Bicorporeal uterus: Treatment options

Abstract

Aims: The aim of this chapter is to present the feasibility of surgical treatment and the surgical treatment alternatives in cases of bicorporeal uterus and its variants. Furthermore, the clinical results and the drawbacks of each treatment option are also addressed. Brief description of the reviewed data: Unification of the uterine cavity by Strassmann’s metroplasty is the traditional surgical correction for bicorporeal uterus (ESHRE/ESGE Classes U3bC0 & U3bC2); laparoscopic version of the procedure has been recently reported. However, it should be avoided as a prophylactic procedure due to its invasiveness and the resulted uterine trauma. Removal of the obstructed hemi-uterus is indicated in patients with bicorporeal uterus and unilateral cervical aplasia (ESHRE/ESGE Class U3bC3); although, restoration of continuity with cervicoplasty or isthmo-vaginal anastomosis has been also reported as surgical alternatives their safety is not yet proven. Incision or resection of the vaginal septum is necessary in patients with bicorporeal uterus, double cervix and longitudinal obstructing vaginal septum (ESHRE/ESGE Class U3bC2V2) to alleviate obstruction and restore continuity. Finally patients with bicorporeal septate uterus (ESHRE/ESGE Class U3c) should be treated by hysteroscopic incision of the septate part of the indentation, thus, offering the patient a better prognosis for future pregnancies.Clinical implications: In view of this evidence, patients with obstructive variants of bicorporeal uterus should be treated in order to restore anatomical obstruction. Bicorporeal septate uterus could be treated hysteroscopically, thus, restoring at least partly the uterine cavity and improving pregnancy outcome. On the other hand, Strassmann metroplasty should be kept as an option only in highly selected cases with poor reproductive outcome in which other causes have been excluded. Open issues for further research: Although several surgical options are nowadays available for the treatment of patients with bicorporeal uterus and its clinically significant variants, their exact place in the management of these patients is not yet clear. Larger number of patients and well-designed studies are essential to withdraw valuable conclusions.