An unusual presentation of uterine didelphys and obstructed hemivagina.

BACKGROUND: Congenital disorders of the genitourinary system can be unpredictable. There are both medical and surgical interventions that can help manage symptoms. CASE: A 10-year-old girl was evaluated 6 months post-menarche with dysuria and pelvic pain. Her symptoms were not relieved with menstrual suppression. Evaluation revealed a probable ectopic ureter versus ureterocele and uterine didelphys with suspicion for obstructed hemivagina and hematocolpos. Surgical exploration revealed an obstructed hemivagina with a high vaginal septum. When resection failed, she ultimately underwent a robot-assisted hemihysterectomy, with resolution of her symptoms. SUMMARY AND CONCLUSIONS: In this case presentation, a surgical approach was necessary to adequately make a diagnosis. When vaginal septum resection failed, robot-assisted laparoscopic hemi-hysterectomy and resection of a vaginal pouch led to symptom resolution in this pediatric patient with a complex anomaly.

Access to conservative surgical therapy for adolescents with benign ovarian masses.

OBJECTIVE: To perform a population-based analysis to determine possible factors associated with use of laparoscopy and ovarian-conserving cystectomy. METHODS: Women and girls aged 18 years or younger with benign ovarian masses who underwent surgery from 2000 to 2010 and were recorded in a commercial database were analyzed. Patients were classified based on the surgical approach (open compared with laparoscopy) and procedure (oophorectomy compared with cystectomy). Use of laparoscopy and performance of cystectomy were characterized using multivariable logistic regression models accounting for patient, surgeon, and hospital characteristics. RESULTS: A total of 2,126 patients, including 1,425 (67.0%) who underwent laparotomy and 701 (33.0%) who had laparoscopy, were identified. Laparoscopy increased from 32.1% in 2000 to 57.9% by 2010. In a multivariable model, African American women and girls (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.37-0.65) and patients in the Northeast (OR 0.65, 95% CI 0.46-0.94) were less likely to undergo laparoscopy, whereas treatment at a high-volume hospital (OR 1.35, 95% CI 1.04-1.75) was associated with use of laparoscopy. Cystectomy was performed in 57.1% in 2000 and increased to 61.4% in 2010. The only significant predictors of cystectomy were age and the specialty of the treating physician; patients aged 13-16 years (OR 1.34, 95% CI 1.03-1.75) were more likely to undergo cystectomy than were younger patients, whereas patients treated by surgeons (OR 0.51, 95% CI 0.38-0.68) were less likely to undergo cystectomy than were those treated by gynecologists. CONCLUSION: The treatment of adolescents with benign ovarian masses is highly variable. In addition to patient characteristics, both physician and hospital factors strongly influenced treatment. LEVEL OF EVIDENCE: II.