Robert's uterus unveiled: a comprehensive exploration of four cases and literature reviews.

Abstract

Background: Robert's uterus is an exceptionally rare obstructive Müllerian anomaly characterized by an asymmetric septate uterus with a non-communicating hemi-cavity. It typically presents with dysmenorrhea and infertility, and its early diagnosis is crucial for optimizing reproductive outcomes. Here we present the case series to document the diverse external morphology (normal vs. saddle-shaped) and propose a structured diagnostic pathway for Robert's uterus.

Case description: This retrospective case series (June 2020-June 2023) describes four patients with a postoperative diagnosis of Robert's uterus. The median age was 25 years. Three patients presented with severe dysmenorrhea, while all four presented with primary infertility. Preoperative imaging was suggestive but not always definitive; magnetic resonance imaging (MRI) confirmed the diagnosis in two cases. A notable finding was the variable external uterine contour observed during laparoscopy, ranging from normal to saddle-shaped. All patients underwent combined hysteroscopic-laparoscopic metroplasty. Postoperatively, dysmenorrhea resolved completely in all symptomatic patients. At the 6-12-month follow-up, no anatomical recurrence was observed, and one patient achieved a spontaneous pregnancy.

Conclusions: Robert's uterus is a diagnostically challenging condition that requires a high index of suspicion. MRI is the preferred tool for definitive preoperative characterization. Combined hysteroscopic-laparoscopic metroplasty is an effective treatment that relieves symptoms and can restore reproductive potential. This series highlights the phenotypic variability of the condition and underscores the importance of a structured diagnostic pathway for patients with severe dysmenorrhea and infertility.