Herlyn-Werner-Wunderlich syndrome in three infants: a case report of surgical treatment

Oblique vaginal septum syndrome (Herlyn-Werner-Wunderlich syndrome) is a congenital reproductive tract malformation frequently accompanied by ipsilateral renal dysplasia. During infancy, it can lead to urinary tract infections, dysuria, and abdominal masses. Delayed intervention predisposes patients to hydronephrosis and even renal failure. Current treatment primarily involves incision and drainage; however, traditional transvaginal surgery in infants is limited by a restricted surgical field and a lack of standardized protocols. This case report presents the clinical data of three affected infants (age range: 5 days to 4 months and 15 days) treated at our institution, evaluating the efficacy of two minimally invasive surgical approaches. During a follow-up period of 1-12 months postoperatively, all patients achieved complete recovery of normal voiding function, with no recurrence of urinary tract infections, and no instances of intestinal injury, hemorrhage, or restenosis were observed. Transvaginal direct incision is considered suitable for patients presenting with vulvar masses caused by a low-positioned oblique septum, whereas a laparoscopy-assisted approach effectively optimizes surgical conditions for cases involving a high-positioned oblique septum or those with significant inflammation following repeated punctures. Both techniques resulted in symptom relief without major complications. We emphasize the importance of early and precise intervention, as well as the avoidance of blind puncture, to preserve renal function.