Complex Genitourinary Malformations and the Need of a Proper Interpretation
We usually read publications communicating exceptional cases [1], new malformations not previously described and/or which are out of any classification, or even new classifications supposedly not described before [2].
Editorial
We usually read publications communicating exceptional cases [1], new malformations not previously described and/or which are out of any classification, or even new classifications supposedly not described before [2]. Actually most of the times it is just a wrong interpretation of the anomaly, sometimes due to an incomplete research on it [3, 4]. And nevertheless, we still keep on looking for the reference tool or gold standard for the diagnosis of malformations [5, 6] trying to relegate others such as the hysterosalpingography, which should hold certain significance [7]. Apart from the well-known and widely used classification of the American Fertility Society (1988) [8] for the müllerian malformations, other systems of classification are in use [9, 10, 11] to try to standardize the denomination of malformations and so, make the comparison of results between groups possible. A correlation between the different subtypes of each of the classifications has been presented [12], but it will be of little help unless the physician makes a proper interpretation of the images, the classification system used is inexact [13, 14], the studies are incomplete [15, 16], or the embryological origin of the malformation and its possible associated malformations are not considered [12]. More important than finding the “best” classification or the “best” diagnostic test is the correct interpretation of the anomaly in all its genitourinary range, its embryological correspondence and the possible implications it may have on our patient [17, 18], also understanding that the case must be completely clarified before making any therapeutically decision.
References
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Di Spiezio Sardo A, Giampaolino P, Scognamiglio M, Varelli C, Nazzaro G, et al. (2016) An Exceptional Case of Complete Septate Uterus With Unilateral Cervical Aplasia (Class U2bC3V0/ESHRE/ESGE Classification) and Isolated Mullerian Remnants: Combined Hysteroscopic and Laparoscopic Treatment. J Minim Invasive Gynecol 23(1): 16-17.
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Zhu L, Chen N, Tong JL, Wang W, Zhang L, et al. (2015) New classification of Herlyn-Werner-Wunderlich syndrome. Chin Med J (Engl) 128(2): 222-225.
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Acien M, Acien P (2008) Details of genital tract malformations. Fertil Steril 90(2): 466-467.
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Acién M, Acién P (2015) Claiming "New" in What Might be an Inadequate Search. Chin Med J (Engl) 128(17): 2410-2411.
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Marcal L, Nothaft MA, Coelho F, Volpato R, Iyer R (2011) Mullerian duct anomalies: MR imaging. Abdom Imaging 36(6): 756-764.
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Graupera B, Pascual MA, Hereter L, Browne JL, Úbeda B, et al. (2015) Accuracy of three-dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Müllerian duct anomalies using ESHRE-ESGE consensus on the classification of congenital anomalies of the female genital tract. Ultrasound Obstet Gynecol 46(5): 616-622.
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Acién P, Acién M (2016a) Diagnostic imaging and cataloguing of female genital malformations. Insights into Imaging 7: 713-726.
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(1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril 49(6): 944-955.
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Oppelt P, Renner SP, Brucker S, Strissel PL, Strick R, et al. (2005) The VCUAM (Vagina Cervix Uterus Adnex- associated Malformation) classification: a new classification for genital malformations. Fertil Steril 84(5): 1493-1497.
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Acién P, Acién M (2011) The history of female genital tract malformations classifications and proposal of an updated system. Hum Reprod Update 17(5): 693-705.
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Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, et al. (2013) The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 28(8): 2032-2044.
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Acién P, Acién M (2016b) The presentation and management of complex female genital malformations. Hum Reprod Update 22(1): 48-69.
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Ludwin A, Ludwin I, Kudla M, Kottner J (2015) Reliability of the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy and American Society for Reproductive Medicine classification systems for congenital uterine anomalies detected using three- dimensional ultrasonography. Fertil Steril 104(3): 688-697.
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Di Spiezio Sardo A, Campo R, Gordts S, Spinelli M, Cosimato C, et al. (2015) The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system. Hum Reprod 30(5): 1046-1058.
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Bhagavath B, Behrman E, Salari BW, Vitek W, Barhan S, et al. (2015) Metroplasty to treat chronic pelvic pain resulting from outflow tract müllerian anomalies. Am J Obstet Gynecol 213(6): 871e1-3.
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Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, Gordts S, Exacoustos C, et al. (2016) The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 31(1): 2-7.
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Acién P, Acién M, Mazaira N, Quesada-Rico JA (2014) Reproductive Outcome in uterine malformations with or without an associated unilateral renal agenesis. J Reprod Med 59(1-2): 69-75.
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Acién P, Acién M (2010) Unilateral renal agenesis and female genital tract pathologies. Acta Obstet Gynecol Scand 89(11): 1424-1431.
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