Concomitant resorptive defects of the reproductive tract: a uterocervicovaginal septum and imperforate hymen

Oakes, Meghan B.; Hussain, Hero K.; Smith, Yolanda R.; Quint, Elisabeth H.

doi:10.1016/j.fertnstert.2009.10.001

Cited by 8 publications

(4 citation statements)

References 7 publications

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“…(2012)SeptateComplete septate uterusSeptateSeptateImperforate hymenImperforate hymenU 2b C 1 V 3 Acién et al (2009) (case 5) and Lev-Toaff et al (1992)SeptateComplete septate uterusBicervicalDouble normalNormalNormalU 2b C 2 V 0 Balasch et al (1996), Brown and Badawy (2013), Caliskan et al (2008), Celik and Mulayim (2012), Chang et al (2004), Duffy et al (2004), Fatum et al (2003), Guo et al (2011), Heinonen (2006), Hundley et al (2001), Ignatov et al (2008). La Fianza et al (1997), McBean and Brumsted (1994), Nigam et al (2010), Oakes et al (2010), Patton et al (2004), Pavone et al (2006), Ribeiro et al (2010), Saygili-Yilmaz et al (2004) and Wai et al (2001)SeptateComplete septate uterusCervical duplication or Double normalDouble normalSeptateLongitudinal non-obstructing vaginal septumU 2b C 2 V 1 Hur et al (2007), Fedele et al (2013) (10/87 cases) and Acién et al (2004c)*SeptateComplete septate uterusDouble cervicesDouble normalUnilaterally obstructed vaginal septumLongitudinal obstructing vaginal septumU 2b C 2 V 2 * In the case of Acién et al (2004c) associated malformation : an ectopic ureter joined to ipsilateral hemi-cervixCapito and Sarnacki (2009)*, Gupta et al (2007)*, Hucke et al (1992) (2/3 cases), Perino et al (1995), ...…”

Section: Resultsmentioning

confidence: 99%

The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system

et al. 2015

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STUDY QUESTIONHow comprehensive is the recently published European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) classification system of female genital anomalies?SUMMARY ANSWERThe ESHRE/ESGE classification provides a comprehensive description and categorization of almost all of the currently known anomalies that could not be classified properly with the American Fertility Society (AFS) system.WHAT IS KNOWN ALREADYUntil now, the more accepted classification system, namely that of the AFS, is associated with serious limitations in effective categorization of female genital anomalies. Many cases published in the literature could not be properly classified using the AFS system, yet a clear and accurate classification is a prerequisite for treatment.STUDY DESIGN, SIZE AND DURATIONThe CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group.PARTICIPANTS/MATERIALS, SETTING, METHODSAmong the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies.MAIN RESULTS AND THE ROLE OF CHANCEThe congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of anomalies, while multiple organs and/or segments of Müllerian ducts (complex anomaly) were involved in 27 (69.2%) types. Uterus was the organ most frequently involved (30/39: 76.9%), followed by cervix (26/39: 66.7%) and vagina (23/39: 59%). In all 39 types, the ESHRE/ESGE classification system provided a comprehensive description of each single or complex anomaly. A precise categorization was reached in 38 out of 39 types studied. Only one case of a bizarre uterine anomaly, with no clear embryological defect, could not be categorized and thus was placed in Class 6 (un-classified) of the ESHRE/ESGE system.LIMITATIONS, REASONS FOR CAUTIONThe review of the literature was thorough but we cannot rule out the possibility that other defects exist which will also require testing in the new ESHRE/ESGE system. These anomalies, however, must be rare.WIDER IMPLICATIONS OF THE FINDINGSThe comprehensiveness of the ESHRE/ESGE classification adds objective scientific validity to its use. This may, therefore, promote its further dissemination and acceptance, which will have a positive outcome in clinical care a...

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Section: Resultsmentioning

confidence: 99%

The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system

et al. 2015

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“…Excision of hymenal tissue and superfluous mucosa is usually required to address clinically severe hymenal abnormalities [32]. However, because of the risk of ascending infection and sepsis, simple incision and drainage of hematocolpos in a patient with an IH should be avoided [36]. Other study suggested that thicker hymenal membranes be surgically resected, while thinner membranes be treated with a vertical incision [32].…”

Section: Discussionmentioning

confidence: 99%

Hymen-saving hymenotomy of imperforate hymen in neonates and adolescents: tertiary medical center experience

Aljahdali

Kurdi

2022

Ann Pediatr Surg

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Background Imperforate hymen (IH) is the most common obstructive anomaly of female genital tract. Hymen saving has a great importance for both cultural and religious reasons. Conventional surgical treatment for this condition is cruciate incision hymenotomy or hymen-saving central annular hymenotomy (HSCAH). This study aimed to review presentations and management of neonate and adolescents with IH at one tertiary hospital over 12 year’s period. The aim also was to stress upon importance of hymen saving to our Muslim community and improve knowledge, enable targeted education, and reduce unnecessary tests and diagnostic delay for this condition. Methods Twenty-five patients with IH were diagnosed and treated in this retrospective cohort study over 12 years, from January 2010 till December 2021. Demographic characteristics of the patients, their symptoms and signs, investigations, type of operations, recurrence, and infections were recorded and analyzed. Results Saudi accounted for the majority of IH cases (88%). There were fifteen adolescents, and ten were neonates. Bulging imperforate hymen, pelvic/abdominopelvic mass, constipation, acute urine retention, abdominal discomfort, and lower abdominal distension were among the signs and symptoms. All 25 patients had HSCAH, 21 of whom had primary HSCAH and four of whom had secondary HSCAH due to recurrence. To avoid recurrence, HSCAH was performed with suturing of the inner vaginal mucosa to the exterior vestibular mucosa. Conclusion Early diagnosis of imperforate hymen for neonate and adolescent girls and prompt definitive HSCAH could have positive impact on treatment outcome and decrease complications and fulfill integrity of hymen as virginity of high importance in our Muslim community and other similar culture, where hymen-sparing procedure is preferred by most of these patients and families.

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“…Among patients described in case reports, there were five patients with transverse vaginal septum combined with imperforate hymen [22,23,24,25,26] and one patient with uterocervicovaginal septum [27]. Also, there was one patient who was a neonate at the time of diagnosis with sacral agenesis [3] not fully separated with an imperforate hymen.…”

Section: Discussionmentioning

confidence: 99%

Imperforate Hymen: A Comprehensive Systematic Review

Lee

Hong

Jung

et al. 2019

JCM

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Imperforate hymen (IH) is an uncommon congenital anomaly of the female genital tract, with the hymen completely obstructing the vaginal opening. Despite the simple diagnosis and treatment of IH, missed or delayed diagnosis is often a clinical problem owing to its low incidence, nonspecific symptoms, or insufficient physical examination. The aim of this study is to identify the characteristics, clinical presentations, treatment modalities, and outcomes of imperforate hymen patients. In this study, a literature search of PubMed databases was performed for sources published up to 3 July 2018 for English-language studies with the term “imperforate hymen”. The literature review identified 251 citations and 155 articles (143 case reports, 12 case series) containing 253 patients who were finally included (two papers were not written in English). Among 236 postnatal patients, the mean age of the patients was 10.7 ± 4.7 years. Abdominal pain (54.2%), urinary retention (20.3%), abnormal menstruation (14.0%), dysuria (9.7%), increased urinary frequency (5.1%), severe presentation of renal failure (n = 5, 2.1%), and urinary tract infection (n = 1, 0.4%) were presented. Most patients diagnosed with the condition underwent surgical treatment (83.5%), most of whom were treated via a hymenotomy (35.2%) and hymenectomy (36.4%), and the use of prophylactic antibiotics were only used in 7 patients. There were no differences in outcomes between two surgical methods. In addition, 141 (59.7%) patients showed improvement and 5 deceased patients were not related to IH or the operation itself; Complications, such as vaginal adhesion, were only noted in 6.6% of patients. In addition, among 17 cases of newborns with a diagnosis of IH before birth, hymenectomy (n = 5, 29.4%) and hymenotomy (n = 9, 52.9%) were the main treatment modalities and showed improved prognosis in 52.9% of newborns. Because IH diagnosis is easy and postsurgical prognosis is good, clinicians should carefully examine every female patient at birth. IH should be considered regarding adolescent girls with abdominal pain, lower back pain, or urinary retention, and perform appropriate physical examinations of the genital introitus. In addition, accurate diagnosis as IH, not misdiagnosing as vaginal septum or agenesis, is important to prevent severe complications such as stricture and ascending infection.

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Concomitant resorptive defects of the reproductive tract: a uterocervicovaginal septum and imperforate hymen

Cited by 8 publications

References 7 publications

The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system

The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system

Hymen-saving hymenotomy of imperforate hymen in neonates and adolescents: tertiary medical center experience

Imperforate Hymen: A Comprehensive Systematic Review

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