Double uterus with obstructed hemivagina and ipsilateral renal agenesis: Pelvic anatomic variants in 87 cases

Abstract

STUDY QUESTION What are the anatomic variants (and their frequencies) of double uterus, obstructed hemivagina and ipsilateral renal agenesis? SUMMARY ANSWER Most cases examined (72.4%) were of the classic anatomic variant of the Herlyn-Werner-Wunderlich syndrome (with didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis) but the 27.6% of cases are of a rare variant of the syndrome (with uterus septum or cervical agenesis), showing relevant clinical and surgical implications. WHAT IS KNOWN ALREADY The extreme variability of anatomic structures involved in this syndrome (both uterus, cervico-vaginal and renal anomalies) is well known, even if a complete and uniform analysis of all its heterogeneous presentations in a large series is lacking. STUDY DESIGN, SIZE, DURATION This is a retrospective study with 87 patients referred to our third level referral center between 1981 and 2011. PARTICIPANTS/ MATERIALS, SETTING, METHODS We analyzed the laparoscopic and chart records of 87 women, who referred to our institute with double uterus, unilateral cervico-vaginal obstruction and ipsilateral renal anomalies.MAIN RESULTSSixty-three of 87 patients had the more classic variant of didelphys uterus with obstructed hemivagina; 10/87 patients had septate bicollis uterus with obstructed hemivagina; 9/87 patients had bicornuate bicollis uterus with obstructed hemivagina; 4/87 patients had didelphys uterus with unilateral cervical atresia; 1/87 patients had bicornuate uterus with one septate cervix and unilateral obstructed hemivagina.LIMITATIONSThis is a retrospective study with a long enrolling period (30 years). WIDER IMPLICATIONS OF THE FINDINGS New insights in the anatomic variants of this rare syndrome with their relevant surgical implications.STUDY FUNDING/COMPETING INTERESTNo specific funding was obtained for this study. None of the authors have any competing interests to declare. © 2013 The Author. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.