Menstrual retention in a Robert's uterus.
TL;DR: Pediatric surgeons and gynecologists should be aware of this atypical obstructive Müllerian malformation and its management in order to avoid inappropriate management of these young patients.
About: This article is published in Journal of Pediatric and Adolescent Gynecology.The article was published on 2009-10-01. It has received 24 citations till now. The article focuses on the topics: Fallopian tube & Abdomen.
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TL;DR: The clinical presentation and management of complex malformations, including Rokitansky syndrome, are reported, including anomalies of the cloaca and urogenital sinus, including congenital vagino-vesical fistulas and cloacal anomalies; malformative combinations and other complex mal Formations.
Abstract: Background Common uterine anomalies are important owing to their impact on fertility, and complex mesonephric anomalies and certain Mullerian malformations are particularly important because they cause serious clinical symptoms and affect woman's quality of life, in addition to creating fertility problems. In these cases of complex female genital tract malformations, a correct diagnosis is essential to avoid inappropriate and/or unnecessary surgery. Therefore, acquiring and applying the appropriate embryological knowledge, management and therapy is a challenge for gynaecologists. Here, we considered complex malformations to be obstructive anomalies and/or those associated with cloacal and urogenital sinus anomalies, urinary and/or extragenital anomalies, or other clinical implications or symptoms creating a difficult differential diagnosis. Methods A diligent and comprehensive search of PubMed and Scopus was performed for all studies published from 1 January 2011 to 15 April 2015 (then updated up to September 2015) using the following search terms: 'management' in combination with either 'female genital malformations' or 'female genital tract anomalies' or 'Mullerian anomalies'. The MeSH terms 'renal agenesis', 'hydrocolpos', 'obstructed hemivagina' 'cervicovaginal agenesis or atresia', 'vaginal agenesis or atresia', 'Herlyn-Werner-Wunderlich syndrome', 'uterine duplication' and 'cloacal anomalies' were also used to compile a list of all publications containing these terms since 2011. The basic embryological considerations for understanding female genitourinary malformations were also revealed. Based on our experience and the updated literature review, we studied the definition and classification of the complex malformations, and we analysed the clinical presentation and different therapeutic strategies for each anomaly, including the embryological and clinical classification of female genitourinary malformations. Results From 755 search retrieved references, 230 articles were analysed and 120 studied in detail. They were added to those included in a previous systematic review. Here, we report the clinical presentation and management of: agenesis or hypoplasia of one urogenital ridge; unilateral renal agenesis and ipsilateral blind or obstructed hemivagina or unilateral cervicovaginal agenesis; cavitated and non-communicating uterine horns and Mullerian atresias or agenesis, including Rokitansky syndrome; anomalies of the cloaca and urogenital sinus, including congenital vagino-vesical fistulas and cloacal anomalies; malformative combinations and other complex malformations. The clinical symptoms and therapeutic strategies for each complex genitourinary malformation are discussed. In general, surgical techniques to correct genital malformations depend on the type of anomaly, its complexity, the patient's symptoms and the correct embryological interpretation of the anomaly. Most anomalies can typically be resolved vaginally or by hysteroscopy, but laparoscopy or laparotomy is often required as well. We also include additional discussion of the catalogue and classification systems for female genital malformations, the systematic association between renal agenesis and ipsilateral genital malformation, and accessory and cavitated uterine masses. Conclusions Knowledge of the correct genitourinary embryology is essential for the understanding, study, diagnosis and subsequent treatment of genital malformations, especially complex ones and those that lead to gynaecological and reproductive problems, particularly in young patients. Some anomalies may require complex surgery involving multiple specialties, and patients should therefore be referred to centres that have experience in treating complex genital malformations.
115 citations
Cites background from "Menstrual retention in a Robert's u..."
..., 2003), but some reported cases of menstrual retention in a Robert’s uterus (Capito and Sarnacki, 2009) might correspond to accessory and cavitated uterine masses (ACUMs) (Acién et al....
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...Some published cases with ‘menstrual retention in a Robert’s uterus’ (Capito and Sarnacki, 2009) might in fact be ACUMs based on the age, symptoms and surgical Management of complex genital malformations 63...
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...…blind hemi-cavity of a Robert’s uterus has also been noted (Singhal et al., 2003), but some reported cases of menstrual retention in a Robert’s uterus (Capito and Sarnacki, 2009) might correspond to accessory and cavitated uterine masses (ACUMs) (Acién et al., 2012), which will be explained below....
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...Some published cases with ‘menstrual retention in a Robert’s uterus’ (Capito and Sarnacki, 2009) might in fact be ACUMs based on the age, symptoms and surgical description of the case report: ‘a complete endometrectomy of the blind cavity after a section of the surrounding myometrium; this cavity…...
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TL;DR: In all 39 types, the ESHRE/ESGE classification system provided a comprehensive description of each single or complex anomaly, and a precise categorization was reached in 38 out of 39 types studied.
Abstract: studydesign,sizeandduration: The CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group. participants/materials, setting, methods: Among the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies. main results and the role of chance: The congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of
60 citations
Cites background or methods from "Menstrual retention in a Robert's u..."
...In the following cases a consultation with the fourth reviewer was necessary before classification: Capito and Sarnacki (2009), Gupta et al. (2007) and Singhal et al. (2003) (Robert’s uterus or Complete septate uterus/unilateral cervical aplasia/normal vagina ESHRE/ESGE Class U2b C3 V0), Nezhat and…...
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...fication: Capito and Sarnacki (2009), Gupta et al. (2007) and Singhal et al. (2003) (Robert’s uterus or Complete septate uterus/unilateral cervical...
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TL;DR: Questions are raised about the embryological origin of Robert's uterus, the suitability of current classification systems, and the role of more invasive approaches and surgical procedures that do not aim to improve uterine cavity shape and volume in women with this condition.
Abstract: Robert's uterus is a unique malformation, described as a septate uterus with a non-communicating hemicavity, consisting of a blind uterine horn usually with unilateral hematometra, a contralateral unicornuate uterine cavity and a normally shaped external uterine fundus. The main symptom in affected young women is pelvic pain that becomes intensified near menses. We describe the case of a 22-year-old woman who was referred for diagnostic assessment and treatment of a congenital uterine anomaly. We used three-dimensional sonohysterography with volume-contrast imaging, HDLive rendering mode and automatic volume calculation (SonoHysteroAVC) for the diagnosis, surgical planning and postoperative evaluation. These imaging techniques provided a complete understanding of the internal and external uterine structures, enabling us to perform a minimally invasive hysteroscopic metroplasty, guided by transrectal ultrasound, and therefore avoiding the need for laparotomy/laparoscopy. The outcome of treatment was considered satisfactory; menstruation ceased to be painful and, after two hysteroscopic procedures, the communicating 0.3-cm3 hemicavity was visualized as a 3.6-cm3 normalized uterine cavity using the same imaging techniques. The findings of this case report raise questions about the embryological origin of Robert's uterus, the suitability of current classification systems, and the role of more invasive approaches (laparoscopy/laparotomy) and surgical procedures (horn resection/endometrectomy) that do not aim to improve uterine cavity shape and volume in women with this condition. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
25 citations
TL;DR: A 24-year-old woman presented with pelvic pain and became pregnant and delivered a healthy baby by caesarean section in the 39th week of gestation because of placenta accreta, bilateral internal iliac artery ligation was needed.
Abstract: Robert's uterus is an uncommon Mullerian anomaly first described by Robert (1970), which results in an asymmetric septate uterus. We present a case of this rare anomaly treated by endometrectomy.A ...
19 citations
Cites background from "Menstrual retention in a Robert's u..."
...Capito and Sarnacki (2009) also performed endometrectomy for a similar case....
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TL;DR: The case of a 26‐year‐old woman whose Robert's uterus was treated with hysteroscopy and who then successfully became pregnant and gave birth to a baby boy, with satisfactory results.
Abstract: Herein is described the case of a 26-year-old woman whose Robert's uterus was treated with hysteroscopy and who then successfully became pregnant and gave birth. The uterus anomaly was diagnosed on combined hysteroscopy and ultrasonography, which showed an asymmetric septate uterus with one blind cavity, causing menstrual retention. The surgery was uncomplicated, with satisfactory results. The patient underwent successful cesarean section delivery of a baby boy weighing 3250 g on 24 March 2014.
11 citations
Cites background from "Menstrual retention in a Robert's u..."
...These symptoms could be explained by a partly functional endometrium lining the blind hemi-cavity,(3) and most likely occur because the blind rudimentary uterine cavity usually communicates with the ipsilateral fallopian tube, which permits a partial reflux of the retained menstrual blood into the peritoneal cavity.(4) These features also explain the association with endometriosis....
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References
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TL;DR: It is concluded that cystic adenomyosis of the uterus is characterized by a well‐circumscribed cystic lesion within the myometrium that demonstrates hemorrhage in differential stages of organization on MR images.
Abstract: Adenomyosis of the uterus is most often seen as focal or diffuse thickening of the myometrial junctional zone on MRI. We describe the morphologic features and signal characteristics of the rarer cystic form of the disease, as revealed by MRI. We conclude that cystic adenomyosis of the uterus is characterized by a well-circumscribed cystic lesion within the myometrium that demonstrates hemorrhage in differential stages of organization on MR images.
52 citations
TL;DR: Two cases of juvenile cystic adenomyoma of the uterus treated by laparoscopic surgery are reported, with both patients, dysmenorrhea disappeared postoperatively.
48 citations
TL;DR: An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death with suspicion of non-communicating uterine horn with bicornuate uterus.
29 citations
TL;DR: A unique congenital mullerian anomaly; asymmetric septate uterus with noncommunicating right sided hemicavity and haematometra a normal extrauterine morphology with right ovarian maldescent and stage III endometriosis was diagnosed on laparotomy.
Abstract: Roberts uterus or asymmetric septate uterus is an uncommon uterine mullerian anomaly first reported by Robert in 1970. It has two uterine cavities with one being blind causing menstrual retention. Till date only 17 such cases have been reported in literature. A unique congenital mullerian anomaly; asymmetric septate uterus with noncommunicating right sided hemicavity and haematometra a normal extrauterine morphology with right ovarian maldescent and stage III endometriosis was diagnosed on laparotomy. (excerpt)
29 citations
TL;DR: A careful inspection of the fallopian tubes, ovaries and gastrointestinal tract, including the appendix, failed to demonstrate a lesion, and the woman was discharged on the fifth post-operative day.
22 citations