Urogenital vascular anomalies in female patients: diagnostic challenges and modern views on treatment

Localization of vascular anomalies (VA) in the urogenital region of girls is rare but clinically significant, as it may cause pain, swelling, bleeding, hygiene difficulties, as well as fertility disorders and psychological problems. Aim - to analyze the clinical course, visualization methods, and treatment of urogenital VA in girls in order to optimize diagnostic approaches and improve treatment outcomes. Materials and methods. A retrospective single-center study included 171 case histories of patients under 18 years (2015-2023). Parameters assessed: type and localization of VA, imaging data (ultrasound, magnetic resonance imaging - MRI), clinical manifestations, and treatment results. Statistical analysis was performed using R-statistics v.4.2.2; Pearson’s χ² test was applied, with p<0.05 considered significant. Results. Vascular tumors were diagnosed in 16 (9.4%) out of patients, of whom 9 (56.3%) had infantile hemangiomas of the urogenital area complicated by ulceration. Systemic β-blocker therapy was effective in all cases. Urogenital vascular malformations (VM) were diagnosed in 17 (25.4%) girls: 5 (29.4%) isolated and 12 (70.6%) extended. Excellent outcomes were achieved after radical excision (n=1), local sclerotherapy (n=2), and combined treatment (n=1). Good results were observed in 9 (52.9%) patients after staged or combined interventions, including sclerotherapy with mTOR inhibitors (n=5). A statistically significant difference in treatment efficacy was revealed depending on anomaly type (χ²=8.56; p=0.0034). Conclusions. Isolated urogenital VM account for 29.4%, which justifies MRI of the pelvis and lower extremities to assess lesion extent. When radical excision is not feasible, sclerotherapy alone or in combination with mTOR inhibitors is effective, leading to lesion reduction, pain relief, cessation of lymphorrhea, and improvement of patients’ quality of life. This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committee of the institution. Informed consent was obtained from all patients (parents or legal guardians). The authors declare no conflict of interest.