Skip to main content

Advertisement

Log in

Hydrometrocolpos: a Contemporary Review of the Last 5 Years

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this review is to provide a comprehensive overview of hydrometrocolpos, covering disease etiology, pathophysiology, clinical presentation, and diagnostic and management techniques, and known outcomes.

Recent Findings

This narrative review presents the literature on hydrometrocolpos in the pediatric population from the past 5 years. We highlight the 69 reported cases of hydrometrocolpos and classify them based on type of obstruction or associated anomaly, discuss new diagnostic algorithms based on imaging, and present novel and underutilized surgical techniques for definitive management.

Summary

Hydrometrocolpos, a condition characterized by retained fluid causing a distended vagina and uterus in the setting of a distal vaginal outflow obstruction, has a wide range of presentation severity based on the type of obstruction. Whether hydrometrocolpos is due to an isolated condition like imperforate hymen, a complex abnormality like cloacal malformation, or a part of a large congenital syndrome, the mainstay of treatment is decompression of the dilated vagina and surgical correction of the outflow obstruction. Imaging-based diagnostic algorithms and new treatment techniques reported in the literature, as well as longitudinal and patient-reported outcome research, can improve the lives of children affected by this condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Availability of Data and Materials

No datasets were used in the writing of this paper. Content from pre-existing literature was used—citations listed in references section.

References

  1. Gupta DK, Sharma S. Hydrometrocolpos. In: Hollwarth M, Puri P, editors. Pediatric surgery diagnosis and management. London New York p: Springer; 2009. p. 957–66.

    Chapter  Google Scholar 

  2. Godefroy M. Imperforation de la membrane hymen. Louccette Franc Gaz d'Hosp. 1856;29:567.

  3. Hill SJ, Hirsch JH. Sonographic detection of fetal hydrometrocolpos. J Ultrasound Med. 1985;4(6):323–5.

    Article  CAS  PubMed  Google Scholar 

  4. Khanna K, Sharma S, Gupta DK. Hydrometrocolpos etiology and management: past beckons the present. Pediatr Surg Int. 2018;34(3):249–61.

    Article  PubMed  Google Scholar 

  5. Spencer R, Levy DM. Hydrometrocolpos: report of three cases and review of the literature. Ann Surg. 1962;155(4):558–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Hwang HJ, et al. Hematocolpos as a result of delayed treatment of acute straddle injury in an adolescent girl. Case Rep Obstet Gynecol. 2016;2016:1987690.

    PubMed  PubMed Central  Google Scholar 

  7. Berkowitz CD, Elvik SL, Logan M. A simulated “acquired” imperforate hymen following the genital trauma of sexual abuse. Clin Pediatr (Phila). 1987;26(6):307–9.

    Article  CAS  PubMed  Google Scholar 

  8. David A, et al. Hydrometrocolpos and polydactyly: a common neonatal presentation of Bardet-Biedl and McKusick-Kaufman syndromes. J Med Genet. 1999;36(8):599–603.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Richards HM, et al. Hydrometrocolpos and polydactyly. Urology. 1980;15(1):53–5.

    Article  CAS  PubMed  Google Scholar 

  10. Sharma D, et al. A case of hydrometrocolpos and polydactyly. Clin Med Insights Pediatr. 2015;9:7–11.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nassar H, Horst M, Gobet R. A rare case of symptomatic hydrometrocolpos in a 5y old female. Urol Case Rep. 2021;39: 101789.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Khaladkar SM, et al. The Herlyn-Werner-Wunderlich syndrome - a case report with radiological review. Pol J Radiol. 2016;81:395–400.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hugele F, et al. Does prenatal MRI enhance fetal diagnosis of intra-abdominal cysts? Prenat Diagn. 2015;35(7):669–74.

    Article  PubMed  Google Scholar 

  14. Cerrah Celayir A, et al. Spectrum of etiologies causing hydrometrocolpos. J Neonatal Surg. 2013;2(1):5.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hayashi S, et al. Prenatal diagnosis of fetal hydrometrocolpos secondary to a cloacal anomaly by magnetic resonance imaging. Ultrasound Obstet Gynecol. 2005;26(5):577–9.

    Article  CAS  PubMed  Google Scholar 

  16. Chen MC, Chang YL, Chao HC. Hydrometrocolpos in infants: etiologies and Clinical Presentations. Children (Basel). 2022;9(2).

  17. Lee KH et al. Imperforate hymen: a comprehensive systematic review. J Clin Med. 2019;8(1)

  18. Nazir Z, et al. Congenital vaginal obstructions: varied presentation and outcome. Pediatr Surg Int. 2006;22(9):749–53.

    Article  PubMed  Google Scholar 

  19. Mallmann MR, et al. Prenatal diagnosis of hydro(metro)colpos: a series of 20 cases. Fetal Diagn Ther. 2019;45(1):62–8.

    Article  PubMed  Google Scholar 

  20. Lambat Emery S, et al. Hydro-metro-colpos diagnosed in utero. J Pediatr Surg Case Rep. 2022;78: 102172.

    Article  Google Scholar 

  21. Uygur L, Demirci O, Celayir A. Fetal hydrometrocolpos: challenges of prenatal differential diagnosis on ultrasound. J Clin Ultrasound. 2023;51(3):426–31.

    Article  PubMed  Google Scholar 

  22. Zhang J, et al. Proposal of the 3O (obstruction, ureteric orifice, and outcome) subclassification system associated with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA). J Pediatr Adolesc Gynecol. 2020;33(3):307–13.

    Article  PubMed  Google Scholar 

  23. Nicassio LN, Cheng JW, Cain MP. Bedside intervention for neonatal hydrometrocolpos and imperforate hymen. Urology. 2022;160:191–4.

    Article  PubMed  Google Scholar 

  24. Garcia Rodriguez R, et al. Fetal hydrometrocolpos and congenital imperforate hymen: Prenatal and postnatal imaging features. J Clin Ultrasound. 2018;46(8):549–52.

    Article  PubMed  Google Scholar 

  25. Dixit Thapa B, Regmi MC. Imperforate hymen: a rare cause of abdominopelvic mass in an infant. J Nepal Health Res Counc. 2021;19(1):201–202.

  26. Grimstad F, Strickland J, Dowlut-McElroy T. Management and prevention of postoperative complications in a neonate with a symptomatic imperforate hymen. J Pediatr Adolesc Gynecol. 2019;32(4):429–31.

    Article  PubMed  Google Scholar 

  27. Ray A, Kumari S. congenital hydrocolpos: diagnostic journey and management-a case report. J Obstet Gynaecol India. 2020;70(5):407–8.

    Article  PubMed  Google Scholar 

  28. Neri ID et al. Prenatal hydrometrocolpos as an unusual finding in Fraser syndrome. Case report. Case Rep Perinatal Med.2023;12(1).

  29. Wang L, et al. Characteristics of fetal physiological and pathological uterine effusion observed on prenatal ultrasonography: a case report. BMC Pregnancy Childbirth. 2022;22(1):405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Day ML, Avila CC, Novak DL. Hydrometrocolpos and postaxial polydactyly in a girl newborn: A case report. Clin Case Rep. 2022;10(2): e05453.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Arriola-Montenegro L, et al. Hydrometrocolpos and post-axial polydactyly complicated with acute intestinal obstruction and hydroureteronephrosis. Cureus. 2021;13(8): e17612.

    PubMed  PubMed Central  Google Scholar 

  32. Traisrisilp K, et al. Fetal hydrometrocolpos with pre-axial mirror polydactyly as a new variant of McKusick-Kaufman syndrome. J Clin Ultrasound. 2021;49(1):62–5.

    Article  PubMed  Google Scholar 

  33. Khalil T, et al. Hydrometrocolpos with polydactyly in consanguineous parents: a case report and review of literature. Cureus. 2023;15(2): e34880.

    PubMed  PubMed Central  Google Scholar 

  34. Ullah I, et al. A case of McKusick-Kaufman syndrome with perinatal diagnosis: case report and literature review. Ann Med Surg (Lond). 2022;79: 103926.

    PubMed  Google Scholar 

  35. Khanke S, et al. McKusick-Kaufman syndrome: a case report with an emphasis on perinatal diagnosis and genetic counseling. Cureus. 2023;15(4): e37808.

    PubMed  PubMed Central  Google Scholar 

  36. Mitani K et al. A rare case of retroperitoneal teratoma with obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome. BMJ Case Rep. 2021;14(5).

  37. Bloomfield V, Kives S, Allen L. 29. Case report: Long term follow up of neonate presenting with acute kidney injury secondary to obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome. J Pediat Adolesc Gynecol. 2023;36(2):185.

  38. Munley JA, Taylor JA. Diagnosis and surgical management of Herlyn-Werner-Wunderlich syndrome. J Pediatr Surg Case Rep. 2020;53: 101364.

    Article  Google Scholar 

  39. Simonetti I, et al. A rare case of hydrometrocolpos from persistent urogenital sinus in patient affected by adrenogenital syndrome. J Ultrasound. 2018;21(3):249–52.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Fiorentino R, et al. Perinatal diagnosis of congenital urogenital sinus abnormality. Congenit Anom (Kyoto). 2023;63(5):170–3.

    Article  CAS  PubMed  Google Scholar 

  41. Kumar S et al. Rare case of pseudohypoaldosteronism in a neonate secondary to congenital hydrometrocolpos. BMJ Case Rep. 2020;13(6).

  42. Bhagat AC, Gupta RS, Malik R. Antenatal diagnosis of hydrometrocolpos with Mullerian duplication on ultrasound and fetal MRI: case report and literature review. BJR Case Rep. 2023;9(3):20230024.

    PubMed  PubMed Central  Google Scholar 

  43. Marín GR. Pancake kidney with a single ureter, hydrometrocolpos, and imperforate anus: a set of uncommon malformations in a female adolescent. Arch Argent Pediatr. 2023;121(3): e202202752.

    PubMed  Google Scholar 

  44. Malanowska E, et al. Case report: Hydrometrocolpos conditioning recurrent urinary tract infections. Front Surg. 2022;9: 869152.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Osman NM, Hamza AM, Elamin HAM. Congenital vaginal obstruction in a newborn. Sudan J Paediatr. 2019;19(2):145–8.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kanso K, et al. A rare case report of hydrometrocolpos in a female newborn. Intern J Curr Res Rev. 2018;10:22–4.

    Google Scholar 

  47. Ngowi BN et al. Hydrometrocolpos in an infant with urological complications: a rare case and review of literature. J Surg Case Rep. 2023;(7):rjad406.

  48. Strauss KJ, Kaste SC. The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients--a white paper executive summary. Pediatr Radiol. 2006;36 Suppl 2(Suppl 2):110–2.

  49. Rouma B, et al. Hydrometrocolpos. 2020;1227–36.

  50. Boruah DK, et al. MR imaging evaluation of obstructing vaginal malformations with hematocolpos or hematometra in adolescent girls: A cross sectional study. The Egyptian Journal of Radiology and Nuclear Medicine. 2017;48(4):1187–96.

    Article  Google Scholar 

  51. Tanitame K, et al. Congenital anomalies causing hemato/hydrocolpos: imaging findings, treatments, and outcomes. Jpn J Radiol. 2021;39(8):733–40.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kurian JJ, et al. An approach to giant neonatal hydrocolpos with normally sited anus – Diagnosis and management including a novel one stage operation. J Pediatr Urol. 2021;17(5):707.e1-707.e7.

    Article  PubMed  Google Scholar 

  53. Williams CE, Cutner AC, Creighton SM. Laparoscopic management of high transverse vaginal septae: a case report. Gynecol Surg. 2013;10(3):189–91.

    Article  Google Scholar 

  54. Cheng C, et al. Vaginoscopic incision of oblique vaginal septum in adolescents with OHVIRA syndrome. Sci Rep. 2019;9(1):20042.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Shaked O, et al. Hydrometrocolpos–diagnostic and therapeutic dilemmas. J Pediatr Adolesc Gynecol. 2008;21(6):317–21.

    Article  CAS  PubMed  Google Scholar 

  56. Ruggeri G, et al. Vaginal malformations: a proposed classification based on embryological, anatomical and clinical criteria and their surgical management (an analysis of 167 cases). Pediatr Surg Int. 2012;28(8):797–803.

    Article  PubMed  Google Scholar 

  57. Chalmers DJ, et al. Clean intermittent catheterization as an initial management strategy provides for adequate preservation of renal function in newborns with persistent cloaca. J Pediatr Urol. 2015;11(4):211.e1-4.

    Article  PubMed  Google Scholar 

  58. Lewis S, Walker J, McHoney M. Antenatally detected abdominal cyst: Does cyst size and nature determine postnatal symptoms and outcome? Early Hum Dev. 2020;147: 105102.

    Article  PubMed  Google Scholar 

  59. Alamo L, et al. Prenatal magnetic resonance imaging of complex female genitourinary system abnormalities, what the fetal medicine specialist needs to know. Prenat Diagn. 2023;43(1):84–94.

    Article  PubMed  Google Scholar 

  60. López Soto Á, et al. Imaging in fetal genital anomalies. Eur J Obstet Gynecol Reprod Biol. 2023;283:13–24.

    Article  PubMed  Google Scholar 

  61. Dannull KA, Browne LP, Meyers MZ. The spectrum of cloacal malformations: how to differentiate each entity prenatally with fetal MRI. Pediatr Radiol. 2019;49(3):387–98.

    Article  PubMed  Google Scholar 

  62. Gang S, et al. Case report: magnetic resonance imaging-based three-dimensional printing for reconstruction of complex cloacal malformations. Front Pediatr. 2023;11:1103401.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Chiaramonte C, et al. Bladder mucosal graft vaginoplasty: a case report. J Pediatr Adolesc Gynecol. 2018;31(5):528–32.

    Article  PubMed  Google Scholar 

  64. Black SA, Maxwell LG, Sun LS, Crowley M. General anesthesia in neonates and children: Agents and techniques. Up to Date, Post TW (Ed), UpToDate, Waltham MA. (Accessed on March 17 2022).

  65. Bodduluri VL, Srinivasan L. Hydrometrocolpos: a lower mesodermal defects sequence. Journal of Fetal Medicine. 2015;2(4):191–6.

    Article  Google Scholar 

  66. Hahn-Pedersen J, Kvist N, Nielsen OH. Hydrometrocolpos: current views on pathogenesis and management. J Urol. 1984;132(3):537–40.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

A.G. and S.K. wrote the main manuscript and prepared tables and figures. All authors reviewed the manuscript.

Corresponding author

Correspondence to Soo Jeong Kim.

Ethics declarations

Ethics Approval and Consent to Participate

Ethical approval and informed consent were not required for the production and submission of this review article. Personal, sensitive, or confidential information from human subjects was not collected in the writing process of this review paper.

Competing Interests

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Table 1 Classification and description of hydrometrocolpos types
Table 2 Summary of hydrometrocolpos cases reported between 2018 and 2023
Fig. 1
figure 1

Hymenectomy technique: A cruciate incision, B circular incision

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grant, A., Carpenter, C.P., Li, B. et al. Hydrometrocolpos: a Contemporary Review of the Last 5 Years. Curr Urol Rep 24, 601–610 (2023). https://doi.org/10.1007/s11934-023-01191-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-023-01191-4

Keywords

Navigation