Kalur et al. Appendix-Cont'd Central nervous system November 1991 Am J Obstet Gyneco1 Autopsy findings: Case 2-cont'd adherent membranes are seen. The myometrium and cervix are hemorrhagic. There are abundant partially necrotic membranes. Gram's stain reveals numerous positive cocci. Bacterial colonies are also present in the myometrium. Ovaries: Two ovaries are present. These are enlarged with hemorrhagic surface. The left ovary measures 3.5 x 1.8 x 1.9 em and the right measures 3.7 x 2.2 x 1.9 em. The cut surface shows multiple cystic spaces measuring up to 0.5 em in diameter. Brain: Not done. Renal agenesis in association with malformation of the female genital tract Pedro Acien, MD,' Jose A. Ruiz, MD,b Jose F. Hernandez, MD,b Francisco Susarte, MD,' and Angel Martin del Moral, MDc Alicante, Spain Four cases of renal agenesis with an ipsilateral blind vagina and two cases with agenesis of all organs derived from one urogenital ridge are presented. These cases confirm the association of renal agenesis with these genital malformations and support the hypothesis that the embryologic development of the vagina is derived from the fused mesonephric ducts. (AM J OSSTET GVNECOL 1991 ;165:1368-70.) Key words: Renal agenesis, genital malformations, embryology of the vagina Malformations of the female genital tract can be as- sociated with various urinary tract anomalies, but some of these anomalies are also observed in women without genital malformations. However, in cases of renal agen- esis there is always an associated genital tract malfor- mation. Detailed analysis of these malformations has allowed us to propose the hypothesis that the embry- ologic development of the vagina is derived from the wolffian ducts.' We report six new cases of renal agen- esis, four with ipsilateral blind vaginas and mullerian duplication and two with agenesis or severe hypoplasia of all organs derived from one urogenital ridge and skeletal anomalies. Table I summarizes symptoms and From the Departments of Obstetrics and Gynecology," Pathology,' and Radiology,' Elche General Hospital, and the School of Medicine," University of Alieante. Received for publication August 17, 1990; revised April 30, 1991; accepted May 8,1991. Reprint requests: P. Acibl, MD, Department of Obstetrics and Gy- necology, Facultad de Medicina, Universidad de Alicante, Campus de San Juan, Apartado de Correos 374, 03080 Alicante, Spain. 6/1/30957 some findings of the six case reports. Fig. I shows the schema of the urogenital tracts in these cases. Comment In general, all cases of unilateral blind vagina are associated with renal agenesis (or hypoplasia if there is an ectopic ureter opening into the blind vagina). On the other hand, all cases of renal agenesis are associated with blind vagina (or Gartner's pseudocyst, which is actually an atretic blind vagina) and usually miillerian duplication caused by the failure of the inductor func- tion of the mesonephric duct. 2 The exceptions to the rule of renal agenesis-blind vagina are agenesis or se- vere hypoplasia of all organs derived from the uro- genital ridge (cases 5 and 6) and some cases with partial reabsorption of the intervaginal septum, in these cases this septum is not typically present in the inferior third of the vagina. ' Renal agenesis-blind vagina association can be caused by a lesion of the mesonephric duct (with the junction of the miillerian tubercle, the origin of the vagina) which causes there to be no opening in the