Document Detail


Pitfalls in the diagnosis and management of obstructive uterovaginal duplication: a series of 32 cases.
MedLine Citation:
PMID:  18824497     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Obstructive uterovaginal duplication is rare and frequently misdiagnosed. The aims of this study were to review all the patients managed for this malformation in our institution, evaluate their long-term outcomes, and discuss the embryologic origin of this malformation. METHODS: From 1984 to 2007, we treated 32 patients for obstructive uterovaginal duplication in our institution. We separated them in 2 groups (prepubertal [n = 8] and pubertal [n = 24]) and analyzed their clinical and radiologic presentations and their treatments. Patients >18 years of age (n = 22) were recontacted. RESULTS: For the prepubertal group, the median age at diagnosis was 6 months. Postnatal ultrasound showed an absent ipsilateral kidney in 6 case subjects, although 4 patients had a prenatal diagnosis of ipsilateral multicystic dysplastic kidney. This renal anomaly was associated with a pelvic sonolucent mass in 3 case subjects, allowing us to prenatally suspect the diagnosis. All of the patients were cured by vaginal approach. For the pubertal group, the median delay of diagnosis after menarche was 9 months. Among patients managed in an emergency setting (n = 11), there were 9 misdiagnoses with inappropriate abdominal surgeries, including 3 hysterectomies of the obstructed hemiuterus. Concerning long-term results, 5 patients were attempting to have children, with successful pregnancies for 4 of them. One patient suffered from infertility attributable to contralateral isthmic stenosis after a hysterectomy of the obstructed hemiuterus. CONCLUSIONS: Obstructive uterovaginal duplication is a benign pathology when properly managed. Therefore, management of abdominal pain in peripubertal girls should include systematic abdominal and gynecologic examinations completed by radiologic pelvic and renal evaluation. Surgical treatment should be performed by vaginal approach to avoid infertility. Concerning the origin of the malformation, the high association of prenatal dysplastic kidneys and postnatal absent kidneys suggests anomalies of both wolffian and müllerian duct development, contrasting with the classic definition of this malformation.
Authors:
Carmen Capito; Anis Echaieb; Stephen Lortat-Jacob; Elisabeth Thibaud; Sabine Sarnacki; Claire Nihoul-Fékété
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-09-29
Journal Detail:
Title:  Pediatrics     Volume:  122     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-02     Completed Date:  2008-10-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e891-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatric, Necker Enfants-Malades, Hospital, Paris V University, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple*
Adolescent
Child
Child, Preschool
Constriction, Pathologic
Diagnosis, Differential
Female
Follow-Up Studies
Gynecologic Surgical Procedures / methods*
Humans
Infant
Infant, Newborn
Magnetic Resonance Imaging
Prognosis
Retrospective Studies
Time Factors
Tomography, X-Ray Computed
Uterine Diseases / congenital,  diagnosis*,  surgery
Uterus / abnormalities*
Vagina / abnormalities*
Vaginal Diseases / congenital,  diagnosis*,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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