woman with bicorporeal septate uterus: A case report. J Obstet Gynaecol Res 2016; 42:1029-33. [PMID: 27094222 DOI: 10.1111/jog.13015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/28/2016] [Accepted: 02/26/2016] [Indexed: 11/29/2022]
Abstract
Herein, we report the first case of successful term delivery of twins in a patient with bicorporeal septate uterus via natural conception. The patient had been diagnosed with complete septate, didelphys and bicornuate uterus during different phases of her three pregnancies. Based on follow-up data at six weeks and then six months post-partum of the last pregnancy, we found that the abnormalities presented in our case did not fit the criteria of any categories following American Fertility Society and European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy classification systems. After comprehensive review of the uterine morphologic characteristics, embryology and pregnancy outcome, we considered 'bicorporeal septate uterus' the most appropriate diagnosis. This case emphasized the atypical changes of uterine shape as twin pregnancy advances and its influence on productive performance and pregnancy outcome in uterine malformation. It also raised concern regarding the usability and comprehensiveness of the two most popular classification systems.
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Affiliation(s)
- Yanfang Li
- Department of Obstetrics, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lilin Yang
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuanyuan Tian
- Department of Ultrasound, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Daocheng Li
- Department of Obstetrics, the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Songping Luo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, Gordts S, Exacoustos C, Van Schoubroeck D, Bermejo C, Amso NN, Nargund G, Timmerman D, Athanasiadis A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Tarlatzis B, Farquharson R, Gianaroli L, Campo R. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 2015; 31:2-7. [PMID: 26537921 DOI: 10.1093/humrep/dev264] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/14/2015] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? SUMMARY ANSWER The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. WHAT IS KNOWN ALREADY Accurate diagnosis of congenital anomalies still remains a clinical challenge because of the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes. STUDY DESIGN, SIZE, DURATION The ESHRE/ESGE CONgenital UTerine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project. PARTICIPANTS/MATERIALS, SETTING, METHODS The consensus is developed based on: (i) evaluation of the currently available diagnostic methods and, more specifically, of their characteristics with the use of the experts panel consensus method and of their diagnostic accuracy by performing a systematic review of evidence and (ii) consensus for the definition of where and how to measure uterine wall thickness and the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method. MAIN RESULTS AND THE ROLE OF CHANCE Uterine wall thickness is defined as the distance between the interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and posterior uterine wall thickness at the longitudinal plane could be used. Gynecological examination and two-dimensional ultrasound (2D US) are recommended for the evaluation of asymptomatic women. Three-dimensional (3D) US is recommended for the diagnosis of female genital anomalies in 'symptomatic' patients belonging to high risk groups for the presence of a female genital anomaly and in any asymptomatic woman suspected to have an anomaly from routine evaluation. Magnetic resonance imaging (MRI) and endoscopic evaluation are recommended for the subgroup of patients with suspected complex anomalies or in diagnostic dilemmas. Adolescents with symptoms suggestive for the presence of a female genital anomaly should be thoroughly evaluated with 2D US, 3D US, MRI and endoscopically. LIMITATIONS, REASONS FOR CAUTION The various diagnostic methods should always be used in the proper way and evaluated by experts to avoid mis-, over- and underdiagnosis. WIDER IMPLICATIONS OF THE FINDINGS The role of a combined US examination and outpatient hysteroscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively evaluate the clinical consequences related to various degrees of uterine deformity. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- Grigoris F Grimbizis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Attilio Di Spiezio Sardo
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Sotirios H Saravelos
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Stephan Gordts
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Caterina Exacoustos
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Dominique Van Schoubroeck
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Carmina Bermejo
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Nazar N Amso
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Geeta Nargund
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Dirk Timmerman
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Apostolos Athanasiadis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Sara Brucker
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Carlo De Angelis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Marco Gergolet
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Tin Chiu Li
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Vasilios Tanos
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Basil Tarlatzis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Roy Farquharson
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Luca Gianaroli
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Rudi Campo
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
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The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. ACTA ACUST UNITED AC 2015; 13:1-16. [PMID: 26918000 PMCID: PMC4753246 DOI: 10.1007/s10397-015-0909-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/27/2022]
Abstract
What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. Accurate diagnosis of congenital anomalies still remains a clinical challenge due to the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, with some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available, enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes. The ESHRE/ESGE Congenital Uterine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project. The consensus is developed based on (1) evaluation of the currently available diagnostic methods and, more specifically, of their characteristics with the use of the experts panel consensus method and of their diagnostic accuracy performing a systematic review of evidence and (2) consensus for (a) the definition of where and how to measure uterine wall thickness and (b) the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method. Uterine wall thickness is defined as the distance between interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and posterior uterine wall thickness at the longitudinal plane could be used. Gynaecological examination and two-dimensional ultrasound (2D US) are recommended for the evaluation of asymptomatic women. Three-dimensional ultrasound (3D US) is recommended for the diagnosis of female genital anomalies in “symptomatic” patients belonging to high-risk groups for the presence of a female genital anomaly and in any asymptomatic woman suspected to have an anomaly from routine avaluation. Magnetic resonance imaging (MRI) and endoscopic evaluation are recommended for the sub-group of patients with suspected complex anomalies or in diagnostic dilemmas. Adolescents with symptoms suggestive for the presence of a female genital anomaly should be thoroughly evaluated with 2D US, 3D US, MRI and endoscopy. The various diagnostic methods should be used in a proper way and evaluated by experts to avoid mis-, over- and underdiagnosis. The role of a combined ultrasound examination and outpatient hysteroscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively evaluate the clinical consequences related to various degrees of uterine deformity.
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Acién P, Acién M. The presentation and management of complex female genital malformations. Hum Reprod Update 2015; 22:48-69. [DOI: 10.1093/humupd/dmv048] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/14/2015] [Indexed: 11/13/2022] Open
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