Diagnostic imaging and cataloguing of female genital malformations

Abstract

To help physicians and radiologists in the diagnosis of female genito-urinary malformations, especially of complex cases, the embryology of the female genital tract, the basis for Müllerian development anomalies, the current classifications for such anomalies and the comparison for inclusion and cataloguing of female genital malformations are briefly reviewed. The use of the embryological system to catalogue female genito-urinary malformations may ultimately be more useful in correlations with clinical presentations and in helping with the appropriate diagnosis and treatment. Diagnostic imaging of the different genito-urinary anomalies are exposed, placing particular emphasis on the anomalies within group II of the embryological and clinical classification (distal mesonephric anomalies), all of them associated with unilateral renal agenesis or dysplasia. Similarly, emphasis is placed on cases of cervico-vaginal agenesis, cavitated noncommunicated uterine horns, and cloacal and urogenital sinus anomalies and malformative combinations, all of them complex malformations. Diagnostic imaging for all these anomalies is essential. The best imaging tools and when to evaluate for other anomalies are also analysed in this review.Teaching points• The appropriate cataloguing of female genital malformations is controversial.• An embryological classification system suggests the best diagnosis and appropriate management.• The anomalies most frequently diagnosed incorrectly are the distal mesonephric anomalies (DMAs).• DMAs are associated with unilateral renal agenesis or renal dysplasia with ectopic ureter.• We analyse other complex malformations. Diagnostic imaging for these anomalies is essential.

Novel approach to locating a hypoplastic kidney in a unique variant of uterine didelphys syndrome presenting with continuous incontinence

“…The appropriate development, fusion and resorption of this wall is thought to be induced by the Wolffian ducts located at both sides (which, in combination with the Müllerian tubercle give rise to the vagina). The absence or distal injury of one of the Wolffian ducts may give rise to renal agenesis, ipsilateral blind or atretic hemivagina and uterine anomalies (fusion or resorption defect) 1 2. When the ureteric bud arises more cephalad than normal on the mesonephric duct, distal ectopic ureteric insertion may occur as it migrates more caudally before inserting into either the distal urinary tract or reproductive tract 3–5.…”

“…CT with IVP can be useful in assessing atypical renal tracts, however is often passed by in favour of other modalities given the very young age of most patients. MRI has been emphasised as a beneficial modality in clarifying anatomical variation in this situation 2 6 12 14. Joshi et al described seven cases of congenital renal dysplasia with single system ureteral ectopia diagnosed preoperatively with MR urography with 100% sensitivity and specificity for confirmation of renal dysplasia and characterisation of ureter course 14.…”

Congenital vesicouterine fistulas—A PRISMA‐compliant systematic review

“…They have, however, been classified in an embryological system developed to catalog female urogenital malformations, proposed by Acién and Acién. In their 2016 classification, congenital VUFs represent anomalies of the cloaca and urogenital sinus . This indicates a shift in thinking on the origin of these fistulas, because earlier work ascribed them solely to abnormalities of the paramesonephric (Müllerian) ducts …”

“…In their 2016 classification, congenital VUFs represent anomalies of the cloaca and urogenital sinus. 35,36 This indicates a shift in thinking on the origin of these fistulas, because earlier work ascribed them solely to abnormalities of the paramesonephric (Müllerian) ducts. 23,24,27 Our descriptive study testifies to the progress made from an initial account of three cases 17 to the current review of 10.…”

Characteristics of the uterine tubes in the fetal period: topographic and morphometric parallels

“…Though even now literature contains disputable, fragmentary and nonsystematize information concerning age morphological peculiarities of the organ systems of fetuses on the whole and uterine tubes in particular. Certain data [2] determine that close shape-generating interrelations are established between the mesenchymal membrane of the paramesonephral ducts and caudal ligament of mesonephros (Wolffian body/inguinal fold) on the eighth week of development. Some other data determined [3] that the mucous membrane of the uterine tubes during early reproductive age is covered with simple columnar epithelium with a small amount of ciliated and secretory cells available.…”