Screening for Mullerian anomalies in patients with unilateral renal agenesis: Leveraging early detection to prevent complications
Screening for Mullerian anomalies in patients with unilateral renal agenesis: Leveraging early detection to prevent complications
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DOI：
10.1016/j.jpurol.2018.01.011
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发表时间：
2018-04-01
影响因子：
2
通讯作者：
Caldamone, Anthony
中科院分区：
文献类型：
--
作者：
Friedman, M. Alexandra;Aguilar, Liza;Caldamone, Anthony
苗勒氏畸形与肾脏发育不全有关，但到目前为止，还没有正式的建议用于筛查患有某些肾脏畸形的女性伴发生殖道疾病。目的本研究的目的是回顾有关肾畸形和苗勒氏畸形之间相关性的最新数据，并提出筛查建议。研究设计综合文献回顾，使用关键词“单侧肾发育不全”、“肾异常”和“苗勒氏畸形”来确定相关文章。然而，在这一人群中，诊断经常被推迟到月经初潮之后，那时月经逆行伴梗阻异常的并发症会导致严重的问题，包括子宫内膜异位症、盆腔炎和不孕症。产前超声医生、产科医生、父母和孩子的儿科医生之间的沟通没有明确的指导方针，这为有效的筛查和随访创造了障碍。此外，目前还没有筛查患有某些肾脏异常的女性苗勒氏畸形的指南。讨论如果及早发现苗勒氏畸形的并发症很容易预防。我们建议对单侧肾发育不全(URA)和多囊发育不良(MCDK)患者的苗勒氏畸形进行教育和筛查，以指导提供者、患者和父母正确识别和处理(表)。结论筛查患有URA和MCDK的年轻女性苗勒氏畸形有可能预防未经治疗的梗阻畸形的长期并发症。单侧肾发育不全的产前超声诊断必须与父母和孩子的儿科医生清楚地联系起来，以便在月经初潮前进行适当的筛查。盆腔超声是一种低成本、高收益的筛查工具，可以识别这些异常。
BackgroundMullerian anomalies have a known association with renal agenesis yet, to date, there are no formal recommendations for screening women with certain renal anomalies for associated genital tract disorders.ObjectiveThe objective of this study is to review current data regarding the association between renal and Mullerian anomalies, and propose screening recommendations.Study designA comprehensive review of the literature was performed to identify relevant articles using the keywords "unilateral renal agenesis," "renal anomalies," and "Mullerian anomalies."ResultsOver 30% of patients with unilateral renal agenesis have an associated Mullerian anomaly. However, diagnosis is frequently delayed in this population until after menarche when complications of retrograde menstruation with obstructive anomalies lead to significant problems including endometriosis, pelvic inflammatory disease, and infertility. No clear guidelines exist for communication among the antenatal sonographer, the obstetrician, the parents, and the child's pediatrician, which creates a barrier to effective screening and follow-up. Further, no current guidelines exist for screening women with certain renal anomalies for Mullerian anomalies.DiscussionThe complications of Mullerian anomalies are easily preventable if identified early. We propose new guidelines for education and screening for Mullerian anomalies in patients with unilateral renal agenesis (URA) and multicystic dysplastic kidney (MCDK) to guide providers, patients, and parents on proper identification and management (Table).ConclusionsScreening young women with URA and MCDK for Mullerian anomalies has the potential to prevent long-term complications from untreated obstructive malformations. Identification of unilateral renal agenesis on antenatal ultrasound must be clearly articulated with parents and the child's pediatrician so that proper screening can be performed before menarche. Pelvic sonography is a low-cost, high-yield screening tool to identify these anomalies.