Claiming “New” in What Might be an Inadequate Search

Correspondence To the Editor: We have read with interest the article entitled " New classification of Herlyn–Werner–Wunderlich syndrome (HWWS) " by Zhu et al. and we want to clarify a few points. Such syndrome, although often reported as such in the literature, does not exist. Herlyn–Werner syndrome in their original description is a unilateral renal aplasia, with double uterus and blind vagina presenting as Gartner's pseudocyst. In the Wunderlich syndrome, the blind hemivagina is developed and filled with a large hematocolpos. The symptoms and management of these entities are different. It is true that the exact etiology of such anomalies is still unknown, but it has been established that they have their origin in a mesonephric (Wolffian duct) anomaly. The mesonephric anomaly with the absence of the Wolffian duct opening into the urogenital sinus and therefore of the ureteral bud sprouting, justifies the blind vagina and unilateral renal agenesis. The uterine anomaly (didelphys, bicornuate, and rarely, septate uterus) is due to the absence of the " inducting " function of the injured mesonephric duct on the Müllerian duct, being thus a consequence. We published in 2010, a large institutional series of 60 patients with unilateral renal agenesis focusing on the gynecological associated pathologies, [3] which the authors do not seem to have found in their search, maybe due to the incorrect use of MeSH terms. Most important, we published in 2004 [4] and updated in 2011, [5] a female genital tract malformations classification which included the claimed " New classification of HWWS " and that the authors seem neither to have found. We there proposed a subdivision for the mesonephric anomalies presenting with: (a) Large hematocolpos in a blind hemivagina (Wunderlich syndrome); (b) Gartner's pseudocyst in the anterolateral wall of the permeable vagina (frequently as a Herlyn–Werner syndrome); (c) partial reabsorption of the intervaginal septum; and (d) complete unilateral vaginal or cervico‑vaginal agenesis with or without communication between both hemiuteri. Finally, we recommend the authors to review their Figure 4 [1] which is incorrectly drawn. If there is a communication between hemiuteri, this will be located at the inferior uterine segment of both hemiuteri. This also has an embryological explanation: It is the closest portion between both Müller ducts and the point where the fusion and reabsorption processes between both start before simultaneously proceed cranially and caudally. To dear Dr. Maribel Acién and Pedro Acién: Thank you for your comments …