{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:14:31Z","timestamp":1787004871217,"version":"build-2736575974"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In this report we present a new anatomical stratification for vaginal obstruction (hydrocolpos) based on MRI findings while referring the level of obstruction to a fixed bony landmark (the pubic symphysis). This new approach can overcome the limitations of current classifications, which are prone to approximation errors during measurement and fail to account for variations in body mass across different age groups.<\/jats:p>\n                  <jats:p>Data of cases diagnosed with vaginal obstruction were retrospectively analyzed. Cases of cloaca with vaginal obstruction were excluded. MRI confirmed the diagnosis and enabled classification of the level of vaginal obstruction relative to the pubic symphysis in the mid-sagittal plane as low, intermediate, or high\u2014opposite the lower, mid, or upper end of the pubic symphysis, respectively.<\/jats:p>\n                  <jats:p>A total of 13 girls presented with vaginal obstruction during the period 2010 through 2024. Their age ranged between 1 month and 14 years (mean: 54 months; median: 18 months). Three cases presented in the neonatal period with antenatal diagnosis of hydrocolpos, while six cases were referred later during infancy\/childhood from other centers. Another group of adolescent girls (four cases) presented with a clinical picture of cryptomenorrhea. The cause of vaginal obstruction was imperforate hymen in one, vaginal atresia in six, persistent urogenital sinus (five cases), and one case of obstructed hemi-vagina. In this series, six cases (46%) had features related to genetic syndromes (Bardet Biedl\/ McKusick-Kaufman spectrum). Chronic parenchymatous renal disease was present in three cases among other syndromic features of Bardet Biedl syndrome, in addition to another case with obstructed left hemi-vagina that had absent left kidney (Herlyn-Werner-Wunderlich syndrome). Surgical techniques included simple excision of distal obstructing membrane (four cases), abdominal assisted vaginoplasty (two cases), vaginal pull-through (four cases), simple introitoplasty (one case), urogenital sinus mobilization (one case), and division of longitudinal vaginal septum for a case of obstructed hemi-vagina. Vaginal stenosis or retraction occurred in three cases with intermediate to high-level obstruction\u2014two following abdominal assisted vaginoplasty and one after vaginal pull-through.<\/jats:p>\n                  <jats:p>MRI-based stratification of vaginal obstruction using the pubic symphysis as a reference provides a practical and reproducible approach for surgical planning.<\/jats:p>\n                  <jats:p>This is a case series (level IV evidence).<\/jats:p>","DOI":"10.1055\/a-2680-6011","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T23:01:43Z","timestamp":1755039703000},"page":"102-110","source":"Crossref","is-referenced-by-count":1,"title":["MRI-based Stratification and Surgical Management of Hydrocolpos in Children and Adolescents"],"prefix":"10.1055","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2681-6086","authenticated-orcid":false,"given":"Amr AbdelHamid","family":"AbouZeid","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Ain Shams University Faculty of Medicine, Cairo, Cairo Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hany Emad","family":"Elhady","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Ain Shams University Faculty of Medicine, Cairo, Cairo Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaimaa Abdelsattar","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Ain Shams University Faculty of Medicine, Cairo, Cairo Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Seada","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Benha Specialized Children Hospital, Benha, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"El-Naggar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Ain Shams University Faculty of Medicine, Cairo, Cairo Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa Mohamed","family":"Elghandour","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Ain Shams University Faculty of Medicine, Cairo, Cairo Governorate, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1053\/spsu.2000.7559","article-title":"Vaginal obstruction","volume":"9","author":"A Stallion","year":"2000","journal-title":"Semin Pediatr Surg"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1007\/s00383-012-3121-7","article-title":"Vaginal malformations: a proposed classification based on embryological, anatomical and clinical criteria and their surgical management (an analysis of 167 cases)","volume":"28","author":"G Ruggeri","year":"2012","journal-title":"Pediatr Surg Int"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"240","DOI":"10.3389\/fped.2019.00240","article-title":"Cloacal malformations: technical aspects of the reconstruction and factors which predict surgical complexity","volume":"7","author":"R J Wood","year":"2019","journal-title":"Front Pediatr"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1055\/s-0041-1725189","article-title":"Correlation between common channel length and urethral length in cloacal malformations","volume":"32","author":"M Abdelmalak Abokandil","year":"2022","journal-title":"Eur J Pediatr Surg"},{"issue":"10","key":"ref5","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1016\/j.jpedsurg.2019.04.005","article-title":"The cloacal anomalies: anatomical insights through a complex spectrum","volume":"54","author":"A A AbouZeid","year":"2019","journal-title":"J Pediatr Surg"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/j.jpedsurg.2020.01.002","article-title":"Transformation of the female genitalia in congenital adrenal hyperplasia: MRI study","volume":"55","author":"A A AbouZeid","year":"2020","journal-title":"J Pediatr Surg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1097\/00000658-196204000-00013","article-title":"Hydrometrocolpos: report of three cases and review of the literature","volume":"155","author":"R Spencer","year":"1962","journal-title":"Ann Surg"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/S0022-3468(84)80092-5","article-title":"Hydrometrocolpos in neonate due to distal vaginal atresia","volume":"19","author":"L Nguyen","year":"1984","journal-title":"J Pediatr Surg"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s00383-022-05078-2","article-title":"Modified balloon vaginoplasty for high position vaginal atresia","volume":"38","author":"M Zhang","year":"2022","journal-title":"Pediatr Surg Int"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jpag.2014.12.007","article-title":"Postoperative course and complications after pull-through vaginoplasty for distal vaginal atresia","volume":"28","author":"R Mansouri","year":"2015","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1111\/j.1464-410X.2005.05354.x","article-title":"A new classification for genital ambiguity and urogenital sinus anomalies","volume":"95","author":"R C Rink","year":"2005","journal-title":"BJU Int"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/0022-3468(71)90482-9","article-title":"An abdomino-perineal-vaginal pull-through for definitive treatment of hydrometrocolpos","volume":"6","author":"M L Ramenofsky","year":"1971","journal-title":"J Pediatr Surg"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jpag.2023.09.001","article-title":"Neonatal single-stage surgical management of complicated distal vaginal atresia: revisiting an appropriate and feasible technique","volume":"37","author":"M Elsherbeny","year":"2024","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s43054-024-00262-6","article-title":"Preoperative evaluation of the persistent urogenital sinus in cases with congenital adrenal hyperplasia","volume":"72","author":"A Aboalazayem","year":"2024","journal-title":"Egypt Pediatr Assoc Gaz"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.jpurol.2006.04.002","article-title":"Partial urogenital mobilization: a limited proximal dissection","volume":"2","author":"R C Rink","year":"2006","journal-title":"J Pediatr Urol"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.1016\/j.jemermed.2014.09.064","article-title":"Herlyn-Werner-Wunderlich syndrome: a very rare urogenital anomaly in a teenage girl","volume":"48","author":"L Karaca","year":"2015","journal-title":"J Emerg Med"},{"issue":"10","key":"ref17","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1007\/s00247-024-05990-w","article-title":"Prenatal hydrocolpos: imaging findings and differential diagnosis","volume":"54","author":"C L Newman","year":"2024","journal-title":"Pediatr Radiol"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.radcr.2022.10.040","article-title":"Prenatal diagnosis of Bardet Biedl syndrome: a case report","volume":"18","author":"E Arora","year":"2022","journal-title":"Radiol Case Rep"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/BF00178827","article-title":"High vaginal atresia: surgical considerations","volume":"7","author":"A Pinter","year":"1992","journal-title":"Pediatr Surg Int"}],"container-title":["European Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2680-6011.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T23:37:23Z","timestamp":1772840243000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2680-6011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":19,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,3,6]]},"published-print":{"date-parts":[[2026,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2680-6011","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0939-7248","1439-359X"],"issn-type":[{"value":"0939-7248","type":"print"},{"value":"1439-359X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8,12]]},"published":{"date-parts":[[2025,8,12]]}}}