OBJECTIVES: Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare female genital tract malformation, and there are few large sample studies reported at home and abroad. The clinical manifestations of this syndrome are diverse, and insufficient understanding may delay the diagnosis and treatment of the patients. This study aims to analyze the clinical characteristics of different types of HWWS patients, and to improve the diagnosis and treatment of HWWS. METHODS: The clinical data of patients with HWWS who were hospitalized in the Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University from October 1, 2009 to April 5, 2022 were retrospectively analyzed. The age, medical history, physical examination, imaging examination and treatment of the patients were collected for statistical analysis. The patients were divided into an imperforate oblique vaginal septum type, a perforate oblique vaginal septum type, and an imperforate oblique vaginal septum and cervical fistula type. The clinical characteristics of different types of HWWS patients were compared. RESULTS: A total of 102 HWWS patients were enrolled, with age of 10-46 years old, including 37 (36.27%) patients with type I, 50 (49.02%) type II, and 15 (14.71%) type III. All patients were diagnosed after menarche, with an average age of (20.5±7.4) years. There were significant differences in the age of diagnosis and course of disease among the 3 types of HWWS patients (both P<0.05). Patients with type I had the youngest age of diagnosis [(18.0±6.0) years] and the shortest course of disease (median course of 6 months), while patients with type III had the oldest age of diagnosis [(22.9±9.8) years] and the longest course of disease (median course of 48 months). The main clinical manifestation of type I was dysmenorrhea, and the main clinical manifestation of type II and type III was abnormal vaginal bleeding. Of the 102 patients, 67 (65.69%) patients had double uterus, 33 (32.35%) had septate uterus, and 2 (1.96%) had bicornuate uterus. The vast majority of patients had renal agenesis on the oblique septum, and only 1 patient had renal dysplasia on the oblique septum. The oblique septum located on the left side in 45 (44.12%) patients and on the right side in 57 (55.88%) patients. There were no significant differences in uterine morphology, urinary system malformation, pelvic mass, and oblique septum among the 3 types of HWWS patients (all P>0.05). Six (5.88%) patients had ovarian chocolate cyst, 4 (3.92%) patients had pelvic abscess, and 5 (4.90%) patients had hydrosalpinx. All patients underwent vaginal oblique septum resection. Among them, 42 patients underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen because they had no sexual life history, and the remaining 60 patients underwent traditional oblique vaginal septum resection. Among the 102 patients, 89 patients were followed up for 1 month to 12 years. The symptoms of vaginal oblique septum in 89 patients such as dysmenorrhea, abnormal vaginal bleeding and vaginal discharge were improved after operation. Among the 42 patients who underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen, 25 patients underwent hysteroscopies again 3 months after operation, and there was no obvious scar formation at the oblique septum incision site. CONCLUSIONS Different types of HWWS have different clinical manifestations, but all can be manifested as dysmenorrhea. The patient's uterine morphology can be manifested as double uterus, septate uterus, or bicornuate uterus. The possibility of HWWS should be considered if uterine malformation is combined with renal agenesis. Vaginal oblique septum resection is an effective treatment.
Pregnancy ; Humans ; Female ; Adolescent ; Young Adult ; Adult ; Child ; Middle Aged ; Male ; Dysmenorrhea ; Retrospective Studies ; Kidney Diseases ; Bicornuate Uterus ; Uterine Duplication Anomalies ; Uterine Hemorrhage

To investigate the clinical value of vaginal endoscopy in the diagnosis and treatment for vaginal and uterine diseases in young girls and adolescent girls. 
 Methods: The clinical data of 156 young girls and adolescent girls treated with vaginoscopy from February 2000 to August 2017 were analyzed retrospectively.
 Results: Of the 37 cases of young girls, the clinical symptoms were the most common in vaginal hemorrhage, accounting for 40.5% (15 cases), the second one in vaginal foreign body, accounting for 29.7% (11 cases), the third one in abnormal vaginal secretion, accounting for 24.3% (9 cases), and the last one in low abdominal pain, accounting for 5.4% (2 cases). The final diagnosis of vaginal foreign body was 13 cases (35.1%). Of the 119 adolescent girls, the clinical symptoms of the visit were the most common in menstrual abnormalities or irregular vaginal bleeding, accounting for 75.6% (90 cases). The final diagnosis of abnormal uterine bleeding-ovulatory dysfunction was the most common with 59 cases (49.6%), following by 16 cases of abnormal uterine bleeding-polyp, 2 cases of abnormal uterine bleeding-malignancy and hyperplasia, and 1 cases of abnormal uterine bleeding-coagulopathy. There were 37 cases (31.1%) of reproductive tract malformation. All 156 patients successfully completed vaginal endoscopy and operation with only 1 case of urinary system infection. No other complications occurred and no damage in the hymen. 
 Conclusion: Vaginal endoscopy is a safe, effective and near-noninvasive way for the diagnosis and treatment of vaginal or uterine diseases in young girls and adolescent girls. In the case of abnormal vaginal secretions and vaginal bleeding, it should be properly recommended to use the vaginal endoscopy for diagnosis and treatment.
Adolescent ; Endoscopy ; Female ; Foreign Bodies ; Humans ; Retrospective Studies ; Uterine Hemorrhage ; Vagina