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PUMCH Published New Viewpoints on Diagnosis and Surgical Treatment of Congenital Cervical Dysplasia in “Science Bulletin”
CopyFrom: PUMCH UpdateTime: 2022-11-30 Hits: 18 Font Size: SmallBig

Recently, Professor Zhu Lan’s team from the Department of Obstetrics and Gynecology of PUMCH and Professor Grigoris F. Grimbizis, former president of the European Society for Gynecological Endoscopy, jointly published an expert viewpoint paper in “Science Bulletin” (IF: 20.577), which provides a comprehensive overview of recent advances in the diagnostic flowchart and surgical treatment of congenital cervical dysplasia. With the advances in surgical techniques, surgical methods that preserve reproductive function have been proven to be safe and effective in literature for the treatment of such disorders. The initial consultation of a patient under such conditions should be undertaken by a medical center experienced in managing genital tract anomalies to comprehensively assess the conditions and select the appropriate surgical approach to restore normal anatomy, relieve symptoms of genital tract obstruction, and preserve female fertility.

Congenital cervical dysplasia is a rare obstructive development anomaly of female genital tract with an incidence of about 1 in 80,000 to 100,000, in mostly cases combining complete or proximal vaginal atresia. The disease causes obstruction of the reproductive tract and retrograde menstruation, which can lead to pelvic endometriosis and reproductive tract infections, seriously impairing the physical and mental health and fertility of adolescent females. The clinical management of congenital cervical dysplasia is very difficult. Inadequate understanding and evaluation of the disease can lead to misdiagnosis and mistreatment, hence the high probability of intraoperative organ damage and early postoperative reobstruction, affecting the patient’s prognosis.

According to expert viewpoints, the clinical manifestations of congenital cervical dysplasia are mostly primary amenorrhea, cyclical lower abdominal pain, retention of blood inside the cervical or uterine cavity due to retrograde menstruation, pelvic endometriosis or infertility in postpubertal females. Imaging studies, especially pelvic MRI, are essential for a definitive diagnosis. A joint review of images with an experienced radiologist can help determine the type of cervical dysplasia and the other concomitant reproductive system anomalies, which can guide the diagnosis and the choose of surgical approach.

According to expert viewpoints, clinical management of congenital cervical dysplasia is mostly surgical treatment. Conservative surgery was once believed to led to intraoperative organ damage, early postoperative adhesions and ascending infections, thus hysterectomy used to be the main surgical treatment for cervical dysplasia. In recent years, with the development of surgical techniques, the safety and efficacy of fertility-preserving procedures such as utero-vaginal anastomosis and canalization procedures have been validated in the research papers. A variety of cervical reconstruction materials and stents have also been tried clinically to prevent postoperative restenosis. In addition, the advances in reconstructive surgery and reproductive medicine also help to make fertility possible in patients with congenital cervical dysplasia.

According to expert viewpoints, in order to improve the prognosis of patients with congenital cervical dysplasia, they should be referred to a medical center experienced in managing abnormalities of the female reproductive tract and given a thorough evaluation that factors in medical history, physical examination, and imaging evaluation. The decision on the surgical approach should take into account the type of cervical abnormality, the concomitant uterine malformation and the severity of concomitant pelvic endometriosis, as well as the patient’s wishes and compliance. There is still no consensus in the medical community regarding the clinical staging of this disease and the choice of surgical approach, and further clinical studies are needed.



Surgical illustration of uterovaginal (cervicovaginal) cannalization



Surgical illustration of uterovaginal (cervicovaginal) anastomosis



Medical records of patients with female genital tract anomalies admitted into PUMCH since the 1920s



Written by: The Department of Obstetrics and Gynecology

Picture courtesy: The Department of Obstetrics and Gynecology

Translator: Liu Haiyan

Editor: Zhang Zhibo and Wang Yao