Assuntos
Transtornos 46, XX do Desenvolvimento Sexual , Ductos Paramesonéfricos , Procedimentos de Cirurgia Plástica , Útero , Humanos , Feminino , Gravidez , Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico , Transtornos 46, XX do Desenvolvimento Sexual/terapia , Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Ductos Paramesonéfricos/anormalidades , Procedimentos de Cirurgia Plástica/métodos , Útero/anormalidades , Vagina/anormalidades , Vagina/cirurgia , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/terapia , Anormalidades Congênitas/cirurgia , Fertilidade , Histerectomia , Genitália Feminina/anormalidades , Infertilidade Feminina/terapia , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Colo do Útero/anormalidades , Laparoscopia/métodosRESUMO
OBJECTIVE: To discuss several techniques of hysteroscopic surgery for complete septate uterus. CASE REPORT: A 40-year-old female with unexplained primary infertility was diagnosed with complete septate uterus with septate cervix. Hysteroscopic incision of complete septate uterus was performed by using ballooning technique. The patient conceived naturally shortly after the operation and delivered a healthy, term infant. CONCLUSION: Hysteroscopic incision of complete septate uterus is a safe and prompt way of metroplasty. With the knowledge obtained from a pre-operative MRI, it can be completed without laparoscopy and the need for hospitalization.
Assuntos
Colo do Útero , Histeroscopia , Útero , Humanos , Feminino , Adulto , Histeroscopia/métodos , Gravidez , Colo do Útero/anormalidades , Colo do Útero/cirurgia , Útero/anormalidades , Útero/cirurgia , Infertilidade Feminina/cirurgia , Infertilidade Feminina/etiologia , Nascimento a Termo , Anormalidades Urogenitais/cirurgia , Anormalidades Urogenitais/diagnóstico por imagem , Útero SeptadoAssuntos
Cerclagem Cervical , Procedimentos Cirúrgicos Robóticos , Incompetência do Colo do Útero , Útero , Adulto , Feminino , Humanos , Gravidez , Útero Bicorno , Cerclagem Cervical/métodos , Colo do Útero/cirurgia , Colo do Útero/anormalidades , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Anormalidades Urogenitais/cirurgia , Anormalidades Urogenitais/complicações , Incompetência do Colo do Útero/cirurgia , Útero/cirurgia , Útero/anormalidadesRESUMO
We report a rare case of a retroperitoneal uterus-like mass communicating with the endocervix, which presented as abdominal pain and bloating associated with severe irregular vaginal and postcoital bleeding. Our patient did not have any structural abnormalities of the urogenital system or otherwise, which makes a müllerian defect unlikely in our case. Based on the diagnostic criteria for the choristoma, that theory would be excluded here as the mass communicated with the endocervix. This strengthens the theory of metaplasia, under the effect of oestrogen and accelerated by the hyperoestrogenic state of pregnancy as the most likely postulate for our patient. Although the uterus-like mass is not commonly reported, it should be considered as a possible differential for pelvic masses.
Assuntos
Colo do Útero , Anormalidades Urogenitais , Gravidez , Feminino , Humanos , Colo do Útero/anormalidades , Útero/diagnóstico por imagem , Útero/anormalidades , Vagina/anormalidades , Dor Abdominal/complicações , Estrogênios , Anormalidades Urogenitais/complicaçõesRESUMO
PURPOSE: To study the long-term results of utero-vaginal anastomosis in cases of cervical malformations. METHODS: This is a retrospective cohort study. Nine patients presented with cryptomenorrhea due to cervical malformations (5 patients with cervical agenesis and vaginal aplasia, 2 patients with cervical agenesis and upper vaginal aplasia, and two patients with cervical dysgenesis in form of cervical obstruction). Five patients had utero-vaginal anastomosis (UVA) with McIndoe vaginoplasty. Four patients had UVA without vaginoplasty. Follow-up was done by transabdominal and/or transvaginal ultrasound monthly for the first 3 months then every 6 months thereafter for a duration that ranged from 15 to 82 months. The main outcome measures are achieving menstruation, dysmenorrhea, pelvic inflammatory disease (PID), needed interventions after primary surgery, infertility, and pregnancy rate. RESULTS: Nine (100%) patients achieved menstruation, one (12%) experienced severe dysmenorrhea, two (22%) had PID, seven (78%) needed dilatation of the anastomosis site, three (33%) needed reoperation, nine (100%) had primary infertility, two (28.5%) achieved clinical pregnancy, and only one (14%) ended by live birth. CONCLUSION: Conservative surgery for cervical malformation is a promising choice for relieving the obstructive symptoms. Regular dilatation is recommended. Pregnancy is a remote hope that is hindered by many challenges.
Assuntos
Colo do Útero , Infertilidade , Gravidez , Feminino , Humanos , Seguimentos , Colo do Útero/cirurgia , Colo do Útero/anormalidades , Dismenorreia/etiologia , Dismenorreia/cirurgia , Estudos Retrospectivos , Vagina/cirurgia , Vagina/anormalidades , Fertilidade , Anastomose Cirúrgica/métodosRESUMO
BACKGROUND: The surgical treatment of girls with cervical atresia and complete absence of the vagina remains a problem because of the rarity of cases and the controversial study results. OBJECTIVE: To describe the surgical technique and long-term results of laparoscopically assisted uterovestibular anastomosis in patients with cervical atresia and complete absence of the vagina STUDY DESIGN: Sixteen consecutive patients with cervical atresia and complete absence of the vagina were conservatively treated with laparoscopically assisted uterovestibular anastomosis in 2 tertiary care referral centers. The follow-up assessments included clinical examination, determination of the presence and quality of sexual intercourse, and vaginoscopy. RESULTS: All patients underwent laparoscopically assisted uterovestibular anastomosis. No perioperative complications occurred. The mean follow-up period was 8 ± 3.2 years. In all patients, the length of the neovagina was greater than 4 cm at 1 year after the surgery and approximately 6 cm after 2 years. After the start of sexual intercourse, the neovagina exceeded 7 cm in length in 2 of the 11 sexually active patients. At 12 months after the surgery, iodine-positive epithelium was present in all patients and was maintained over time. The continuity of the neovagina, neocervix, and uterine body was maintained without further interventions in 15 of the 16 patients. During the follow-up, 11 patients were sexually active, 5 were married, 4 were seeking conception, and 2 had spontaneous pregnancy. CONCLUSIONS: Laparoscopically assisted uterovestibular anastomosis seems to be a safe and effective treatment for patients with cervical atresia and complete absence of the vagina, at least in terms of the recovery of menstrual function and sexual activity.
Assuntos
Colo do Útero , Laparoscopia , Doenças do Colo do Útero , Vagina , Doenças Vaginais , Feminino , Humanos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Colo do Útero/cirurgia , Colo do Útero/anormalidades , Seguimentos , Laparoscopia/métodos , Vagina/cirurgia , Vagina/anormalidades , Doenças do Colo do Útero/congênito , Doenças do Colo do Útero/cirurgia , Doenças Vaginais/congênito , Doenças Vaginais/cirurgiaRESUMO
The authors discuss the incidence, the embryological development, the classification, the presentation and the treatment options of this rare reproductive tract abnormality. In the past, the treatment proposed almost unanimously was hysterectomy and subsequent construction, when necessary, of a neovagina. In recent decades, numerous experiences of conservative therapies have accumulated that allow the restoration of menstrual function and in some rare cases even the achievement of a pregnancy. However, complications associated with recanalization of the cervix frequently resulted in the need for repeated surgery, risk of serious and sometimes fatal ascending infection. This review aims to analyze the most recent and significant experiences of conservative surgery in this field to provide an accurate picture of the various techniques and their outcomes, especially from the point of view of fertility. Conservative surgery should now be considered as the first-line treatment option. On the other hand, it is not possible to draw conclusions on the superiority of one technique over another among the various conservative options. This would require large series with adequate follow-up, which unfortunately are not available.
Assuntos
Anormalidades Congênitas , Procedimentos de Cirurgia Plástica , Cirurgia Plástica , Neoplasias do Colo do Útero , Gravidez , Feminino , Humanos , Colo do Útero/cirurgia , Colo do Útero/anormalidades , Neoplasias do Colo do Útero/cirurgia , Histerectomia , Vagina/cirurgia , Anormalidades Congênitas/cirurgiaRESUMO
OBJECTIVE: To describe the surgical technique of laparoscopically assisted uterovaginal/vestibular anastomosis in patients with cervical atresia associated with partial or complete absence of the vagina. DESIGN: Surgical video article. Local institutional review board approval and written permission from the patients were obtained. SETTING: Tertiary referral center. PATIENT(S): The surgical video presents surgical correction in 3 different patients with cervical agenesis. The first patient, aged 14 years, had a normoconformed uterus and total absence of the vagina. The second patient, aged 12 years, demonstrated a left unicornuate uterus and partial absence of the vagina. The third patient, aged 13 years, displayed a right unicornuate uterus and total absence of the vagina. INTERVENTION(S): Laparoscopic time and perineal time. During laparoscopy, the entire abdominopelvic cavity was assessed to evaluate the uterine morphology and size to exclude anomalies such as hematometra. The adnexa and adhesions were evaluated and any endometrial flare-ups were treated appropriately. A laparoscopic ultrasound probe was used to evaluate the size and location of the endometrial cavity. In cases with total absence of vaginas, an H-shaped incision in the hymenal dimple allowed a larger area of available tissue for the anastomosis. A tunnel was then created by blunt finger dissection between the bladder and rectum. Simultaneously, the uterus was pushed caudally by an assistant while the operator grasped it from below using an internal probe. A circular myometrial incision at the uterine caudal body allowed to reach the endometrial cavity and open it. The edges of the uterine cavity were then anastomized with the edges of the hymenal incision. In cases with partial absence of vaginas, the creation of the tunnel between the vagina and rectum was not necessary and the open uterus was anastomosed with the margins of the vaginal dome, engraved on the guide of a metal dilator. All patients received broad-spectrum antibiotics (i.e., cephalosporins of the last available generation) on the day before surgery and on the day of surgery. MAIN OUTCOME MEASURE(S): Intraoperative anatomic and ultrasound data, neovaginal length, and recovery of menstrual function 180 days after surgery. RESULT(S): The surgical procedure was successful in all cases. No major complications were recorded, and in particular, no bladder or rectal injuries occurred. No stenosis of the neocervix was recorded. The main hospital stay of the patients was 3.5 ± 1.5 days. In each case, the neovagina developed gradually over time after surgery because of the upward traction action exerted by the uterus through its natural ligament apparatus (cardinal ligaments and ovarian vessels). This fact eliminated the requirement for the use of a mold after surgery. At the 15-week follow-up, vaginoscopy was performed, with mucus observed at the site of uterovaginal anastomosis in all cases. None of the patients developed infection after surgery because of the avoidance of molds or pessaries and the natural mucus production. Six months after surgery, the length of the neovagina was >4 cm in all 3 cases. CONCLUSION(S): Laparoscopic-assisted uterovaginal/vestibular anastomosis may be considered the treatment of choice for patients with cervical atresia associated with partial or complete absence of the vagina.
Assuntos
Laparoscopia , Doenças do Colo do Útero , Antibacterianos , Cefalosporinas , Colo do Útero/anormalidades , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Anormalidades Urogenitais , Doenças do Colo do Útero/cirurgia , Útero/anormalidades , Útero/cirurgia , Vagina/anormalidades , Vagina/diagnóstico por imagem , Vagina/cirurgiaRESUMO
BACKGROUND: Vaginal agenesis is a rare condition worldwide. Most reported cases were accompanied by the absence of uterus or uterine hypoplasia; for patients with functional endometrium, hysterectomy was most likely to be conducted to lower postoperative complications. OBJECTIVE: Based on our successful experience in vaginoplasty with autologous buccal mucosal, the purpose of this article is to discuss the surgical strategies in the reconstruction of neovaginal for vaginal agenesis patients with functional uterus and cervical hypoplasia. METHODS: The uterus was preserved in our procedure, and the cervicoplasty was performed to connect the uterine cavity with the neovagina. After the vaginal cavity was formed, the cervix was confirmed and fixed. With the assistance of laparoscope, the direction and angle of the cervix and the uterine body were observed and confirmed. An incision was made in cervix to connect the uterine cavity, and a Foley's catheter was inserted. The newly formed opening of cervix and neovagina was covered by autologous buccal mucosal. RESULTS: The connection between neovagina and cervix uteri was successfully conducted in patient with functional uterus. Unimpeded and regular menstrual was achieved, and the cyclic abdominal pain was disappeared. No complications were observed. CONCLUSION: For patients without functional uterus, vaginoplasty with autologous buccal mucosal can be conducted. However, fertility-preserving surgery should be the primary choice in patients with functional endometrium. It can be concluded from our experience that the utero-vaginal connection with the assistance of laparoscope and the use of autologous buccal mucosa is a promising way to achieve ideal outcomes.
Assuntos
Procedimentos de Cirurgia Plástica , Vagina , Colo do Útero/anormalidades , Colo do Útero/cirurgia , Anormalidades Congênitas , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Procedimentos de Cirurgia Plástica/métodos , Útero/anormalidades , Útero/cirurgia , Vagina/anormalidades , Vagina/cirurgiaRESUMO
BACKGROUND: Congenital external cervical os stenosis is a form of Mullerian duct abnormality which is rare in virginal adolescents. CASE: Pre-operatively, two non-sexually active adolescents of 12 and 14 years of age, with history of light menses and severe lower abdominal pain for 2 and 4 months respectively, were diagnosed with an obstructed, oblique vaginal septum syndrome. However, at operative vaginoscopy, a single cervix with a duplicated cervical os and unilateral cervical stenosis was discovered, confirming the diagnosis of a complete uterine septum involving the cervix and unilateral cervical stenosis. They were treated by expanding the affected external cervical os while leaving the hymen intact. A year following the treatment, follow up results found no recurrence of symptoms. SUMMARY AND CONCLUSION: Operative vaginoscopy using a hysteroscope is crucial and recommended for the diagnosis and treatment of congenital external cervical os stenosis in virginal adolescents.
Assuntos
Colo do Útero , Doenças do Colo do Útero , Adolescente , Colo do Útero/anormalidades , Constrição Patológica , Feminino , Humanos , Lactente , Útero/anormalidades , Vagina/anormalidades , Vagina/cirurgiaRESUMO
OBJECTIVE: To study the efficacy of a novel approach to vaginoplasty in a patient with vaginal aplasia and a preserved cervix. DESIGN: We present the case of a 28-year-old patient who was referred with a history of absent menstruation and vaginal intercourse was absent as well as abnormal development of the internal genitals. The patient underwent a laparoscopic cystectomy in 2012 because of an ovarian cyst and later that year underwent laparotomic supracervical hysterectomy with bilateral salpingectomy because of severe pain caused by a hematometra in their uterine remnant. In the period from 2013 to 2016, multiple pelvic ultrasound examinations revealed a fluid structure in the pelvis. By 2020, the size of the lesion had increased to 10 cm on average. A computed tomography scan and magnetic resonance imaging showed a mucinous lesion in the lower part of the patient's pelvis resembling the cervical origin. No pathology of the urinary tract was found. A laparoscopic approach was chosen to achieve the two main goals of the patient-the possibility of vaginal intercourse and the treatment of the intraabdominal lesion. The procedure started with a vaginal step when the neovagina dissection was performed as in the classical Davydov technique up to the beginning of the dilated cervical remnant. Bilateral ureterolysis was performed laparoscopically to prevent ureteral injury. The peritoneum was widely dissected from both the anterior and posterior surfaces of the uterine cervix, which appeared as a large structure filled with typical cervical mucus. Partial dissection of the sacrouterine and ovarian ligaments on both sides was performed to mobilize the cervix. A transverse incision of the cystically dilated cervix in the cranial part was performed and the edges of the incision were brought down to the introitus of the vagina. The cervicovulvar anastomosis was fixed by separate sutures with Vicryl 2-0. SETTING: The surgery was performed in an inpatient setting equipped with conventional laparoscopic instruments, a 30-degree laparoscope, a high-definition video system, xenon light source, insufflator, irrigator, and bipolar and monopolar energy sources. PATIENT(S): A single patient, mentioned previously. INTERVENTION(S): Surgical vaginoplasty using the preserved cervix. The details are explained in the Design section. MAIN OUTCOME MEASURE(S): Restoration of the normal vaginal anatomy and function. RESULT(S): In the postoperative period, the patient did not have any postoperative complications. The urinary catheter was removed on the first postoperative day. From day 1, the patient was taught to make daily vaginal dilations with a vaginal dilator to maintain normal vaginal depth and width. The patient was discharged on day 3 after surgery. In a 3-month follow-up visit, the patient's vagina appeared normal in size with transverse folds and was very well lubricated because of the natural secretions of the cervical mucosa. The patient had been sexually active by the time of the follow-up visit. CONCLUSION(S): According to a literature search, this was the first published case of a successful neovagina creation through cervicovulvar anastomosis. Although different surgical approaches were widely discussed in previous publications of Fertility and Sterility, such as "Laparoscopic uterovaginal anastomosis in Mayer-Rokitansky-Küster-Hauser syndrome with functioning horn", "Laparoscopy-assisted Ruge procedure for the creation of a neovagina in a patient with Mayer-Rokitansky-Küster-Hauser syndrome", and "Evaluation of amnion in creation of neovagina in women with Mayer-Rokitansky-Küster-Hauser syndrome", which were all variants of vaginoplasty with allograft, vaginal distention (Vecchietti procedure), or the use of native tissues (Davydov technique), our approach could be more feasible in the rare cases of preserved distended cervix because of less induced trauma when compared with that of cervical removal. This is because of the strong and lubricated nature of the cervical epithelium, which is already present and does not require time for epithelization.
Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Colo do Útero/cirurgia , Anormalidades Congênitas/cirurgia , Procedimentos Cirúrgicos em Ginecologia , Ductos Paramesonéfricos/anormalidades , Estruturas Criadas Cirurgicamente , Vagina/cirurgia , Transtornos 46, XX do Desenvolvimento Sexual/diagnóstico por imagem , Adulto , Colo do Útero/anormalidades , Anormalidades Congênitas/diagnóstico por imagem , Feminino , Humanos , Ductos Paramesonéfricos/diagnóstico por imagem , Ductos Paramesonéfricos/cirurgia , Técnicas de Sutura , Resultado do Tratamento , Vagina/anormalidadesRESUMO
We describe a successful surgical technique of abdominal trachelectomy and re-vaginoplasty for cervico-vaginal stenosis following unsuccessful uterovaginal anastomosis and vaginoplasty in a patient with congenital cervical and vaginal aplasia. After the surgical procedure, cervico-vaginal stenosis was resolved and periodic menstruation without dysmenorrhoea resumed. While long-term follow-up is essential to ensure successful pregnancy and delivery, we conclude that this novel surgical procedure is a promising alternative for improvement of the quality of life and normal sexual function, and for preservation of fertility in patients with cervical and vaginal aplasia.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/cirurgia , Traquelectomia/métodos , Vagina/cirurgia , Doenças Vaginais/cirurgia , Adolescente , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Colo do Útero/anormalidades , Colo do Útero/patologia , Constrição Patológica/cirurgia , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Gravidez , Reoperação , Vagina/anormalidades , Vagina/patologia , Doenças Vaginais/etiologia , Doenças Vaginais/patologiaRESUMO
OBJECTIVE: To review the diagnosis and management of 3 variations of incomplete müllerian duct fusion and reabsorption. DESIGN: Narrated video delineating the surgical management of 3 müllerian anomalies; this video was deemed exempt from review by the institutional review board of the Mayo Clinic. SETTING: Tertiary care academic medical center. PATIENT(S): This video focuses on 3 müllerian anomalies: complete septate uterus with a single septate cervix (septate uterus unicollis); complete septate uterus with duplicated cervix (septate uterus bicollis); and complete duplication of the uterus and cervix (uterine didelphys). INTERVENTION(S): Magnetic resonance imaging (MRI), cervical septoplasty, operative hysteroscopy, and uterine septoplasty. MAIN OUTCOME MEASURE(S): Several variations of uterine malformations exist. In our practice, we differentiate complete septate uteri as either unicollis or bicollis via MRI and vaginal examination. The bicollis presentation can be identified on MRI by the "lambda sign," which is seen as the 2 cervices that diverge as they enter the vagina. This is in comparison with the unicollis presentation when the single septate cervix can be traced with parallel lines as it enters the vagina. The circle method is described in this video to help distinguish between a single and duplicated cervix on examination. RESULT(S): The cervical and uterine septa were resected completely in the patient with a complete septate uterus unicollis. In contrast, the uterine septum was resected completely and the 2 cervical canals were not incised in the case of the complete septate uterus bicollis. Although uterine and cervical septa resection is controversial, our practice is to avoid the incision of the 2 cervical canals in cases that are more clearly consistent with a bicollis classification. CONCLUSION(S): Müllerian anomalies represent a continuum of disorders caused by different degrees of disruption in embryogenesis. MRI with vaginal gel and vaginal examination are tools to help classify the anomaly and guide surgical management.
Assuntos
Ductos Paramesonéfricos/anormalidades , Anormalidades Urogenitais , Útero/anormalidades , Colo do Útero/anormalidades , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Ductos Paramesonéfricos/diagnóstico por imagem , Ductos Paramesonéfricos/cirurgia , Anormalidades Urogenitais/diagnóstico por imagem , Anormalidades Urogenitais/cirurgia , Útero/diagnóstico por imagem , Útero/cirurgiaRESUMO
OBJECTIVE: To demonstrate a systematic approach for the hysteroscopic management of a patient with uterine septum with double cervix and a nonobstructive longitudinal vaginal septum (Class U2bC2V1 of the ESHRE/ESGE classification). DESIGN: A step-by-step demonstration of the technique with narrated video footage of three different cases. SETTING: University Hospital. PATIENT(S): We present three patients diagnosed with uterine septum with double cervix and a nonobstructive longitudinal vaginal septum (Class U2bC2V1 of the ESHRE/ESGE classification). Case 1 is a 31-year-old woman with class U2bC2V1 müllerian anomaly and primary infertility. Case 2 is a 29-year-old patient with class U2bC2V1 müllerian anomaly, infertility, and dyspareunia. Case 3 is a 32-year-old patient with class U2bC2V1 müllerian anomaly, infertility, and abnormal uterine bleeding. She also was diagnosed with a submucous leiomyoma. INTERVENTION(S): Hysteroscopic management of this complex müllerian anomaly using miniaturized hysteroscopic instruments, including the mini-resectoscope, was performed. All three procedures were performed in the operating room with the patient under general anesthesia. No complications were encountered. Patients were discharged home the same day of the procedure after a short period of observation. The critical aspects of the procedure are highlighted. MAIN OUTCOME MEASURE(S): Description of the systematic approach with a detailed demonstration of the critical steps of the procedure. RESULT(S): Complete resolution of the vaginal septum with creation of a single uterine cavity was obtained in all three cases. Absence of intrauterine adhesion formation was confirmed. CONCLUSION(S): Due to the recent innovations in hysteroscopic equipment and improved surgical techniques, the hysteroscopic management of patients with complex müllerian anomalies using miniaturized instruments is a feasible and effective treatment option.
Assuntos
Colo do Útero/anormalidades , Histeroscopia/métodos , Ductos Paramesonéfricos/anormalidades , Útero/anormalidades , Vagina/anormalidades , Adulto , Colo do Útero/cirurgia , Feminino , Humanos , Útero/cirurgia , Vagina/cirurgiaRESUMO
Congenital vaginal atresia is a rare congenital reproductive tract abnormality. To assess the clinical manifestations and feasibility of preserving uterus for congenital complete vaginal atresia with cervical aplasia, nineteen cases who underwent surgical treatment in West China Second Hospital of Sichuan University were retrospectively studied. The cervical status, clinical manifestations, the rate of vaginal re-stenosis and pelvic inflammation after surgery were assessed. Additional 101 similar cases searched through digital Pub Med were included to analyze the feasibility of preserving the uterus. Periodic abdominal pain, primary amenorrhea, and pelvic mass were the primary signs and symptoms. According to the magnetic resonance imaging (MRI), all the uterine cavities expanded, and the atresia sites were above the inner urethral orifice. Data of the cases preserving uteri from both our hospital and the literature showed the rate of re-stenosis in patients with external cervical obstruction was 15.9% while it was 40% in the other types of cervical aplasia (P = .026). The rate of recurrent pelvic inflammation and hysterectomy was 2.3% for cervical external os obstruction and 8% for the other cervical aplasia types(P = .296). In conclusion, vaginoplasty and cervicovaginal anastomosis could preserve the fertility for complete vaginal atresia with cervical external os obstruction.
Assuntos
Colo do Útero/anormalidades , Anormalidades Congênitas/diagnóstico , Fenótipo , Anormalidades Urogenitais/diagnóstico , Útero/anormalidades , Vagina/anormalidades , Adolescente , Adulto , Colo do Útero/cirurgia , Criança , Anormalidades Congênitas/cirurgia , Gerenciamento Clínico , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Resultado do Tratamento , Anormalidades Urogenitais/cirurgia , Útero/cirurgia , Vagina/cirurgia , Adulto JovemRESUMO
Currently, ultrasound (US) is a valuable imaging tool for the initial assessment and evaluation of the female genital organs, uterus, and adnexa. However, it is easy to overlook the uterine cervix while conducting a pelvic US. Uterine cervical lesions may range from benign to malignant in nature. Therefore, meticulous examination with US may play a key role in assessing uterine cervical lesions. Although there is substantial overlap in the US findings across various uterine cervical lesions, some US features, in tandem with clinical characteristics, may suggest a specific diagnosis. Familiarity with the clinical settings and US characteristics of different uterine cervical lesions can support prompt and accurate diagnosis of suspicious lesions. This review article aims to describe the features of US and possible values for distinction of these lesions in the uterine cervix.
Assuntos
Colo do Útero/diagnóstico por imagem , Ultrassonografia , Doenças do Colo do Útero/diagnóstico por imagem , Neoplasias Uterinas/diagnóstico por imagem , Aborto Espontâneo/diagnóstico por imagem , Adolescente , Adulto , Carcinoma/diagnóstico por imagem , Colo do Útero/anormalidades , Colo do Útero/anatomia & histologia , Criança , Endometriose/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Pólipos/diagnóstico por imagem , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Ultrassonografia/métodos , Artéria Uterina/diagnóstico por imagem , Incompetência do Colo do Útero/diagnóstico por imagemRESUMO
BACKGROUND: Müllerian anomalies take many forms of manifestation. The oblique cervical septum with a complete uterine septum (OCSCUS), as a rare form of Müllerian anomaly, has never been reported in the literature. CASE: A 10-year-old female adolescent presented with progressive abdominal pain after the onset of menarche was diagnosed as OCSCUS using magnetic resonance imaging and treated with hysteroscopic dissection of the uterine part of the septum. SUMMARY AND CONCLUSION: Greater awareness of the OCSCUS will lead to earlier detection and is the key to alleviating patient suffering and avoiding potentially severe complications, such as endometriosis and infertility. For the treatment of OCSCUS, hysteroscopic dissection of the uterine part of the septum is a minimally invasive treatment choice with low surgical risk.
Assuntos
Colo do Útero/anormalidades , Histeroscopia/métodos , Colo do Útero/diagnóstico por imagem , Colo do Útero/cirurgia , Criança , Feminino , Humanos , Laparoscopia/métodos , Imageamento por Ressonância Magnética , Ductos Paramesonéfricos/anormalidades , Útero/anormalidades , Útero/diagnóstico por imagem , Útero/cirurgiaRESUMO
Uterine isthmus atresia is a rare Müllerian duct anomaly occasionally diagnosed in adolescents with primary amenorrhea and cyclic abdominal pain. A case is presented of a 14-year-old female with monthly cyclic lower abdominal pain of a 2-year duration. Magnetic resonance imaging and 3-dimensional ultrasound showed separation of a 10-mm fibrotic tissue between the cervical canal and the endometrial cavity. In an attempt to preserve reproductive ability, an end-to-end anastomosis was laparoscopically performed between the cervical canal and uterine cavity. A platinol stent (WallFlex Biliary RX; Boston Scientific, Boston, MA) was placed by hysteroscopy to avoid stenosis after surgery. Laparoscopic end-to-end anastomosis is proposed to treat congenital uterine isthmus atresia.
Assuntos
Colo do Útero/cirurgia , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/cirurgia , Útero/anormalidades , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Adolescente , Amenorreia/diagnóstico , Amenorreia/etiologia , Amenorreia/cirurgia , Anastomose Cirúrgica/métodos , Colo do Útero/anormalidades , Feminino , Hematometra/diagnóstico , Hematometra/etiologia , Hematometra/cirurgia , Humanos , Histeroscopia/métodos , Laparoscopia/métodos , Imageamento por Ressonância Magnética , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Dor Pélvica/cirurgia , Espanha , Ultrassonografia/efeitos adversos , Anormalidades Urogenitais/complicações , Útero/cirurgiaRESUMO
Cervical agenesis is a rare congenital pathology linked to an abnormality in the development of the Mullerian system, the mechanism of this anomaly is unknown. We reported a case of complete cervical agenesis in a 17-year-old girl who underwent a successfully utero-vaginal anastomosis.