Abstract
Study Objective
To assess the clinical course of obstructive Müllerian anomalies found in girls after
menarche.
Design
A retrospective case series of adolescents who, between 2009 and 2016, were treated
for vaginal or uterine obstructive malformations diagnosed after menarche.
Setting
Division of Gynecology, Poznań University of Medical Sciences, Poznań, Poland.
Participants and Interventions
Twenty-two patients who, at the age range between 11.4 and 18.2 (median, 13.1) years,
between 2 and 74 (median 7.5) months after menarche, underwent surgical repair of
obstructive genital anomaly.
Main Outcome Measures
Müllerian defect type, presentation, radiologic findings, pre- and postoperative course.
Results
Eighteen patients (18 of 22; 81.8%) were diagnosed with obstructed hemivagina ipsilateral
renal anomaly syndrome. One patient (1 of 22; 4.5%) was diagnosed with uterus didelphys
and unilateral cervical atresia. Three patients (3 of 22; 13.6%) had unicornuate uterus
with a cavitated, noncommunicating rudimentary horn. The right side was affected in
13 patients (13 of 22; 59.1%), and the left side in 9 patients (9 of 22; 40.9%; P > .05). All but 1 patient had renal agenesis on the side of obstruction. Before repair
of the obstructive genital anomaly, 4 patients underwent unnecessary surgeries for
misdiagnosed ovarian cysts. Serious complications (pelvic inflammatory disease, vesicovaginal
fistula) occurred in 2 patients with microperforated pyocolpos. Pelvic endometriosis
was found in 4 of our patients.
Conclusion
Our case series suggests that obstructed hemivagina ipsilateral renal anomaly syndrome
is the most common obstructive Müllerian anomaly diagnosed in adolescents after menarche.
The differential diagnosis for unilateral kidney agenesis accompanied by dysmenorrhea
in adolescent girls should include obstructive genital tract anomaly. Accurate diagnosis
of an obstructive genital anomaly early after menarche might help prevent unnecessary
surgeries and infection-related complications. Meanwhile, prompt surgical correction
of an obstructive genital tract anomaly results in relief of symptoms and might reduce
the risk of endometriosis.
Key Words
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Article info
Publication history
Published online: October 10, 2017
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
