Anatomie Features of 49 Unicornuate Uteri: Gynecologic and Urologie Findings, Associated Disorders, and Endometrial Patterns

Our objective was to study the anatomic features, associated pelvic and urologie abnormalities, and histologic endometrial patterns of women with unicornuate uterus. We reviewed the clinical records of women with unicornuate uterus who underwent laparoscopy or laparotomy at our department from 1975 to 1994. The presence and characteristics of the adnexa, the presence of pelvic endometriosis, and the features of the urinary apparatus were recorded. Endometrium of the removed rudimentary horns and the hemiuteri were studied by light microscopy. Forty-nine unicornuate uteri were identified by laparotomy or laparoscopy and classified according to Buttram and Gibbons' criteria. Three women (6.1%) had Buttrams and Gibbons' subclass Ala unicornuate uterus, 14 (28.6%) had subclass Alb, 19 (38.8%) had subclass A2, and 13 (26.5%) had subclass B. The adnexa ipsilateral to the hemiuterus were all normal, whereas the contralateral ones presented various anomalies. Endometriosis was detected in 23 women (revised American Fertility Society classification stage I in 13, stage II in 5, stage III in 3, and stage IV in 2). Hematometra was present in 4 patients in subclass Alb. In most women, endometrial mucosa of the rudimentary horn did not correspond to the cycle phase of endometrium of the hemiuterus. Fourteen patients (37.8%) had urinary tract abnormalities. Unicornuate uterus is an anatomically and clinically heterogeneous malformation. The clinical picture and consequent therapeutic management may vary widely according to the subclass and also any associated disorders. (J GYNECOL SURG 12:167, 1996)