Treatment of Haematocolpos in Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA)

Clinical Scenario

This protocol addresses haematocolpos occurring in the context of OHVIRA — a congenital triad characterised by didelphys uterus, obstructed hemivagina, and ipsilateral renal agenesis. The condition arises from abnormal development of both the Müllerian and Wolffian ducts, leading to unilateral outflow obstruction and progressive haematocolpos.

The OHVIRA Triad

OHVIRA (Obstructed Hemivagina and Ipsilateral Renal Anomaly) combines three structural anomalies: a didelphys uterus, a hemivagina blocked by a vaginal septum, and absence of the ipsilateral kidney. The obstructed segment results in retained menstrual blood, producing haematocolpos and associated pain.

Surgical Approach

Management is directed at relieving the vaginal outflow obstruction through a surgical procedure targeting the vaginal septum. The structured protocol specifies the operative technique, extent of resection, and approach to achieve durable relief and preserve fertility — see full regimen for details.

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References

DOI: 10.1007/s11604-021-01115-7

OHVIRA is a congenital anomaly associated with the abnormal development of the Müllerian and Wolffian ducts, which is characterized by the triad of didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis.

Resection of the vaginal septum to relieve obstruction is the treatment of choice, and full resection of the vaginal septum is considered to achieve good outcomes and fertility.

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