ANATOMIC FEATURES OF 49 UNICORNUATE UTERI - GYNECOLOGIC AND UROLOGIC FINDINGS, ASSOCIATED DISORDERS, AND ENDOMETRIAL PATTERNS

Our objective was to study the anatomic features, associated pelvic an d urologic abnormalities, and histologic endometrial patterns of women with unicornuate uterus. We reviewed the clinical records of women wi th unicornuate uterus who underwent laparoscopy or laparotomy at our d epartment from 1975 to 1994. The presence and characteristics of the a dnexa, the presence of pelvic endometriosis, and the features of the u rinary 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 cla ssified according to Buttram and Gibbons' criteria. Three women (6.1%) had Buttrams and Gibbons' subclass Aba unicornuate uterus, 14 (28.6%) had subclass Alb, 19 (38.8%) had subclass A2, and 13 (26.5%) had subc lass B. The adnexa ipsilateral to the hemiuterus were all normal, wher eas the contralateral ones presented various anomalies. Endometriosis was detected in 23 women (revised American Fertility Society classific ation 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 A1b. 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 anatomica lly and clinically heterogeneous malformation. The clinical picture an d consequent therapeutic management may vary widely according to the s ubclass and also any associated disorders.