Didelphic uterus and obstructed hemivagina with renal agenesis

Literature Review Article

Didelphic uterus and obstructed hemivagina with renal agenesis: case report and review of the literature. Zurawin R, Dietrich J, Heard M, Edwards C. J Ped Adoles Gyn 01 Apr 2004; 17(2): 137-41.  

Review
Kelly E. Peacock, M.D., Charlotte, NC

This is a retrospective review of eight cases of uterine didelphys with obstructed hemivagina and unilateral renal agenesis. The patients' initial presentations, management, and operative findings are presented and discussed. Cases were located from the archives of three hospitals over a 35 month period. Mean age at diagnosis was 14.5 years. Seven of eight patients were diagnosed within two years of menarche. They all reported regular menstrual cycles with cyclic pelvic pain. The initial diagnosis was incorrect in all of them: pelvic pain, pelvic mass, or pelvic inflammatory disease. The mean time to proper diagnosis was 37.8 weeks. It is proposed that this delay in diagnosis is due to several factors: (1) regular menstrual cycles, (2) uncommon condition, and (3) treatments such as NSAIDs and oral contraceptives diminishing or eliminating menses, thus decreasing their symptomatology. Initial imaging was by CT or ultrasound; half received MRIs. Ultimately all patients underwent vaginal septum resection. Five had hematocolpos, three had pyocolpos. Five patients underwent laparoscopy at the time of resection, which assisted with diagnosis of adhesions and associated mullerian/renal defects. Three of the eight patients had contralateral renal anomalies, in addition to the unilateral renal agenesis. Two patients required unilateral salpingoophorectomy due to inflammation; one required abdominal hysterectomy.
 

Comments 
Steven R. Lindheim, M.D., Dept Ob/Gyn, Univ of Wisconsin
Meike L. Uhler, M.D., Fertility Center of Illinois

This is a randomized study of a clinically challenging congenital anomaly of the uterus, namely, the complete uterine septum with duplicated cervix. Other studies in the literature have advocated sparing the cervix due to possible cervical incompetence. This investigation found no difference in the number of abortions, preterm deliveries and term deliveries following hysteroscopic metroplasty with resection or preservation of the cervical section of the septum. Due to the small number of patients (n=28), the conclusions of this study must be interpreted with caution.

 

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

 

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