Malformations of the Female Genital Tract and Embryological Bases

Abstract

Female genital tract malformations are frequently a cause of reproductive problems. Besides, complex malformations also frequently generate serious gynecological problems, often ones with inappropriate surgical solutions, as the gynecologist does not think of the malformation as either the cause of the symptoms or of its embryonary origin. Apart from analyzing the embryological bases in the development of the female genital tract and insisting on the well known müllerian origin of the uterus, the ratification of the embryological hypothesis about the origin of the human vagina from the Wolff ducts and the Müller tubercle allows us to not only advance in knowledge but to use that knowledge for better clinical management of the problems generated by the complex malformations of the female genital tract. In this review we study the methods and means for the diagnosis of female genital-urinary malformations, their classification and clinical findings, and especially those cases involving unilateral renal agenesis, vaginal ectopic ureter and other complex malformations. We also analyze the related obstetric and gynecologic pathology, and especially that cases of complex genital malformations. We review the related literature and some interesting case reports, as well as our experimental studies in rats. After reasserting our hypothesis about the embryology of the human vagina as derived from the Wolff ducts and the Müller tubercle, we suggest different recommendations for a better approach and management of the malformations of the female genital tract according to the findings observed in different diagnostic procedures.

Ectopic ovary confirmed by ovarian stimulation in a case of unicornuate uterus

“…A unicornuate uterus is the result of complete development of only one of the m€ ullerian ducts, with failure in the development of the contralateral side either partially or completely, and accounts for 5% of all congenital uterine anomalies. The ovary, which forms from the urogenital ridge, is present on the affected side but may be higher in the abdomen than its normal pelvic location (1,2,6). In our case the unicornuate uterus had no contralateral horn, the right ovary was not in the pelvis, and the right kidney was absent.…”

“…The malformations affecting the uterus also known as m€ ullerian anomalies originate from adverse embryologic events of m€ ullerian ducts ranging from agenesis to lateral and vertical fusion defects (1). Unicornuate uterus is an infrequent type of m€ ullerian anomaly and represents a lateral fusion defect (2).…”

Müllerian anomalies “without a classification”: from the didelphys-unicollis uterus to the bicervical uterus with or without septate vagina

“…The origin of the injury/ lesion may be in the same M€ ullerian ducts and/or tubercle or in the wolffian ducts, because the appropriate development, fusion, and resorption of the M€ ullerian ducts is induced at all times by the mesonephric or wolffian ducts placed at both sides, which behave as ''guide'' elements (7,(19)(20)(21)(22).…”

Pitfalls in the Diagnosis and Management of Obstructive Uterovaginal Duplication: A Series of 32 Cases

“…This mechanism could also explain the clinical fact that the blind hemivagina, when moderately dilated, is found as a bulging mass high in the normal hemivaginal sidewall. Another hypothesis to explain the malformation has been proposed by Acié n et al 23,24 in their work on the embryology of the female genital tract. They hypothesize that, contrary to the classical description, the entire vagina originates from the fused wolffian ducts.…”