Chung-Pin Sheih

DIAGNOSING THE COMBINATION OF RENAL DYSGENESIS, GARTNER'S DUCT CYST AND IPSILATERAL MULLERIAN DUCT OBSTRUCTION

PURPOSE We describe the differential points in the diagnosis of the combination of renal dysgenesis, Gartners duct cyst and ipsilateral müllerian duct obstruction. Various imaging studies and urological procedures were performed. We report our experience in detecting these anomalies in 10 girls and review the literature. MATERIALS AND METHODS Ten girls, 7 to 13 years old, with this combination of anomalies were identified in the last 10 years. Imaging studies as well as urological procedures were selectively performed, especially at puberty following menarche. Patients received long-term followup with ultrasound. RESULTS Cystic dilation of Gartners duct protruded into the bladder and presented as a ureterocele in 5 patients and posterior to the bladder in 5. Surgical removal of a partial portion of a Gartners duct cyst was performed in 5 patients for alleviation of urinary symptoms. Unilateral müllerian duct obstruction was demonstrated in all 10 patients. Excision of the vaginal septum was performed in 6 patients for relief of genital obstruction. CONCLUSIONS When cystic dilatation of the pelvis, especially a ureterocele-like cyst without ureteral dilatation, is found in girls with ipsilateral renal dysgenesis, the possibility of a Gartners duct cyst should be considered. For early detection and treatment of unilateral obstruction of duplicated müllerian ducts pelvic sonography should be performed at puberty, especially just after menarche, in girls with renal dysgenesis and ipsilateral Gartners duct cyst.

Early detection of unilateral occlusion of duplicated müllerian ducts: the use of serial pelvic sonography for girls with renal agenesis.

For early detection of unilateral occlusion of duplicated müllerian ducts, serial pelvic sonography was performed in 215 girls with known renal agenesis, especially following menarche, during the last 6 years. To date, 16 girls with unilateral occlusion of duplicated müllerian ducts were detected. We stress the value of this modality, which can lead to a prompt diagnosis, and allow for early and appropriate surgical intervention.

Seminal Vesicle Cyst Associated with Ipsilateral Renal Malformation and Hemivertebra: Report of 2 Cases

AbstractTwo cases of a seminal vesicle cyst, ipsilateral renal malformation and a hemivertebra are reported.

Magnetic resonance imaging of seminal vesicle cyst associated with ipsilateral urinary anomalies.

BACKGROUND Seminal vesicle cysts rarely cause symptoms. Data on long-term follow-up from childhood to adulthood are lacking. The study analyzed the magnetic resonance imaging (MRI) and follow-up results of this condition. METHODS From 1991 to 1996, seminal vesicle cyst was diagnosed in 13 boys (mean age, 12 years; range, 7-15 years), six of whom had long-term follow-up data. The clinical symptoms and MRI findings at diagnosis and at follow-up were analyzed. RESULTS The seminal vesicle cyst was on the right side in six patients and on the left in seven. The size varied, ranging from 1.0 x 1.3 x 1.4 to 4.4 x 3.1 x 3.6 cm. All showed high signal intensity on T2-weighted images but variable signal intensity on T1-weighted images. Associated urinary tract anomalies included renal anomalies (dysplasia in 2 patients, agenesis in 11), ectopic ureteral orifice (11), hydroureter (6), and vertebral anomalies (2). One of the six patients with follow-up had repeated urinary tract infection and underwent surgical resection of the cyst 8 years after the diagnosis. The other five had no symptoms during the follow-up period. Three of the six patients had repeat MRI after a median of 11 years, which showed slight cyst enlargement and increased T1-weighted signal intensity. CONCLUSION Most seminal vesicle cysts were asymptomatic and did not change during long-term follow-up. MRI is a powerful tool for detecting seminal vesicle cysts and in delineating associated congenital anomalies of the urogenital tract.

BILATERAL CONGENITAL CYSTS OF THE SEMINAL VESICLE WITH BILATERAL DUPLEX KIDNEYS

Congenital cyst of the seminal vesicle is a rare anomaly, which is associated with ectopic insertion of an ipsilateral ureter into the seminal vesicle or other ectopic site.3 Since the embryonic event that causes this anomaly occurs early in gestation, urinary obstruction with distant ectopic ureteral insertion may lead to dysgenesis of the involved kidney. This anomaly usually develops in a single collecting system. It is rarely associated with an ipsilateral duplex ectopic ureter, and only a few such cases have been reported.3 To our knowledge bilateral congenital cysts of the seminal vesicle in a patient with bilateral duplex kidneys have not been described previously. In a single collecting system congenital cysts of the seminal vesicle are often associated with ipsilateral renal dysgenesis. Therefore, bilateral congenital cysts of the seminal vesicle are usually fatal because of severe functional impairment of both kidneys. On the other hand, since normal or nearly normal function of the lower pole moieties develops in bilateral duplex kidneys, bilateral congenital cysts of the seminal vesicle, as in our case, are possible. In our patient mild straining to void and progression of hydronephrosis of both lower moieties may be caused by distension of the seminal vesicle cysts and associated dilated ureters. However, no thickened wall of the bladder was noted on sonography or MRI. Treatment of the seminal vesicle cyst usually is restricted to symptomatic cases. Heminephrectomy with transabdominal excision of the cyst is indicated in patients with no function of the upper renal segment, as in our case. Trans

Unilateral Occlusion of Duplicated Müllerian Ducts Associated with Ipsilateral Gartner’s Duct Cyst: Report of 3 Cases

AbstractWe evaluated 3 girls with unilateral occlusion of duplicated mullerian ducts, ipsilateral renal malformation and an ipsilateral Gartner’s duct cyst.

DUPLEX KIDNEY, GARTNER'S DUCT CYST AND IPSILATERAL MULLERIAN DUCT OBSTRUCTION

Unilateral mullerian duct obstruction associated with ipsilateral Gartner’s duct cyst and renal dysgenesis is extremely rare. To date only 10 cases have been documented and all have occurred in a single collecting system.’ A duplex collecting system with an ectopic ureter inserted into a Gartner’s duct cyst is also rare and, to our knowledge, has not been reported in combination with ipsilateral mullerian duct obstruction. CASE REPORT

Spontaneous rupture of the uterovaginal septum in 2 girls with unilateral hematocolpos and ipsilateral vaginal ectopic ureter

Unilateral hematocolpos associated with ipsilateral single vaginal ectopic ureter is unusual with fewer than 30 cases reported. 1,2 Spontaneous rupture of the common uterovaginal septum in unilateral hematocolpos has been described only rarely.3 We report on 2 girls with unilateral hematocolpos and an ipsilateral vaginal ectopic ureter in whom the common uterovaginal septum ruptured spontaneously.

A Modified Approach of Cystic Puncture With Contrast Medium Injection for Diagnosis of Obstructed Hemivagina and Urinary Tract Anomalies

This study investigated the diagnostic value of a modification of the conventional technique of X-ray imaging after cystic puncture with injection of contrast medium for obstructed hemivagina and related urinary tract anomalies in girls. The modified procedure made the following diagnostic findings: ipsilateral obstructed hemivagina in one patient with renal agenesis; vaginal ectopic ureter and ipsilateral obstructed hemivagina in one patient with renal dysplasia; and vaginal ectopic ureter, Gartners duct cyst and ipsilateral obstructed hemivagina in six patients with renal dysplasia or aplasia. This modified method might have improved diagnostic value over the traditional method, and accurately identify genitourinary tract anomalies. It could therefore serve as an alternative and complementary method of sonography.