A 22 year old nulligravid presented with progressively increasing dysmenorrhea. Transvaginal ultrasound showed a unicornuate uterus with a functioning left rudimentary horn which was confirmed on exploratory laparotomy. The patient was also found to have a missing right fallopian tube and ovary. Excision of the left rudimentary horn was done. The surgery resulted in the patient with a remaining hemiuterus on one side and a separate fallopian tube with the ovary on the other. A very limited number of case reports are available in the literature to describe concomitant occurrence of gonadal and uterine developmental abnormalities. Rarer still is the occurrence of a unilateral fallopian tube and ovary contralateral to a unicornuate uterus. Its possible pathogenesis and implications on the patient's reproductive outlook are discussed.
Human ; Female ; Young Adult ; ABNORMALITIES ; UTERUS

Female ; Humans ; Male ; Urogenital Abnormalities ; classification ; diagnosis ; Uterus ; abnormalities

Female ; Humans ; Male ; Urogenital Abnormalities ; classification ; diagnosis ; Uterus ; abnormalities

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare congenital anomaly. Excision of the obstructed vaginal septum is the treatment of choice for symptom relief and the preservation of reproductive capability. A 14-yr-old girl complained of persistent vaginal spotting following each menstruation. Pelvic magnetic resonance imaging revealed a uterus didelphys with left hematocolpos and ipsilateral renal agenesis. Instead of conventional transvaginal excision of the vaginal septum, we used hysteroscopic excision under transabdominal ultrasonographic guidance to preserve the integrity of the hymen. The postoperative course was uneventful, and clinical symptoms were completely resolved after this intervention. Resectoscopic excision of the vaginal septum was found to be easy, safe, effective, and appropriate for young women as it preserved hymen integrity. We believe that this is the first Korean report on the use of a hysteroscopy for vaginal septum resection in a patient with uterus didelphys with obstructed hemivagina.
Adolescent ; Female ; Humans ; Hysteroscopy/*methods ; Kidney/abnormalities ; Urogenital Abnormalities/surgery ; Uterus/*abnormalities ; Vagina/*abnormalities/*surgery/ultrasonography

Uterine torsion, which most often occurs during pregnancy, is rare. Torsion of a nongravid uterus is extremely rare and is associated with pelvic adhesions, uterine leiomyomas, or uterine anomalies. We experienced a case of uterine torsion, with a huge subserosal leiomyoma and multiple intramural leiomyomas, in a postmenopausal woman, one that showed the most extreme degree of rotation among the known cases of uterine torsion. Necrosis of the uterus and both adnexae was observed. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. We present this case with a brief review of the relevant literature.
Female ; Humans ; Hysterectomy ; Leiomyoma ; Necrosis ; Postmenopause ; Pregnancy ; Urogenital Abnormalities ; Uterus

Adult ; Female ; Humans ; Pregnancy ; Pregnancy Complications ; diagnosis ; therapy ; Uterus ; abnormalities

BACKGROUNDUterus didelphys and blind hemivagina associated with ipsilateral renal agenesis are collectively known as Herlyn-Werner-Wunderlich syndrome (HWWS). In the literature, the syndrome often appears as a single case report or as a small series. In our study, we reviewed the characteristics of all HWWS patients at Peking Union Medical College Hospital (PUMCH) and suggested a new classification for this syndrome because the clinical characteristics differed significantly between the completely and incompletely obstructed vaginal septum. This new classification allows for earlier diagnosis and treatment.

METHODSFrom January 1986 to March 2013, all diagnosed cases of HWWS at PUMCH were reviewed. A retrospective long-term follow-up study of the clinical presentation, surgical prognosis, and pregnancy outcomes was performed. Statistical analyses were performed using SPSS, version 15.0 (IBM, Armonk, NY, USA). Between-group comparisons were performed using the χ2 test, Fisher's exact test, and the t-test. The significance level for all analyses was set at P < 0.05.

RESULTSThe clinical data from 79 patients with HWWS were analyzed until March 31, 2013. According to our newly identified characteristics, we recommend that the syndrome be classified by the complete or incomplete obstruction of the hemivagina as follows: Classification 1, a completely obstructed hemivagina and Classification 2, an incompletely obstructed hemivagina. The clinical details associated with these two types are distinctly different.

CONCLUSIONSHWWS patients should be differentiated according to these two classifications. The two classifications could be generalized by gynecologists world-wide.

Adolescent ; Child ; Congenital Abnormalities ; classification ; diagnosis ; Female ; Humans ; Male ; Retrospective Studies ; Urogenital Abnormalities ; classification ; diagnosis ; Uterus ; abnormalities ; Vagina ; abnormalities

BACKGROUNDThe pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accepted treatment method for women with unicornuate uterus, other than expectant measures. The aim of this study was to evaluate the reproductive outcome of transcervical uterine incision (TCUI) in patients with unicornuate uterus.

METHODSThirty-three patients with unicornuate uterus presented to our tertiary center for infertility or miscarriage. All 33 patients underwent TCUI and were followed up for 10-52 months. The pregnancy outcomes ( first-trimester miscarriage, second-trimester miscarriage, preterm, term, intrauterine death, ongoing pregnancy, and live birth) before and after TCUI were compared by t- test.

RESULTSAmong 31 patients who attempted to conceive after TCUI, twenty conceived including one termination of pregnancy, one second-trimester miscarriage, one ectopic pregnancy, five preterm deliveries, 11 term delivery, and one ongoing pregnancy. There were 16 live births in total. There was significant reduction in the first-trimester miscarriage rate (t = 4.890; P< 0.001), increase in term delivery (t = -3.288; P = 0.002), and live birth rates (t = -4.073; P< 0.001) after TCUI.

CONCLUSIONTCUI appeared to improve the pregnancy outcome in women with unicornuate uterus presenting with infertility or miscarriage.

Adult ; Female ; Humans ; Hysteroscopy ; Pregnancy ; Pregnancy Complications ; surgery ; Pregnancy Outcome ; Urogenital Abnormalities ; surgery ; Uterus ; abnormalities ; surgery

OBJECTIVETo describe the magnetic resonance (MR) imaging manifestations in vaginal anomalies, and to discuss the utility and limit of MR imaging in diagnosis of this abnormality.

METHODSNine female patients with congenital vaginal anomalies who required surgical intervention were studied. MR imaging and ultrasound of the pelvic was performed before surgery. MR imaging features were retrospectively analyzed correlating with surgery.

RESULTSThe vaginal anomalies were categorized into three groups: (1) congenital absence of the vagina and uterus, i.e. Mayer-Rokitansky-Küster-Hauser syndrome (MRKH syndrome) (n=3); (2) vaginal atresia (n=2); and (3) transverse vaginal septum (n=2). There was also one case of absence of vaginal with complicated urinogenital abnormality, and 1 case of obstructed hymen.

CONCLUSIONSMRI is a reliable method for evaluating vaginal anomalies. An accurate MRI examination can be helpful for surgical management.

Abnormalities, Multiple ; diagnosis ; Adolescent ; Adult ; Female ; Humans ; Hymen ; abnormalities ; Magnetic Resonance Imaging ; Retrospective Studies ; Urogenital Abnormalities ; diagnosis ; Uterus ; abnormalities ; Vagina ; abnormalities

We present a case of vaginal ectopic ureter with ipsilateral partial duplication of the upper ureter (Y-type ureter), ipsilateral hypoplastic pelvic kidney and bicornuate uterus in a 20-year-old woman who presented with mild urinary incontinence since infancy. Ultrasonography, computed tomography and intravenous pyelography examination showed a left kidney with no evidence of a right kidney. Cystourethroscopy showed absence of the right hemitrigone. Magnetic resonance (MR) urography demonstrated the presence of a bicornuate uterus, an ectopic dysplastic right kidney in the pelvic cavity, and a right ureter that terminates in the vaginae fornix. The patient underwent right nephroureterectomy and urinary continence was restored completely. Although congenital malformations of the urinary tract are frequently associated with genital tract abnormalities, to best our knowledge, this is the first report of the coexistence of all of these anomalies in an individual. Our report also highlights the importance of MR urography in the diagnosis of such rare and complex anomalies.
Female ; Humans ; Kidney ; abnormalities ; pathology ; Kidney Diseases ; diagnosis ; pathology ; Magnetic Resonance Imaging ; Ureter ; abnormalities ; pathology ; Urinary Incontinence ; etiology ; Uterus ; abnormalities ; pathology ; Vagina ; abnormalities ; pathology ; Young Adult