DOI QR코드

DOI QR Code

Herlyn-Werner-Wunderlich Syndrome: A Mini-review

  • Lee, Jiwon M. (Department of Pediatric Nephrology, Chungnam National University Children's Hospital)
  • Received : 2017.09.04
  • Accepted : 2018.03.16
  • Published : 2018.04.30

Abstract

Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital malformation syndrome that is characterized by a triad of uterine didelphys, blind hemivagina, and ipsilateral renal agenesis. There is a wide variety of phenotypic presentation which is recognized as a spectrum of disease rather than a separate entity. The exact incidence and pathogenesis of HWW syndrome are yet to be investigated. While this disease typically involves adolescent girls who present with abdominal pain or a pelvic mass that is secondary to hematocolpos, nowadays, a majority of potential patients with HWW are being prenatally screened for renal anomalies. Therefore, it is recommended to search for uterovaginal anomalies whenever a multicystic dysplastic kidney or the absence of a kidney is noted in a newborn female, and the role of pediatric nephrologists has become ever more important for early recognition of the disease.

Keywords

References

  1. Orazi C, Lucchetti MC, Schingo PM, Marchetti P, Ferro F. Herlyn-Werner-Wunderlich syndrome: uterus didelphys, blind hemivagina and ipsilateral renal agenesis. Sonographic and MR findings in 11 cases. Pediatr Radiol 2007;37:657-65. https://doi.org/10.1007/s00247-007-0497-y
  2. 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. https://doi.org/10.1016/S0029-7844(97)83836-7
  3. Smith NA, Laufer MR. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome: management and followup. Fertil Steril 2007;87:918-22. https://doi.org/10.1016/j.fertnstert.2006.11.015
  4. George Wilson J. A case of double uterus and vagina with unilateral hematocolpos and hematometra. J Obstet Gynaecol Br Emp 1925;32:127-8. https://doi.org/10.1111/j.1471-0528.1925.tb06260.x
  5. Herlyn U, Werner H. Simultaneous occurrence of an open Gartnerduct cyst, a homolateral aplasia of the kidney and a double uterus as a typical syndrome of abnormalities. Geburtshilfe Frauenheilkd 1971;31:340-7.
  6. Wunderlich M. Unusual form of genital malformation with aplasia of the right kidney. Zentralbl Gynakol 1976;98:559-62.
  7. Santos XM, Dietrich JE. Obstructed Hemivagina with Ipsilateral Renal Anomaly. J Pediatr Adol Gynec 2016;29:7-10. https://doi.org/10.1016/j.jpag.2014.09.008
  8. Vercellini P, Daguati R, Somigliana E, Vigano P, Lanzani A, Fedele L. Asymmetric lateral distribution of obstructed hemivagina and renal agenesis in women with uterus didelphys: institutional case series and a systematic literature review. Fertil Steril 2007;87:719-24. https://doi.org/10.1016/j.fertnstert.2007.01.173
  9. 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. https://doi.org/10.1093/humrep/det081
  10. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions. Fertil Steril 1988;49:944-55. https://doi.org/10.1016/S0015-0282(16)59942-7
  11. Wang S, Lang JH, Zhu L, Zhou HM. Duplicated uterus and hemivaginal or hemicervical atresia with ipsilateral renal agenesis: an institutional clinical series of 52 cases. Eur J Obstet Gynaecol Reprod Biol 2013;170:507-11. https://doi.org/10.1016/j.ejogrb.2013.07.015
  12. Hall-Craggs MA, Kirkham A, Creighton SM. Renal and urological abnormalities occurring with Mullerian anomalies. J Pediatr Urol 2013;9:27-32. https://doi.org/10.1016/j.jpurol.2011.11.003
  13. Angthong W, Visetsripong M, Amornvithayachan O, Varavithya V. Herlyn-Werner-Wunderlich syndrome emphasizes ultrasonographic and MR findings: a case report and review of the literatures. J Med Assoc Thai 2012;95 Suppl 12:S129-33.
  14. Wu TH, Wu TT, Ng YY, et al. Herlyn-Werner-Wunderlich syndrome consisting of uterine didelphys, obstructed hemivagina and ipsilateral renal agenesis in a newborn. Pediatr Neonatol 2012;53: 68-71. https://doi.org/10.1016/j.pedneo.2011.11.014
  15. Gholoum S, Puligandla PS, Hui T, Su W, Quiros E, Laberge JM. Management and outcome of patients with combined vaginal septum, bifid uterus, and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome). J Pediatr Surg 2006;41:987-92. https://doi.org/10.1016/j.jpedsurg.2006.01.021
  16. Tong J, Zhu L, Lang J. Clinical characteristics of 70 patients with Herlyn-Werner-Wunderlich syndrome. Int J Gynaecol Obstet 2013;121:173-5. https://doi.org/10.1016/j.ijgo.2012.11.023
  17. Coskun A, Okur N, Ozdemir O, Kiran G, Arykan DC. Uterus didelphys with an obstructed unilateral vagina by a transverse vaginal septum associated with ipsilateral renal agenesis, duplication of inferior vena cava, high-riding aortic bifurcation, and intestinal malrotation: a case report. Fertil Steril 2008;90:2006 e9-11.
  18. Pieroni C, Rosenfeld DL, Mokrzycki ML. Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. A case report. J Reprod Med 2001;46:133-6.
  19. Sardanelli F, Renzetti P, Oddone M, Toma P. Uterus didelphys with blind hemivagina and ipsilateral renal agenesis: MR findings before and after vaginal septum resection. Eur J Radiol 1995;19:164-70. https://doi.org/10.1016/0720-048X(95)00605-P
  20. Tanaka YO, Kurosaki Y, Kobayashi T, et al. Uterus didelphys associated with obstructed hemivagina and ipsilateral renal agenesis: MR findings in seven cases. Abdom Imaging 1998;23:437-41. https://doi.org/10.1007/s002619900375
  21. Hoeffel C, Olivier M, Scheffler C, Chelle C, Hoeffel JC. Uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. Eur J Radiol 1997;25:246-8. https://doi.org/10.1016/S0720-048X(96)01149-7
  22. 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 Adol Gynecol 2004;17:137-41. https://doi.org/10.1016/j.jpag.2004.01.016
  23. Guducu N, Gonenc G, Isci H, Yigiter AB, Dunder I. Herlyn-Werner-Wunderlich syndrome--timely diagnosis is important to preserve fertility. J Pediatr Adol Gynecol 2012;25:e111-2. https://doi.org/10.1016/j.jpag.2012.05.013
  24. Fedele L, Bianchi S, Di Nola G, Franchi D, Candiani GB. Endometriosis and nonobstructive mullerian anomalies. Obstet Gynecol 1992;79:515-7.
  25. Ugur M, Turan C, Mungan T, et al. Endometriosis in association with mullerian anomalies. Gynecol Obstet Inves 1995;40:261-4. https://doi.org/10.1159/000292349
  26. Acien P, Susarte F, Romero J, et al. Complex genital malformation: ectopic ureter ending in a supposed mesonephric duct in a woman with renal agenesis and ipsilateral blind hemivagina. Eur J Obstet Gynaecol Reprod Biol 2004;117(1):105-8. https://doi.org/10.1016/j.ejogrb.2004.01.042
  27. Capito C, Echaieb A, Lortat-Jacob S, Thibaud E, Sarnacki S, Nihoul-Fekete C. Pitfalls in the diagnosis and management of obstructive uterovaginal duplication: a series of 32 cases. Pediatrics 2008; 122:e891-7. https://doi.org/10.1542/peds.2008-0219
  28. Wang ZJ, Daldrup-Link H, Coakley FV, Yeh BM. Ectopic ureter associated with uterine didelphys and obstructed hemivagina: preoperative diagnosis by MRI. Pediatr Radiol 2010;40:358-60. https://doi.org/10.1007/s00247-009-1454-8
  29. Westland R, Kurvers RA, van Wijk JA, Schreuder MF. Risk factors for renal injury in children with a solitary functioning kidney. Pediatrics 2013;131:e478-85. https://doi.org/10.1542/peds.2012-2088
  30. Acien P. Reproductive performance of women with uterine malformations. Hum Reprod 1993;8:122-6. https://doi.org/10.1093/oxfordjournals.humrep.a137860
  31. Haddad B, Barranger E, Paniel BJ. Blind hemivagina: long-term follow-up and reproductive performance in 42 cases. Hum Reprod 1999;14:1962-4. https://doi.org/10.1093/humrep/14.8.1962
  32. Olive DL, Henderson DY. Endometriosis and mullerian anomalies. Obstetr Gynecol 1987;69:412-5.

Cited by

  1. Herlyn-Werner-Wunderlich Syndrome with Central Precocious Puberty: A Case Report vol.23, pp.2, 2018, https://doi.org/10.3339/jkspn.2019.23.2.124
  2. Herlyn-Werner-Wunderlich syndrome in the prepubescent period (literature review and clinical observations) vol.21, pp.4, 2018, https://doi.org/10.17650/2070-9781-2020-21-4-60-67
  3. Herlyn Werner Wunderlich Syndrome with Vagino-umbillical Fistula: A Most Unique Presentation vol.3, pp.1, 2018, https://doi.org/10.1142/s2661318221300014
  4. Acute abdomen: Unusual presentation of Herlyn-Werner Wunderlich syndrome vol.82, pp.None, 2021, https://doi.org/10.1016/j.ijscr.2021.105911