Robert's Uterus - Symptoms and Treatment

Introduction

Development of the baby in the mother's womb occurs in a place called the uterus. It is a pear-shaped, hollow organ. Any abnormality occurring in the uterus can alter a woman's critical phase of life, which is giving birth to a child. One such rarest abnormality is Roberts's uterus, which may or may not hamper a woman's reproductive potential. It can present with usual abdominal or heavy pain during menstrual cycles. This condition can be diagnosed with the help of digital imaging techniques, and surgical procedures are carried out to achieve the success of the treatment.

What Is Robert's Uterus?

Roberts's uterus is also termed an asymmetric septate uterus or obstructive septate uterus. It is a rare condition that can occur as a rare Mullerian duct anomaly. The Mullerian duct is a part of the female reproductive system that provides a place for fertilization (fusion of sperm and egg), embryo implantation, and fetus development. Rather than categorizing it as a defect, it can be stated as an anomaly of the uterus and a variant of the septate uterus.

The uterus usually is divided by a uterine septum which is generally fused on one side of the uterine wall and complete. It is divided into asymmetric hemi cavities, one which is communicating and non communicating to the cervix.

What Are the Clinical Manifestations of Robert’s Uterus?

Following are the clinical findings of Roberts's uterus:

• Pain during the menstrual cycle is heavy, which is termed dysmenorrhea.

• Menstrual flow can be normal or increased.

• Recurrent and short-term abdominal pain.

• Pain that is not relieved after the menstrual cycle.

How Is Robert's Uterus Diagnosed?

Following are the diagnostic methods for diagnosing the Robert's uterus:

• Three-Dimensional Ultrasonography: 3D ultrasonography is used to determine the shape abnormalities of the uterus and evaluation of polyps, fibroids, and adhesions in the uterus.

• Magnetic Resonance Imaging: MRI can very well characterize the Roberts uterus and show the presence of hamartomas and endometriomas, which can develop as complications to this condition.

• Imaging Findings: The septum is present that divides the uterus. Examining the uterine cavity, it is shown that internally it is asymmetrical, and the septum is obstructed on one side. The external part of the uterus is normal. Division of the uterus by a fibrous bridge of myometrium is seen in which the septum is less vascularized when compared to the other structures.

• Hysteroscopy: It shows the presence of complete septa covering the half cavity of the uterus.

• Laparoscopy: The condition of the ovaries is examined, and any rudimentary ovaries or tubes are detected. Endometriosis can be observed.

What Is the Management Modality for Robert's Uterus?

It is essential to obtain a perfect diagnosis before starting any treatment. Differentiating the rudimentary uterine horn from Roberts's uterus, which can appear similar, forms a crucial role.

Roberts's uterus is effectively managed with the help of surgery.

• Laparotomy - It can be performed to remove the defective tissue after diagnosis or used as a diagnostic procedure.

• Total Resection of the Horn - Surgical procedure where the rudimentary part of the uterus (horns) are resected completely.

• Hysteroscopic Metroplasty - It is a procedure in which the uterine septum is incised, and the cavity is unified.

• Hysteroscopy Along With Laparoscopy - Hysteroscopy is a procedure performed to visualize and identify uterine defects. Laparoscopy is a minimally invasive procedure that gives access to the internal structures to remove the defect without making a more significant incision. These surgeries were performed to change and provide sufficient uterine cavity, volume, and shape. The recurrence of hematometra can also be prevented. There have been cases where a healthy baby was successfully born following surgery to treat Roberts uterus..

• Progestin Therapy - It is a treatment that can be used as a hormone replacement therapy.

• Hysteroscopic Septal Resection - Removal of the intervening septa is carried out. When the septa are challenging to resect, removal of the other half is done.

• Hysterotomy and Ipsilateral Tube Ligation - Hysterotomy (removal of the uterus) was done, along with ligation of the ipsilateral tube is performed. It is done in cases where the patient was pregnant with Roberts's uterus.

What Are the Complications of Robert's Uterus?

Following are the complications of Roberts's uterus:

• Hematometra - A condition in which blood is retained or collected in the uterus. Symptoms usually include lower abdominal pain, cramping, and spotting of dark brown blood. In a few cases, it can also be asymptomatic. Clinical and imaging findings are correlated, and the proper diagnosis is made. Treatment aims at providing symptomatic relief as well as removing the cause.

• Adnexal Mass - An overgrowth or lump of tissue near the fallopian tube or ovary. Adnexal masses can show pelvic pain, bloating, irregular periods, constipation, and bleeding at the site where the mass is present. These can be diagnosed with clinical findings and ultrasound.

• Hematosalpinx - A condition related to the female reproductive system where there is bleeding into the fallopian tube. An ultrasound procedure can also diagnose it and causes abdominal pain, fever, uterine bleeding, and vaginal spotting. Consulting a physician at the onset of the symptoms is essential as this condition is life-threatening.

• Endometriosis - Abnormal growth of a uterus wall outside the uterine cavity is called endometriosis. It is a painful condition that can even lead to problems in fertility. Pain medication, hormone therapy, and surgical treatments, including treatments to improve fertility or even removal of the uterus, are also done to treat the condition.

Conclusion:

Robert's uterus is a rare anomaly due to the unequal irregular division of the uterus. Though the symptoms can be as common as the pain, it can lead to complications, as the article explains, requiring enough care. Laparoscopy is a diagnostic as well as therapeutic procedure that is done as per the surgeon's treatment plan. Before beginning any treatment, a precise diagnosis must be made. It is essential to distinguish the primitive uterine horn from Roberts' uterus since they can seem similar. Surgery is used to manage Roberts' uterus successfully. Diagnosing the condition with the imaging technique correctly and correlating the same with the clinical findings can help the physician decide the best treatment plan for a more positive outcome.