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Herlyn-Werner-Wunderlich syndrome: Challenges in diagnosis and management Roziana, Roziana; Nora, Hilwah; Maharani, Cut R.; Yeni, Cut M.; Dewi, Tengku P.; Rusnaidi, Rusnaidi; Indirayani, Ima; Aditya, Rizka; Al-shather, Zain; Haryani, Siti D.
Narra J Vol. 3 No. 2 (2023): August 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i2.223

Abstract

Herlyn-Werner-Wunderlich syndrome (HWWS), also known as OHVIRA syndrome (obstructed hemivagina and ipsilateral renal anomaly) is a complex congenital malformation characterized by a triad including uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis. In this case report, we present a case of HWWS along with the challenges in diagnosis and multi-step treatment processes. A 25-year-old woman presented to Dr. Zainoel Abidin Hospital in Banda Aceh, Indonesia with a chief complaint of lower back pain for the past six months (two months after the marriage). The patient also complained of late menstruation, followed by thick yellow vaginal discharge resembling malodorous pus occurring after menstruation. Additionally, a history of fever and pain during intercourse was reported. Vaginal examination revealed purulent fluid emerging from a pinpoint hole on the right vaginal wall. Vaginal palpation revealed a two-branched uterus, along with a palpable cystic mass on the right vaginal wall. Ultrasound examination indicated the presence of the right and left hemi-uteri, measuring 4.7x1.35 cm and 5.7x1.26 cm in size, respectively with both ovaries appearing normal. Fluid accumulation was observed in the right hemivagina, while the left kidney exhibited normal features, and the right kidney showed signs of hypoplasia. The patient was diagnosed with uterus didelphys, fluid accumulation in the hemivagina, and right kidney hypoplasia. Magnetic resonance imaging (MRI) confirmed uterus didelphys and revealed narrowing of the right hemivagina, suggestive of HWWS. Hysteroscopy was performed to resect the vaginal septum with laparoscopic guidance, along with drainage of hematocolpos, pyocolpos and placement of an intracervical mold. Despite HWWs having conservative gradual management, it was opted to perform vaginal septum resection, hematocolpos and pyocolpos drainage and placement of an intracervical mould in this case, in order to relieve symptoms and restore the reproductive and sexual functions.
Evaluating serum cyclooxygenase-2 and vascular endothelial growth factor as biomarkers for endometriosis severity in reproductive-age women Aslam, Aga; Rajuddin, Rajuddin; Munizar, Munizar; Rusnaidi, Rusnaidi; Hasanuddin, Hasanuddin
Narra J Vol. 6 No. 1 (2026): January 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.2984

Abstract

Endometriosis affects approximately 10–15% of reproductive-age women and up to 70% of those with chronic pelvic pain, with diagnosis typically relying on invasive laparoscopy with histopathological confirmation. Cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) are central mediators of the inflammatory and angiogenic pathways underpinning endometriosis pathogenesis, making them promising candidates for non-invasive biomarkers. This study aimed to analyze the correlation between serum COX-2 and VEGF concentrations and endometriosis severity to evaluate their potential utility as non-invasive biomarkers. A cross-sectional study was conducted among women with confirmed endometriosis at Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia, in 2025. Peripheral blood samples were collected preoperatively, and serum COX-2 and VEGF concentrations were quantified using ELISA. Endometriosis severity was classified according to the American Society for Reproductive Medicine staging system. Correlation analyses were performed to assess associations between biomarker levels and disease stage, and diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC) values, optimal cut-off points, sensitivity, and specificity. Twenty-eight patients were included, with the mean COX-2 and VEGF levels being 1.16±1.28 ng/mL and 266.50±72.91 pg/mL, respectively. VEGF demonstrated a strong and statistically significant correlation with endometriosis staging (r=0.744, p<0.001), while COX-2 showed a limited correlation that did not reach statistical significance (r=0.367, p=0.055). The ROC analysis further highlighted VEGF’s superior diagnostic performance, with an AUC of 0.975 (95%CI: 0.926–1.000, p<0.001) compared with COX-2 (AUC 0.734; 95%CI: 0.518–0.950, p=0.057). The optimal VEGF threshold of 221 pg/mL yielded 90% sensitivity and 100% specificity, whereas the COX-2 threshold of 0.675 ng/mL provided 80% sensitivity and 62.5% specificity. These findings indicate that VEGF is a highly promising non-invasive biomarker for assessing endometriosis severity and may support the development of improved diagnostic approaches for endometriosis management.
Associations of VEGF and CA125 with disease stage and pain among women with endometriosis: A cross-sectional study in Indonesia Sujudi, Akmal; Rusnaidi, Rusnaidi; Rajuddin, Rajuddin; Septivera, Yusra
Narra J Vol. 6 No. 1 (2026): January 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3013

Abstract

Endometriosis is a chronic gynecological disease characterized by the presence of endometrial tissue outside the uterine cavity, affecting approximately 10% of women of reproductive age. Vascular endothelial growth factor (VEGF) and cancer antigen 125 (CA125) have been proposed as potential biomarkers in endometriosis; however, evidence regarding their association with disease stage and pain severity remains limited, particularly in the Indonesian population. The aim of this study was to evaluate the relationship between peritoneal fluid VEGF and serum CA125 levels with endometriosis stage and pain severity. A cross-sectional study was conducted involving patients with surgically and histopathologically confirmed endometriosis who underwent laparoscopy or laparotomy at Dr. Zainoel Abidin Hospital, Banda Aceh, between February and July 2025. Peritoneal fluid VEGF and serum CA125 levels were measured using enzyme-linked immunosorbent assay and chemiluminescence immunoassay, respectively. Endometriosis stage was classified according to the revised American Society for Reproductive Medicine (rASRM) criteria, and pain severity was assessed using the Numeric Rating Scale. Statistical analyses included Spearman’s correlation and receiver operating characteristic (ROC) curve analysis. Our data suggested no significant correlation between VEGF levels and endometriosis stage (r=0.042; p=0.813). Peritoneal fluid VEGF levels showed a moderate positive correlation with pain severity (r=0.505; p<0.05), and ROC analysis identified an optimal cut-off value of 39.45 pg/mL, with a sensitivity of 73.68% and specificity of 73.33% for distinguishing severe pain from mild-to-moderate pain. Serum CA125 levels demonstrated a significant positive correlation with endometriosis stage (r=0.422; p=0.013), and ROC analysis yielded an optimal cut-off value of 32.45 U/mL, with a sensitivity of 86.95% and a specificity of 63.64% for distinguishing stage IV endometriosis from lower stages. No significant correlation was observed between CA125 levels and pain severity (r=0.186; p=0.292). This study represents the first report from Indonesia to simultaneously evaluate peritoneal fluid VEGF and serum CA125 in relation to endometriosis stage and pain severity. This study highlights that CA125 is primarily associated with endometriosis stage, whereas VEGF is more closely related to pain severity, supporting their complementary roles in endometriosis assessment.
Co-Authors Adinda, Okta Aditya, Rizka Ajeng Savitri, Dini Al-shather, Zain Anam, Budi Safatul Aslam, Aga Assyifa, Shofiya Chaira Mauli Usrina Cut M. Yeni Desy Purnamasari Dewi, Tengku P. Haryani, Siti D. Hasanuddin Hasanuddin Hilwah Nora Indirayani, Ima Irmawati Irmawati Ismail, Taufik Suryadi Khaira, Fathul Lintang, Muhammad M.J, Ermad Maharani, Cut R. Mj, Ermad Muknisa, Liza Munizar Munizar, Munizar Nainggolan, Sarah Ika Nainggolan Nurfadhilla, Nurfadhilla Okta Adinda Prety, Annisa Rajuddin Rajuddin Rizki Munazar Roziana Roziana, Roziana Saputra, Dian Andra Septivera, Yusra Siska Azizah Solly Aryza Sujudi, Akmal Suraiya Husna Syamsidar Syamsidar syamsidar syamsidar Tarmizi Gadeng Tarmizi Gadeng Wulan Dari Zulkifli Umar ZURAIDAH ZURAIDAH