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Double Uterus with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA)

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Reproductive Surgery

Abstract

Double uterus with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) is a well-described syndrome that most commonly involves a triad of associated anomalies. However, given the rarity of this syndrome in the general population, patients with this syndrome are commonly misdiagnosed and incorrectly managed. It is important for providers to be familiar with the features of this syndrome in order to decrease the time to diagnosis and to ensure that patients receive appropriate counseling regarding management options and long-term outcomes. Once a patient is diagnosed with OHVIRA syndrome, a physician with experience treating this syndrome should be involved in the development of a management plan which should ultimately include surgical correction. In this chapter, we will cover the development and classification of this anomaly, the diagnostic considerations, and the management goals and strategies that providers should understand in order to provide optimal care to patients with OHVIRA syndrome.

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References

  1. Herlyn U, Werner H. Simultaneous occurrence of an open Gartner-duct cyst, a homolateral aplasia of the kidney and a double uterus as a typical syndrome of abnormalities. Geburtshilfe Frauenheilkd. 1971;31:340–7.

    CAS  PubMed  Google Scholar 

  2. Wunderlich M. Unusual form of genital malformation with aplasia of the right kidney. Zentralbl Gynakol. 1976;98:559–62.

    CAS  PubMed  Google Scholar 

  3. Acién P. Embryological observations on the female genital tract. Hum Reprod. 1992;7:437–45.

    Article  Google Scholar 

  4. Aswani Y, Varma R, Choudhary P, Gupta RB. Wolffian origin of vagina unfolds the embryopathogenesis of OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly) syndrome and places OHVIRA as a female counterpart of Zinner syndrome in males. Pol J Radiol. 2016;81:549–56.

    Article  Google Scholar 

  5. 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. 1988;49:944–55.

    Google Scholar 

  6. Smith NA, Laufer MR. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome: management and follow-up. Fertil Steril. 2007;87:918–22.

    Article  Google Scholar 

  7. Fedele L, Motta F, Frontino G, Restelli E, Bianchi S. Double uterus with obstructed hemivagina and ipsilateral renal agenesis: pelvic anatomic variants in 87 cases. Hum Reprod. 2013;28:1580–3.

    Article  CAS  Google Scholar 

  8. Candiani GB, Fedele L, Candiani M. Double uterus, blind hemivagina, and ipsilateral renal agenesis: 36 cases and long-term follow-up. Obstet Gynecol. 1997;90:26–32.

    Article  CAS  Google Scholar 

  9. Mandava A, Prabhakar RR, Smitha S. OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) with uterus didelphys, an unusual presentation. J Pediatr Adolesc Gynecol. 2012;25:e23–5.

    Article  Google Scholar 

  10. Kueppers J, Wehrli L, Zundel S, Shavit S, Stahr N, Szavay PO. OHVIRA-syndrome in a newborn. J Pediatr Surg Case Rep. 2021;69:101859.

    Article  Google Scholar 

  11. Dhar H, Razek YA, Hamdi I. Uterus didelphys with obstructed right hemivagina, ipsilateral renal agenesis and right pyocolpos: a case report. Oman Med J. 2011;26:447–50.

    Article  Google Scholar 

  12. Zurawin RK, Dietrich JE, Heard MJ, Edwards CL. Didelphic uterus and obstructed hemivagina with renal agenesis: case report and review of the literature. J Pediatr Adolesc Gynecol. 2004;17:137–41.

    Article  CAS  Google Scholar 

  13. Rivas AG, Epelman M, Ellsworth PI, Podberesky DJ, Gould SW. Magnetic resonance imaging of Müllerian anomalies in girls: concepts and controversies. Pediatr Radiol. 2021. https://doi.org/10.1007/s00247-021-05089-6.

  14. Romanski PA, Aluko A, Bortoletto P, Troiano RN, Pfeifer SM. Aqueous vaginal contrast and scheduled hematocolpos with magnetic resonance imaging to delineate complex Müllerian anomalies. Fertil Steril. 2022;117(1):221–3.

    Article  Google Scholar 

  15. Unlu E, Virarkar M, Rao S, Sun J, Bhosale P. Assessment of the effectiveness of the vaginal contrast media in magnetic resonance imaging for detection of pelvic pathologies: a meta-analysis. J Comput Assist Tomogr. 2020;44:436–42.

    Article  Google Scholar 

  16. Mishra N, Ng S. Sonographic diagnosis of obstructed hemivagina and ipsilateral renal anomaly syndrome: a report of two cases. Australas J Ultrasound Med. 2014;17:153–8.

    Article  Google Scholar 

  17. Deutch TD, Abuhamad AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of Müllerian duct anomalies. J Ultrasound Med. 2008;27:413–23.

    Article  Google Scholar 

  18. Kamio M, Nagata C, Sameshima H, Togami S, Kobayashi H. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome with septic shock: a case report. J Obstet Gynaecol Res. 2018;44:1326–9.

    Article  Google Scholar 

  19. Ludwin A, Lindheim SR, Bhagavath B, Martins WP, Ludwin I. Longitudinal vaginal septum: a proposed classification and surgical management. Fertil Steril. 2020. https://doi.org/10.1016/j.fertnstert.2020.06.014.

  20. Romanski PA, Bortoletto P, Pfeifer SM. Unilateral obstructed Müllerian anomalies: a series of unusual variants of known anomalies. J Pediatr Adolesc Gynecol. 2021. https://doi.org/10.1016/j.jpag.2021.04.005.

  21. Ludwin A, Pfeifer SM. Reproductive surgery for Müllerian anomalies: a review of progress in the last decade. Fertil Steril. 2019;112:408–16.

    Article  Google Scholar 

  22. Cosgrove P, Kahlden K, Barr L, Sanchez J. Obstructed hemivagina with ipsilateral renal agenesis (OHVIRA) syndrome with imperforate anus. J Pediatr Surg Case Rep. 2016;12:34–7.

    Article  Google Scholar 

  23. Ludwin A, Ludwin I, Bhagavath B, Martins WP, Lindheim SR. Virginity-sparing management of blind hemivagina in obstructed hemivagina and ipsilateral renal anomaly syndrome. Fertil Steril. 2018;110:976–8.

    Article  Google Scholar 

  24. Xu B, Xue M, Xu D. Hysteroscopic management of an oblique vaginal septum in a virgin girl with a rare variant of Herlyn-Werner-Wunderlich syndrome. J Minim Invasive Gynecol. 2015;22:7.

    Article  Google Scholar 

  25. Gungor Ugurlucan F, Dural O, Yasa C, Kirpinar G, Akhan SE. Diagnosis, management, and outcome of obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome): is there a correlation between MRI findings and outcome? Clin Imaging. 2020;59:172–8.

    Article  Google Scholar 

  26. Tong J, Zhu L, Lang J. Clinical characteristics of 70 patients with Herlyn–Werner–Wunderlich syndrome. Int J Gynecol Obstet. 2013;121:173–5.

    Article  Google Scholar 

  27. Haddad B, Barranger E, Paniel BJ. Blind hemivagina: long-term follow-up and reproductive performance in 42 cases. Hum Reprod. 1999;14:1962–4.

    Article  CAS  Google Scholar 

  28. Heinonen PK. Pregnancies in women with uterine malformation, treated obstruction of hemivagina and ipsilateral renal agenesis. Arch Gynecol Obstet. 2013;287:975–8.

    Article  Google Scholar 

  29. Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol. 2011;38:371–82.

    Article  CAS  Google Scholar 

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Correspondence to Phillip A. Romanski .

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Romanski, P.A., Bortoletto, P., Pfeifer, S.M. (2022). Double Uterus with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA). In: Lindheim, S.R., Petrozza, J.C. (eds) Reproductive Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-05240-8_1

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  • DOI: https://doi.org/10.1007/978-3-031-05240-8_1

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