Vaginal Malformations Research Articles

Vaginal Agenesis: Diagnosis on Ultrasound and Management of a Case at the Gabriel Toure University Hospital in Bamako (Mali)

Vaginal malformations can be diagnosed by ultrasound in a large number of cases. The prevalence of uterovaginal aplasia usually reported in the literature is 1/4000 to 1/10,000. Objectives: We tell you about the difficulties of diagnosis with ultrasound, the difficulties of managing our case of vaginal aplasia. Observation: This was a 20-year-old patient saleswoman, single. History of the disease: was marked by cyclic pelvic headache for 6 months with primary amenorrhea. She has no particular medical-surgical history. On physical examination: Secondary sexual characteristics were developed. On inspection of the vulva, normal pubic hair was noted. Examination of the vulva showed the labia majora and labia minora present and normal-looking. A hymen could not be identified and there was no visible vaginal opening. Faced with this clinical and paraclinical symptomatology, we made the diagnosis of vaginal agenesis. The ultrasound showed a uterus measuring about 92x71x62 mm, its parenchyma is homogeneous, its contours are regular. The presence in the uterine cavity at the corporeofundic level of a homogeneous echogenic collection of about 66.5 cc (69x35 mm). Note the congenital malformation of the cervix with agenesis). The Surgical Procedure Performed is vaginoplasty. Conclusion: Ultrasound of uterine malformation is difficult and requires some experience from the sonographer.

Concomitant extragenital malformations of female reproductive tract anomalies: analysis of 444 cases in Peking Union Medical College Hospital

Objective: To analyze the incidence and clinical phenotype of the concomitant extragenital malformations in the patients with female reproductive tract anomalies. Methods: A retrospective study was conducted using clinical data of hospitalized patients diagnosed with uterine, cervical, or vaginal malformations from January 2003 to December 2022 in Peking Union Medical College Hospital. The malformations were classified according to American Society for Reproductive Medicine müllerian anomalies classification 2021, and in each type, the incidence and specific manifestations of concomitant extragnital malformations were analyzed. Results: A total of 444 patients were included. The overall incidence of concomitant extragenital malformations was 43.5% (193/444), including urinary system, skeletal system, and other system malformations. Renal malformations on the obstructed side were present in all patients with oblique vaginal septum syndrome (100.0%, 78/78). The total incidence of concomitant extragnital malformations was as high as 8/11 in uterus didelphys, 43.5% (10/23) in unicornuate uterus, 33.6% (79/235) in Mayer-Rokitansky-Küster-Hauser syndrome, 18.8% (6/32) in septate uterus and 18.5% (12/65) in cervical agenesis. Urinary system malformations (30.6%, 136/444) and skeletal system malformations (13.5%, 60/444) were the most common concomitant malformations in all types, in which, unilateral renal agenesis and scoliosis were the most common. Conclusions: Urinary and skeletal system malformations are important features of female reproductive tract anomalies. Urologic ultrasonography and spinal roentgenogram are recommended for all patients with female reproductive tract anomalies.

High incidence of imperforate vagina in ADGRA3-deficient mice

BackgroundTen percent of the female population suffers from congenital abnormalities of the vagina, uterus, or oviducts, with severe consequences for reproductive and psychological health. Yet, the underlying causes of most of these malformations remain largely unknown. ADGRA3 (GPR125) is involved in WNT signaling and planar cell polarity, mechanisms vital to female reproductive tract development. Although ADGRA3 is a well-established spermatogonial stem cell marker, its role within the female urogenital system remains unclear.ResultsIn this study, we found Adgra3 to be expressed throughout the murine female urogenital system, with higher expression pre-puberty than after sexual maturation. We generated a global Adgra3−/− mouse line and observed imperforate vagina in 44% of Adgra3−/− females, resulting in distension of the reproductive tract and infertility. Ovarian morphology, plasma estradiol, ovarian Cyp19a1, and vaginal estrogen receptor α (Esr1) expression were unaffected. However, compared to controls, a significantly lower bone mineral density was found in Adgra3−/− mice. Whereas vaginal opening in mice is an estrogen-dependent process, 17β-estradiol treatment failed to induce vaginal canalization in Adgra3−/− mice. Furthermore, a marked reduction in vaginal and ovarian progesterone receptor expression was observed concomitant with an upregulation of apoptotic regulators Bcl2, Bid, and Bmf in adult Adgra3−/− females with a closed vagina.ConclusionsOur collective results shed new insights into the complex mechanisms by which the adhesion receptor ADGRA3 regulates distal vaginal tissue remodeling during vaginal canalization via altered sex hormone responsiveness and balance in apoptotic regulators. This highlights the potential of ADGRA3 as a target in diagnostic screening and/or therapy for obstructive vaginal malformations in humans.

Vaginal Agenesis: Diagnosis on Ultrasound and Management of a Case at the Gabriel Toure University Hospital in Bamako (Mali)

Abstract: Vaginal malformations can be diagnosed by ultrasound in a large number of cases. The prevalence of uterovaginal aplasia usually reported in the literature is 1/4000 to 1/10,000. Objectives: We tell you about the difficulties of diagnosis with ultrasound, the difficulties of managing our case of vaginal aplasia. Observation: This was a 20-year-old patient saleswoman, single. History of the Disease: was marked by cyclic pelvic headache for 6 months with primary amenorrhea. She has no particular medical-surgical history. On Physical Examination: secondary sexual characteristics were developed. On inspection of the vulva, normal pubic hair was noted. Examination of the vulva showed the labia majora and labia minora present and normal-looking. A hymen could not be identified and there was no visible vaginal opening. Faced with this clinical and paraclinical symptomatology, we made the diagnosis of vaginal agenesis. The ultrasound showed a uterus measuring about 92x71x62 mm, its parenchyma is homogeneous, its contours are regular. The presence in the uterine cavity at the corporeofundic level of a homogeneous echogenic collection of about 66.5 cc (69x35 mm). Note the congenital malformation of the cervix with agenesis). The Surgical Procedure Performed: is vaginoplasty. Conclusion: Ultrasound of uterine malformation is difficult and requires some experience from the sonographer.

Diverse ultrasound image features of unilateral genital tract obstruction with ipsilateral renal anomaly syndrome on genitourinary system segmental sequential ultrasound screening and the accuracy of ultrasonic diagnosis.

Unilateral genital tract obstruction with ipsilateral renal anomaly (UGTOIRA) syndrome is a rare congenital urogenital anomaly, characterized by different combinations of uterine abnormalities, unilateral cervical-vaginal obstruction, and ipsilateral renal abnormalities. Timely and correct diagnosis is critical. In this study, we analyzed the diverse ultrasound image features of UGTOIRA syndrome on genitourinary system segmental sequential ultrasound screening (SSUS) and the accuracy of ultrasonic diagnosis. The data from 59 patients with UGTOIRA syndrome over the last decade were analyzed retrospectively, which included ultrasound presentations and diagnoses of abnormalities of the uterus, cervix, and vagina, as well as the conditions associated with the bilateral fallopian tubes, ovaries, pelvis, kidneys and ureters, bladder, and urethra. All 59 patients (100%) were found to have ipsilateral renal agenesis, and the diagnostic accuracy of ultrasound was 100%. The uterus was correctively diagnosed as complete bicorporal uterus in 42 cases (71.2%), bicorporal septate uterus in 7 cases (11.9%), complete uterus septate in 8 cases (13.6%), partial uterus septate in 1 case (1.7%), and unilateral isthmus atresia in 1 case (1.7%). The cervix was correctively diagnosed as septate cervix in 28 cases (47.5%), double cervix in 17 cases (28.8%), unilateral small cervix in 5 cases (8.5%), unilateral obliterated cervical orifice in 5 cases (8.5%), partial development of the unilateral cervix with a blind end in 3 cases (5.1%), and unilateral completely undeveloped cervix appearing as a normal cervix in 1 case (1.7%). The vagina was correctively diagnosed as oblique vaginal septum (OVS) in 45 cases (76.3%), and normal vagina in 13 cases (22.0%) via preoperative ultrasound. In 1 case (1/59, 1.7%) of high OVS with ipsilateral obliterated external cervical orifice, the OVS was missed by preoperative ultrasound. The ultrasound diagnostic accuracy rates of uterine malformation, cervical malformation, vaginal malformation, hematoma location and volume, uterine communication, and cervical communication were respectively 100%, 100%, 98.3%, 100%, 100%, and 100%. The ultrasonic detection rate for a hole on the OVS was 0%, and the missed diagnosis rate was 100%. SSUS can be used to accurately evaluate uterine, cervical, and vaginal malformation, obstruction site, location and volume of keratocele, cervical or uterine communication, and ovarian endometriosis cyst in patients with UGTOIRA syndrome and ipsilateral urinary system malformation. However, ultrasound is unable to identify a hole on the OVS.

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.

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.

Pregnancy outcome in uterus didelphys: case report

Most malformations of the female reproductive organs, depending on their features, have a serious impact on reproductive function and the condition of pregnant women. Therefore, all women with uterine and vaginal malformations require counseling in preparation for pregnancy, follow-up during the pregnancy from the early stages, taking into account possible complications, adequate pregnancy management and prevention of complications, as well as fetal monitoring according to gestational age and planning the term and method of delivery.

Stricture rate in patients after the repair of anorectal malformation following a standardized dilation protocol.

The aim of this study was to determine and analyze the stricture rate in patients who underwent a PSARP or PSARVUP and followed a postoperative protocol of anal dilation (Fig. 1). A retrospective review of patients with anorectal malformation (ARM) who underwent a primary PSARP or PSARVUP from February 2016 to October 2021 was performed. Data collected included patients' demographics, type of ARM, age at the time of operation, postoperative complications, with emphasis on whether there were any strictures or any difficulties during dilations, and on follow-up. During the surgical repair, emphasis was placed on preserving the blood supply of the bowel and performing a tension-free bowel-to-skin anastomosis. Eighty-four patients met the inclusion criteria. Forty-four patients were females: 21 recto-perineal fistula, 12 cloaca, 9 recto-vestibular fistula, one imperforate anus without fistula, and one patient had a complex anorectal and vaginal malformation with an anal stricture and a rectovaginal fistula. Forty patients were males: 14 recto-perineal fistula, 11 recto-urethral bulbar fistula, 6 recto-urethral prostatic fistula, 6 imperforate anus without fistula, and 2 bladder neck fistula. One patient had an anal stenosis with sacral agenesis, without a presacral mass. Patient ages ranged from 0 to 79months (mean 7.5months, median 5months) at the time of surgery. Follow-up time ranged from 7 to 73months (mean 38months, median 35months). No patient suffered of a postoperative anal stricture. Six patients suffered of a rectal prolapse that required a surgical repair. Post-operative anal stricture after PSARP and PSARVUP can be avoided with proper surgical technique and postoperative care. Namely, by preserving adequate blood supply of the bowel and avoiding tension at the anoplasty, and by adhering to a structured protocol of anal dilations.

Unicornuate Uterus with Noncommunicating Rudimentary Horn (Class U4aC0V0/ESHRE/ESGE Classification) and a Communicating Bladder Endometriotic Nodule

To describe the diagnostic workup and laparoscopic management of a noncommunicating left uterine rudimentary horn (class U4aC0V0 European Society of Human Reproduction and Embryology/European Society of Gastrointestinal Endoscopy Classification) with communicating endometriotic bladder nodule. Step-by-step description of the surgical treatment. A 33-year-old woman with unicornuate uterus and a left-side noncommunicating rudimentary horn affected by primary infertility, mild dysmenorrhea (visual analog scale score 6), severe catamenial dysuria (visual analog scale score 10), and catamenial hematuria. Noncommunicating rudimentary horns are rare Müllerian anomalies present in 20% to 25% of women with a unicornuate uterus. It is associated with severe dysmenorrhea, pelvic pain, subfertility, and poor obstetric outcomes and usually presents with cyclic pelvic pain that starts early after the menarche. Endometriotic bladder nodules are present in 1% to 2% of patients with endometriosis. In the literature, there are no reported cases of noncommunicating rudimentary horn with communicating endometriotic bladder nodules. Surgical excision of the rudimentary horn is the treatment of choice. In our case, the 2-dimensional/3-dimensional ultrasound revealed a right unicornuate uterus with a left noncommunicating rudimentary horn with hematometra. The uterine fundus presented «gamma sign» vascularization. In addition, a bladder endometriotic nodule (16×15 mm) communicating with hematometra was displayed. Magnetic resonance imaging demonstrated no additional malformations. Diagnostic hysteroscopy revealed a single cervix without vaginal malformation and small right uterine cavity with single tubal ostium. At laparoscopy, using hysteroscopic transillumination, a clear plane of dissection was identified between the rudimentary horn and the uterus confirming the presence of a noncommunicating horn. Evaluation of the abdominal cavity showed bilateral normal adnexa with normal ovaries. Chromopertubation showed a patent right Fallopian tube and obstructed left tube. A left salpingectomy using bipolar and the ultrasonic energy was performed. The utero-ovarian ligament was transected, and the left ovary was preserved. The left ovary was suspended at the pelvic wall, the retroperitoneum was opened, the ureter was identified, and the left uterine artery was temporary occluded. The left round ligament was transected and the left paravesical space was developed. With a lateromedial approach, we opened the vesicouterine septum to dissect the bladder from the rudimentary horn. The endometriotic bladder nodule was gently detached from the uterine horn with a lateromedial approach. The left uterine artery was coagulated and dissected at level of the cervix. A solution of vasopressin was injected between the uterine horn and the uterus. Resection of the rudimentary horn was performed. The peritoneum was closed. The temporary occlusion of the uterine artery was removed. The specimen was placed in a bag and removed using an extracorporeal tissue extraction technique. The late clinical presentation of our patient with only mild dysmenorrhea could be explained by the drainage of the hematometra from the noncommunicating horn into the endometriotic bladder nodule. The bladder symptoms in patients with Müllerian anomalies should be carefully investigated. The laparoscopic removal of rudimentary horn with mobilization of communicating bladder nodule when present is a safe and feasible method to improve symptomatology.

Pregnancies in anomalous uterus

Uterine malformations can result from various alterations in the normal development of Mullerian ducts that make up a diverse category of congenital anomalies. In most cases, the defect remains undiagnosed and exhibits the normal number of chromosomes. Very few malformations require any intervention after thorough investigations. The most frequently used classification by the American Society for Reproductive Medicine is comprehensive, but does not include cervical or vaginal malformations. The European Society of Human Reproduction and Embryology has postulated a consensus that precisely shows independent cervical malformations.

Mullerian Malformations and Reconstructive Surgery: Clinicians' Approach.

Mullerian malformations are not uncommon. Overall incidence ranges widely between 1 in 200 women and 4 in 100 women (Chan et al. in Hum Reprod Update 17:761-771, 2011; Grimbizis et al. in Hum Reprod 28:2032-2044, 2013). Other way, these observations suggest presently an increased number of Mullerian abnormalities are diagnosed with more details, following the use of newer diagnostic modalities. Most classifications that are available have limitations. Diagnosis was based on imaging studies that had low diagnostic accuracy. It was focused mainly on the anomalies of the uterus. Less is known about the anomalies of the cervix or the vagina in isolation or in combination with the utero-cervical and vaginal malformations. Improved diagnostic modalities and incorporation of assisted reproductive technology have improved the outcome further. Therefore, a more expanded classification needs to be introduced with wider criteria for the clinicians. This will make clinicians' approach for the management more simple.

Complex clinical and echographic assessment of the peculiarities of developmental anomalies of uterus and vagina in children and adolescents

The objective. To assess the structure of independent and combined forms of anomalies in the development of the uterus and/or vagina in children and adolescents, justifying the need for ultrasound screening in this age group.Materials and methods. The study involved 146 patients with malformations of the uterus and/or vagina at the age from 10 to 20 years. All patients underwent a clinical examination, which included anamnestic data, gynecological examination, and ultrasound examination. The calculation of indicators of the diagnostic information content of ultrasound was carried out taking into account the sensitivity, specificity and accuracy of the method.Results. In the course of the study, it was found that the largest proportion of all anomalies of the internal genitals was uterine malformations (37,0%), complete doubling of the uterus and vagina (17,1%), vaginal aplasia (15,1%). Genetic or chromosomal pathology was detected in 36 patients (24,7%), in the remaining 110 patients (75,3%) a multifactorial nature of the disease was assumed.Attention is drawn to the fact that 48 patients (32.8%) with uterine and/or vaginal malformations, who did not present complaints, were identified during the primary ultrasound screening, which indicates the effectiveness of this method in examining girls and adolescents. In 12 children (8,25%) in addition to abnormalities in the development of the uterus and/or vagina, ultrasound revealed tumors and tumor-like diseases of the uterine appendages. Also, 57 malformations of other organs and systems were revealed in 49 (33,6%) examined patients, and 8 (5,5%) had concomitant defects. In most cases, in 99 patients (67,8%) with anomalies in the development of internal genitalia, the anamnesis was aggravated by the factors of their parents (burdened heredity, disease, occupational health, etc.)Conclusion. As a result of a comprehensive clinical examination of patients with congenital anomalies in the development of internal genitalia, the diagnosis was clarified, the share of hereditary and some environmental factors in the manifestation of this pathology was revealed, which is one of the common gynecological diseases that are characterized by a variety of forms of anomalies, clinical symptoms and a high percentage of diagnostic errors. At puberty, the use of echography to clarify the state of the internal genital organs is of great practical importance. Non-invasiveness, absence of psychogenic traumatization, safety and high information content make it possible not only to diagnose congenital pathology, but also to use this method as a dynamic observation of the state of the uterus and/or vagina in girls and adolescents, which is very important when choosing rational methods for correcting this pathology

A New Perspective on the Problem of Concomitant Endometriosis and Genital Malformations: Surgical and Embryogenetic Aspects

Study Objective To optimize the results of surgical treatment and rehabilitation of patients with genital tract malformations combined with external genital endometriosis. Design Prospective study. Level II. Setting Department of Operative Gynecology, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russian Federation. Patients or Participants 453 patients with utero-vaginal malformations underwent surgery from 2013 to 2018. Based on the presence of endometriotic foci, two groups of patients were created: group 1 included 240 patients with uterine and vaginal malformations and external genital endometriosis; group 2 included 213 patients with uterine and vaginal malformations without concomitant endometriosis. Interventions All patients underwent surgical treatments using laparocopic and hysteroscopic approaches for correction of congenital malformations and endometriosis excision. Measurements and Main Results The indications for surgical treatment of patients with utero-vaginal anomalies included primary infertility in 41.5%, secondary infertility in 18.6%, recurrent miscarriages in 26.2%, dysmenorrhea in 45.4%, menorrhagia in 23.2%, pain syndrome in 17.2%, and dyspareunia in 8.1% cases. External genital endometriosis was diagnosed in 53.0% of these patients. We revealed no significant difference in the incidence of endometriosis in patients with utero-vaginal anomalies with or without the obstruction to the menstrual flow. Conclusion Implantation theory cannot explain the development of endometriosis in all patients with utero-vaginal malformations. Therefore, all pathogenetic theories must be considered in the investigation of possible mechanisms of endometriosis development in patients with genital tract malformations.

Two cases of uterine and vaginal malformations

Objective: To evaluate the efficacy of hysteroscopy and laparoscopy for oblique uterine septum and oblique vaginal septum. Case Report: There were one patient with oblique uterine septum and another patient with oblique vaginal septum. Case 1 was a 14-year-old female, who revealed a left unicornuate uterus and right non-communicating rudimentary horn with a cavity. Using a resectoscope with a needle electrode, the authors made a transverse incision on the bulging area of the septum at the level of the tubal ostium. Case 2 was a 14-year-old female with a double vagina, large fluid collection in the occluded right hemivagina, and absent of the right kidney. The authors performed a hysteroscopy, resection of the vaginal septum, and vaginoplasty. Conclusion: Intraoperative ultrasound monitoring can improve surgery safety, with the advantages of lesser amounts of trauma, a good therapeutic effect, fewer complications, less bleeding, quick recovery, and simultaneous protection of the hymen.

A STUDY ON CONGENITAL VAGINAL MALFORMATIONS IN RURAL POPULATION OF NORTH MAHARASHTRA REGION

Objective: To find out types of vaginal malformations in rural population of North Maharashtra, to study various operative procedures designed for vaginal malformations and to evaluate the use of rubber mould for McIndoe operation. Method: Eighteen cases of congenital vaginal malformations were screened in OPD. We found seventeen patients of primary amenorrhea were having congenital vaginal malformation. One patient of stricture of upper vagina was having normal menstruation. They were investigated according to the standard protocol. After clinical examination patients were investigated by U.S.G. and I.V.P. sos and diagnostic laparoscopy, the investigations for operation were Hb, Urine (Alb. Sug. Microscopy), BSL (R), BUL, Serum creatine. Then all of them were operated between Jan.1985 to Oct. 2002 under general anaesthesia & the analysis was done. The type of operations done were 1) Mcindoe operation 2) Pull through operation 3) Excision of imperforate hymen. Results: Twelve cases of Rokitansky-Kuster-Hauster Syndrome were operated by McIndoe technique. None of the patients developed V.V.F. or R.V.F. The average vaginal length was 8.76 cms.; Four cases of imperforate hymen had undergone excision & Two cases of congenital stricture in upper vagina had undergone pull through operation Conclusions: Use of foam rubber mold is without any pressure necrosis of bladder or rectum.

Congenital Cervical and Vaginal Malformations: Lessons from 42 cases Managed Clinically by a Common Protocol [28Q

INTRODUCTION: To outline the anatomic variations and the clinical management of congenital cervical and vaginal malformations in a cohort of 42 patients in China. METHODS: From January 2008 to January 2017, a total of 42 patients with congenital cervical and vaginal malformations were treated in the department of Gynecology at the 3rd affiliated hospital of Shenzhen University (China). Clinical examinations, magnetic resonance imaging, hormonal profile and laparoscopy were collected. All surgical findings were carefully reviewed to determine the anatomic characteristics of the cervical and vaginal malformations. RESULTS: The mean age at the time of symptom onset was 12.8±1.9 years (range 9-17). The mean time from symptom onset to surgery was 3.4±0.9 years (range 0.1-14). Among the 38 patients, (90.5%) had pelvic endometriosis. Among the 38 patients with pelvic endometriosis, 20 patients had ovarian endometrial cysts. Endometriosis was staged as minimal-mild in 21 and as moderate-severe in 17. Of the 42 patients, 5 underwent hysterectomy during their first surgery and 37 received cervical reconstruction surgery. Among these 37 patients, 25 underwent Luohu III procedure (peritoneal vaginoplasty, trachelectomy and uterus-neovagina anastomosis), 12 underwent Luohu IV procedure (laparoscopic vaginal section and peritoneal vaginoplasty). Of the 37 patients with a preserved uterus, 2 attempted pregnancy up to day, and one woman achieved a successful pregnancy but experienced premature delivery. CONCLUSION: Our study found that cervical and vaginal malformations might be successfully treated by uterovaginal anastomosis under laparoscopy. With appropriate evaluation and individualized management, we believe that a successful treatment and pregnancy outcome might be achieved.

MR imaging evaluation of obstructing vaginal malformations with hematocolpos or hematometra in adolescent girls: A cross sectional study

ObjectiveVaginal or uterine outlet obstruction leads to hematocolpos or hematometra. Detection of the etiology of this entity is important to guide adequate surgical management and thereby avoid complications and to preserve fertility. The aim of this study was to evaluate obstructing vaginal malformations in adolescent girls presenting with hematocolpos or hematometra with MR imaging. Materials and methodsA hospital based prospective study was conducted in a tertiary care centre from September 2015 to October 2016. The study included 17 adolescent females who were evaluated with MRI. ResultOf 17 adolescent female with vaginal or uterine outflow obstructive anomalies with hematocolpos or hematometra, where 6 patients (35.3%) had HWWS, 6 patients (35.3%) had imperforate hymen, 2 patients (11.8%) had transverse vaginal septum, 1 patient each (5.9%) had cervico-vaginal atresia, unicornuate uterus and communicating rudimentary Uterine horn. MRI revealed hematocolpos in 15 patients (88.2%), hematometra in 13 patients (76.5%), endometriotic ovarian cysts in 6 patients (35.3%) and hematosalpnix in 3 patients (17.6%). ConclusionEarly radiological diagnosis of the cause of vaginal or uterine outflow obstruction is important to guide adequate surgical management which if undertaken promptly helps to avoid complications due to reflux from vaginal or uterine outflow obstruction.

Laparoscopic Management of a Rudimentary Uterine Horn

Study ObjectiveTo demonstrate a technique of laparoscopic management of a rudimentary horn in a 12-year-old girl. DesignA step-by-step explanation of the surgery using a video (instructive video) approved by the local institutional review board. SettingA university hospital (University Hospital of Strasbourg, Strasbourg, France). PatientA 12-year-old girl with a uterine rudimentary horn. InterventionWe describe a case of a 12-year-old girl who had no medical history. She had her first menstruation at 11 years old with major left pelvic pain occurring each month. Ultrasonography showed a duplication of the uterus with a liquid collection on the left side; this type of malformation is called an accessory and cavitated uterine mass. Medical treatment was initiated with progestin. Magnetic resonance imaging showed a left noncommunicating rudimentary horn with a unicornuate uterus. No other malformation was present, particularly in the kidneys. A primary vaginal endoscopy was performed showing a single cervix without vaginal malformation. It was decided to perform a laparoscopic excision of the left rudimentary horn. We placed a 10-mm optical port into the umbilicus and 3 accessory 5-mm trocars. Evaluation of the abdominal cavity showed 2 normal adnexas with normal ovaries. We decided to start with a left salpingectomy using the Ligasure device (Medtronic, Minneapolis, MN), staying close to the tube to preserve ovarian vascularization. The remnant fimbria must be removed to avoid cancerization. Then, the vesicouterine septum was divided until we reached the cervix to dissect the bladder from the rudimentary horn. The broad ligament was fenestrated in order to push the left ureter laterally .The utero-ovarian pedicle was transected with the Ligasure device; the left ovary was preserved and vascularized by the left infundibulopelvic ligament. We then dissected the left uterine artery. The posterior peritoneum was opened. The resection of the rudimentary horn was performed by means of a monopolar hook. The dissection was performed slowly with selective coagulation until we reached the cavity of the horn, with old blood flowing out. The entire cavity was removed, and we confirmed the absence of communication with the other part of the uterus. Uterine reconstruction was performed with inverted separated stiches of a 2-0 braided suture, and, finally, an antiadhesion barrier was placed. ConclusionsLaparoscopic management of a uterine rudimentary horn is feasible with satisfactory uterine reconstruction. This is not the first case of this surgery performed by laparoscopy. A similar case has been published in 2015 [1], and recently another video [2] has been published describing 2 other cases.

Magnetic resonance imaging in diagnosis and classification of uterovaginal congenital anomalies

Uterine congenital anomalies are clinically relevant because these are associated with increased incidences of infertility and menstrual disorder. These are frequently not diagnosed at birth. These anomalies usually diagnosed at child-bearing age when reproductive malfunction arise. When normal mullerian duct development interrupted at any stage, it results in mullerian abnormality. Magnetic resonance imaging (MRI) has an excellent role in evaluation of mullerian duct anomalies. Ultrasonography is the primary investigation; however, MRI is an excellent noninvasive investigation for accurate evaluation of uterine congenital anomalies. MRI is a very good modality to evaluate the vaginal malformation, which usually difficult to evaluate by ultrasound.

Clinical Characteristics of Patients Who Underwent Surgery for Genital Tract Malformations at Peking Union Medical College Hospital across 31 Years.

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.