Antegrade genitography - A new diagnostic modality of obstructive abnormalities in the female reproductive tract

Hysterosalpingography (HSG) is the standard imaging modality for diagnosing Müllerian structural abnormalities. However, its utility is limited in cases of complete obstruction of the Müllerian ducts. Ultrasonography and MRI often fall short in pinpointing the obstruction's location and extent, which can be critical for surgical planning. This report introduces antegrade genitography as a novel diagnostic approach for congenital obstructive Müllerian malformations, highlighting its potential to enhance diagnostic accuracy and guide patient management.

This retrospective case series describes three patients with Müllerian obstructive malformations. Using laparoscopic guidance, fluoroscopy, and ultrasound, we performed percutaneous puncture of the uterine cavity and contrast injection into it, followed by X-ray imaging to assess the obstruction's characteristics and location.

Two adolescents (17 and 19 years) with primary amenorrhea and a newborn with oligohydramnios and urinary retention were included. In the two adolescent patients, antegrade genitography confirmed cervical agenesis by showing no contrast progression from the uterus to the cervical canal or vagina. The newborn was diagnosed with a high urogenital sinus and obstructed stenotic distal vaginal insertion into the bladder trigone.

antegrade genitography proves to be a valuable diagnostic tool for patients with complete Müllerian obstructive malformations. We advocate its integration into clinical practice, emphasizing collaboration among urologists, gynecologists, and radiologists to optimize the management of patients with complex Müllerian malformations.