Ultrasound-guided endoscopy to improve accuracy of persistent urogenital sinus (PUGS) diagnosis in adult patient: A case report
Introductionpersistent urogenital sinus (PUGS) is a rare condition characterized by abnormal communication between the urethra and vagina, that can frequently be associated with other complex Mullerian malformation (33%). We present a case of PUGS associated with a complex Mullerian malformation dia...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1105551/full |
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| author | Mariateresa Mirandola Benedetta Gui Angelica Naldini Nazario Foschi Viola Casula Antonia Carla Testa Antonia Carla Testa Giovanni Scambia Giovanni Scambia Ursula Catena |
| author_facet | Mariateresa Mirandola Benedetta Gui Angelica Naldini Nazario Foschi Viola Casula Antonia Carla Testa Antonia Carla Testa Giovanni Scambia Giovanni Scambia Ursula Catena |
| author_sort | Mariateresa Mirandola |
| collection | DOAJ |
| description | Introductionpersistent urogenital sinus (PUGS) is a rare condition characterized by abnormal communication between the urethra and vagina, that can frequently be associated with other complex Mullerian malformation (33%). We present a case of PUGS associated with a complex Mullerian malformation diagnosed in adult age after the integration of gynecological ultrasound with hysteroscopy, both performed by expert operators.Case description27-year-old women was referred to our clinic because of frequent urinary tract infections and cyclic pelvic pain. She was virgo, with normal menstrual cycles and dysmenorrhea. A didelphys uterus and double vagina with bilateral hematocolpos was firstly diagnosed through transrectal and transabdominal ultrasound. An MRI was then performed and a monorenal and ipsilateral ureteral malformation were diagnosed; in addition, a complete absence of the lower third of the vagina and an abnormal origin of the urethra from the bladder were described. Patient underwent lower genital tract endoscopy: external vaginal orifice was obliterated, a PUGS was diagnosed and both vaginas' ostia were detected on the PUGS's posterior-lateral walls. The procedure was performed under transabdominal ultrasound guidance which confirmed the endoscopic anatomical suspicion, avoiding complications such as perforation and misdiagnosis.Discussionultrasound guided endoscopy plays an essential role in the evaluation of complex anatomic anomalies, such as persistent urogenital sinus (PUGS), leading to a dynamic one-stop diagnosis; it avoids delays and misdiagnosis in preoperative assessment possibly related to the separately application of different radiological and endoscopic techniques. |
| first_indexed | 2024-04-10T05:14:21Z |
| format | Article |
| id | doaj.art-eddd3a44323044f18113ba4825fc314f |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-10T05:14:21Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-eddd3a44323044f18113ba4825fc314f2023-03-09T05:14:19ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-03-011010.3389/fsurg.2023.11055511105551Ultrasound-guided endoscopy to improve accuracy of persistent urogenital sinus (PUGS) diagnosis in adult patient: A case reportMariateresa Mirandola0Benedetta Gui1Angelica Naldini2Nazario Foschi3Viola Casula4Antonia Carla Testa5Antonia Carla Testa6Giovanni Scambia7Giovanni Scambia8Ursula Catena9Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, ItalyDepartment of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyDepartment of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, ItalyDepartment of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyIntroductionpersistent urogenital sinus (PUGS) is a rare condition characterized by abnormal communication between the urethra and vagina, that can frequently be associated with other complex Mullerian malformation (33%). We present a case of PUGS associated with a complex Mullerian malformation diagnosed in adult age after the integration of gynecological ultrasound with hysteroscopy, both performed by expert operators.Case description27-year-old women was referred to our clinic because of frequent urinary tract infections and cyclic pelvic pain. She was virgo, with normal menstrual cycles and dysmenorrhea. A didelphys uterus and double vagina with bilateral hematocolpos was firstly diagnosed through transrectal and transabdominal ultrasound. An MRI was then performed and a monorenal and ipsilateral ureteral malformation were diagnosed; in addition, a complete absence of the lower third of the vagina and an abnormal origin of the urethra from the bladder were described. Patient underwent lower genital tract endoscopy: external vaginal orifice was obliterated, a PUGS was diagnosed and both vaginas' ostia were detected on the PUGS's posterior-lateral walls. The procedure was performed under transabdominal ultrasound guidance which confirmed the endoscopic anatomical suspicion, avoiding complications such as perforation and misdiagnosis.Discussionultrasound guided endoscopy plays an essential role in the evaluation of complex anatomic anomalies, such as persistent urogenital sinus (PUGS), leading to a dynamic one-stop diagnosis; it avoids delays and misdiagnosis in preoperative assessment possibly related to the separately application of different radiological and endoscopic techniques.https://www.frontiersin.org/articles/10.3389/fsurg.2023.1105551/fullendoscopyhysteroscopyultrasoundmullerian malformationcongenital malformationPUGS-persistent urogenital sinus |
| spellingShingle | Mariateresa Mirandola Benedetta Gui Angelica Naldini Nazario Foschi Viola Casula Antonia Carla Testa Antonia Carla Testa Giovanni Scambia Giovanni Scambia Ursula Catena Ultrasound-guided endoscopy to improve accuracy of persistent urogenital sinus (PUGS) diagnosis in adult patient: A case report Frontiers in Surgery endoscopy hysteroscopy ultrasound mullerian malformation congenital malformation PUGS-persistent urogenital sinus |
| title | Ultrasound-guided endoscopy to improve accuracy of persistent urogenital sinus (PUGS) diagnosis in adult patient: A case report |
| title_full | Ultrasound-guided endoscopy to improve accuracy of persistent urogenital sinus (PUGS) diagnosis in adult patient: A case report |
| title_fullStr | Ultrasound-guided endoscopy to improve accuracy of persistent urogenital sinus (PUGS) diagnosis in adult patient: A case report |
| title_full_unstemmed | Ultrasound-guided endoscopy to improve accuracy of persistent urogenital sinus (PUGS) diagnosis in adult patient: A case report |
| title_short | Ultrasound-guided endoscopy to improve accuracy of persistent urogenital sinus (PUGS) diagnosis in adult patient: A case report |
| title_sort | ultrasound guided endoscopy to improve accuracy of persistent urogenital sinus pugs diagnosis in adult patient a case report |
| topic | endoscopy hysteroscopy ultrasound mullerian malformation congenital malformation PUGS-persistent urogenital sinus |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1105551/full |
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