Vaginoscopic Incision of Oblique Vaginal Septum in Adolescents with OHVIRA Syndrome

Chunxia Cheng,Xingping Zhao,Grace Johnson,Xiaoming Guan,Aiqian Zhang,Jigyasa Subedi,Dabao Xu

doi:10.1038/s41598-019-56471-2

Abstract

This study is to evaluate the efficacy and safety of vaginoscopic incision of oblique vaginal septum in adolescents with Obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) syndrome. It is about Fourteen adolescents with OHVIRA syndrome managed by vaginoscopic incision of the oblique vaginal septum using a “No-touch” technique over an 8-year period. In all fourteen adolescents with OHVIRA the oblique vaginal septum was incised successfully without any intraoperative complications. Postoperative pain was unremarkable and each patient’s symptoms resolved postoperatively. The 3-month postoperative follow up office vaginoscopy revealed that the vaginal septum had not reformed nor was any vaginal stenosis noted. Vaginoscopic incision of the oblique vaginal septum using a “No-Touch” technique is a safe, minimally invasive, and effective approach for treating OHVIRA syndrome in adolescents with hematocolpos. This technique may be utilized to minimize disruption to the undeveloped vaginal wall and postoperative pain while providing excellent surgical visualization throughout the procedure.

Highlights

Obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare Mullerian duct anomaly that presents with an obstructing vaginal septum, ipsilateral renal anomalies and various types of uterine malformations[1,2]
We retrospectively analyzed fourteen adolescents with OHVIRA syndrome who underwent hysteroscopic incision of an oblique vaginal septum according to the technique described above from 2009 to 2017
The preoperative diagnosis of OHVIRA syndrome was made by clinical presentation, transabdominal and transrectal ultrasound scan, computed tomography (CT) or magnetic resonance imaging (MRI), and routine digital rectal examination

Summary

Introduction

Obstructed hemi-vagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare Mullerian duct anomaly that presents with an obstructing vaginal septum, ipsilateral renal anomalies and various types of uterine malformations[1,2]. The triad of obstructed hemi-vagina, uterus didelphys and ipsilateral renal anomaly was named Herlyn-Werner-Wunderlich syndrome (HWWS) in 1980. Type III: Complete hemi-vaginal septum with cervical fistula In this case a fistula connects the two cervices of the obstructed vagina and the contralateral cervix. We have developed a hysteroscopic management of OHVIRA with hematocolpos using a “No-touch” technique in virgin adolescents This procedure has several benefits including excellent safety outcomes, improved visualization, decreased post-operative pain due to no vaginal retractors or speculum use, and the ability to leave the hymen intact[17]. We review a series of 14 cases of patients treated with the above procedure to validate its efficacy and safety

Methods

Results

Conclusion