scholarly journals Uterine submucosal leiomyomas: modern diagnosis and miniinvasive surgery

2021 ◽  
Vol 6 (2) ◽  
pp. 88-93
Author(s):  
Oana Denisa Balalau ◽  
◽  
Mihai-George Loghin ◽  
Sabin Vasilache ◽  
Octavian Gabriel Olaru ◽  
...  
Keyword(s):  
Recovery Time ◽  
Uterine Fibroids ◽  
Therapeutic Decision ◽  
Common Complication ◽  
Hysteroscopic Myomectomy ◽  
Abdominal Myomectomy ◽  
Pelvic Tumors ◽  
Submucosal Fibroids ◽  
Miniinvasive Surgery ◽  
Vaginal Myomectomy

Uterine leiomyomatosis is one of the most common benign pelvic tumors diagnosed in women aged 25-44 years. Clinically, it is manifested by vaginal bleeding, pelvic pain, infertility, digestive and urinary symptoms. The diagnosis of uterine fibroids requires careful clinical and paraclinical evaluation. Based on these data, the therapeutic decision is conducted in most cases. The treatment of uterine leiomyomatosis involves several procedures, such as: total abdominal hystectomy, total vaginal hystectomy, abdominal myomectomy, vaginal, laparoscopic or hysteroscopic myomectomy. Hysteroscopic myomectomy is currently the preferred procedure for submucosal fibroids. It has multiple advantages: shorter recovery time, reduced pain related to movements, shorter duration procedure and fewer risks. The procedure has few contraindications. The most common complication is recurrence. The treatment of choice for prolapsed pedunculated submucous leiomyoma is vaginal myomectomy. As described, the procedure has multiple advantages and generally has a low recurrence rate.

scholarly journals Fibroids and Infertility

2021 ◽  
Author(s):  
Juan Luis Giraldo Moreno ◽  
Susana Salazar López
Keyword(s):  
Negative Impact ◽  
Embryo Implantation ◽  
Uterine Fibroids ◽  
Abnormal Uterine Bleeding ◽  
Open Approach ◽  
Pelvic Tumors ◽  
Increased Risk ◽  
Submucosal Fibroids ◽  
Intramural Fibroids

Uterine fibroids (also known as leiomyomas or myomas) are the most common pelvic tumors, affecting more than 70% of women over 70 years of age and although most are asymptomatic, some women may experience symptoms, depending on their location and size, which can alter your quality of life, such as abnormal uterine bleeding, anemia, pelvic pain and pressure, dyspareunia, increased urinary frequency and constipation. Its relationship with infertility has been controversial and, although insignificant for subserous fibroids, it appears that submucosal and intramural fibroids that distort the endometrial cavity can affect embryo implantation and are associated with an increased risk of early pregnancy loss. Its treatment will depend on the patient’s symptoms, size, location, whether it is one or multiple, and whether or not she suffers from infertility. It is clear that submucosal fibroids have a negative impact on fertility and with respect to intramural fibroids it is known that fibroids larger than 4 cm alter the probability of pregnancy, however there are studies that show that even smaller or multiple fibroids could affect pregnancy rates. There are multiple options for the treatment of fibroids; however, patients who are candidates for expectant, medical or surgical management should be individualized, and especially if they are going to be taken to surgery, an excellent mapping of fibroids prior to surgical intervention is recommended. Minimally invasive surgery continues to be the approach of choice, it should be left for the open approach in cases in which Laparoscopy is contraindicated or the patient with multiple myomatosis.

scholarly journals Large cervical fibroid: a rare case report

2019 ◽  
Vol 8 (8) ◽  
pp. 3414
Author(s):  
Sunanda N.
Keyword(s):  
Uterine Fibroids ◽  
Total Abdominal Hysterectomy ◽  
Large Mass ◽  
Abdominal Hysterectomy ◽  
Reproductive Age ◽  
Pelvic Tumors ◽  
Rare Case Report ◽  
Tender Mass ◽  
Restricted Mobility ◽  
Reproductive Age Group

Although leiomyomas are the most common pelvic tumors presenting in the reproductive age group, cervical fibroids are rare accounting for 2% of all uterine fibroids. We report a case of 40 year old lady presenting with a firm, non-tender mass of 22-24 weeks size pregnant uterus with restricted mobility. Laparotomy showed a large mass arising from the anterior lip of cervix, with a small uterus pushed posteriorly. Enucleation followed by total abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases. 

scholarly journals Intrauterine Adhesions following Conservative Treatment of Uterine Fibroids

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Pietro Gambadauro ◽  
Johannes Gudmundsson ◽  
Rafael Torrejón
Keyword(s):  
Conservative Treatment ◽  
Current Knowledge ◽  
Uterine Fibroids ◽  
Reproductive Age ◽  
Surgical Trauma ◽  
Tumor Removal ◽  
Intrauterine Adhesions ◽  
Hysteroscopic Myomectomy ◽  
Uterine Arteries ◽  
Diagnostic Pitfalls

Uterine fibroids are common in women of reproductive age and various conservative treatments are available. In order to achieve a successful conservative treatment of fibroids, functional integrity of the uterus is as important as tumor removal or symptoms relief. In this context, intrauterine adhesions must be recognized as a possible complication of conservative management of uterine fibroids, but diagnostic pitfalls might justify an underestimation of their incidence. Hysteroscopic myomectomy can cause adhesions as a result of surgical trauma to the endometrium. The average reported incidence is around 10% at second-look hysteroscopy, but it is higher in certain conditions, such as the case of multiple, apposing fibroids. Transmural myomectomies also have the potential for adhesion, especially when combined with uterine ischemia. Uterine arteries embolization also carries a risk of intracavitary adhesions. Prevention strategies including bipolar resection, barrier gel or postoperative estradiol, might be useful, but stronger evidence is needed. In view of current knowledge, we would recommend a prevention strategy based on a combination of surgical trauma minimization and identification of high-risk cases. Early hysteroscopic diagnosis and lysis possibly represents the best means of secondary prevention and treatment of postoperative intrauterine adhesions.

scholarly journals Delayed presentation of giant uterine fibroids in a Nigerian private specialist health facility

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110631
Author(s):  
Joseph Ifeanyichukwu Ikechebelu ◽  
Boniface Chukwuneme Okpala ◽  
George Uchenna Eleje ◽  
Cyril Emeka Nwachukwu ◽  
Louis Anayo Nwajiaku ◽  
...  
Keyword(s):  
Low Income ◽  
Uterine Fibroids ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Low Income Countries ◽  
Delayed Presentation ◽  
Abdominal Drain ◽  
Abdominal Myomectomy ◽  
Major Operation ◽  
Private Specialist

Giant uterine fibroids (leiomyoma or myomas) which are fibroid masses greater than 11.4 kg are very rare. Although benign in nature, it may present with symptoms that impact negatively on the quality of life and health of the patient and impose greater management challenges. We present two cases of giant uterine fibroids that were successfully managed in a private specialist hospital without complications. Case 1 was a 38-year-old nulliparous Nigerian woman who presented with giant uterine fibroids (11.6 kg) who initially had delay of surgery due to fear that after surgery she may lose her “womb” or not be able to conceive after the operation. Later, she had successful open abdominal myomectomy, with the use of Foley catheters as improvise equipment for tourniquet and abdominal drain. Anti-adhesion agent was not used. Case 2 was a 47-year-old nulliparous Nigerian teacher with giant fibroids (13.2 kg) who also initially had delayed surgery due to fear that fibroid surgery is a major operation that it may get complicated and she may die. Also, she was afraid that she may not have her womb in her next world if she gets reincarnated. She had total abdominal hysterectomy and bilateral salpingo-oophorectomy without complications. For both cases, pre-surgery leiomyosarcoma assessment with computed tomography scan or magnetic resonance imaging and anti-adhesion agent were not used due to very unaffordable high costs. These reports of giant uterine fibroids (leiomyoma or myomas) are very rare gynecological entity, and management can be successful despite overwhelming challenges in low-income countries. Cheaper, affordable and available alternatives (improvises) can be resorted to for tackling its challenges in low-income settings.

scholarly journals Complications of Uterine Fibroids and Their Management, Surgical Management of Fibroids, Laparoscopy and Hysteroscopy versus Hysterectomy, Haemorrhage, Adhesions, and Complications

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Liselotte Mettler ◽  
Thoralf Schollmeyer ◽  
Andrea Tinelli ◽  
Antonio Malvasi ◽  
Ibrahim Alkatout
Keyword(s):  
Surgical Treatment ◽  
Surgical Management ◽  
Critical Analysis ◽  
Severe Pain ◽  
Uterine Fibroids ◽  
Statistical Analyses ◽  
Hysteroscopic Myomectomy

A critical analysis of the surgical treatment of fibroids compares all available techniques of myomectomy. Different statistical analyses reveal the advantages of the laparoscopic and hysteroscopic approach. Complications can arise from the location of the fibroids. They range from intermittent bleedings to continuous bleedings over several weeks, from single pain episodes to severe pain, from dysuria and constipation to chronic bladder and bowel spasms. Very seldom does peritonitis occur. Infertility may result from continuous metro and menorrhagia. The difficulty of the laparoscopic and hysteroscopic myomectomy lies in achieving satisfactory haemostasis using the appropriate sutures. The hysteroscopic myomectomy requires an operative hysteroscope and a well-experienced gynaecologic surgeon.

scholarly journals Ultrasound assessment of the uterine wall after hysteroscopic myomectomy of submucous uterine fibroids

2020 ◽  
Vol 19 (4) ◽  
pp. 5-21
Author(s):  
I.А. Esipova ◽  
◽  
L.M. Kappusheva ◽  
V.G. Breusenko ◽  
D.M. Lyafisheva ◽  
...  
Keyword(s):  
Uterine Fibroid ◽  
Surgical Navigation ◽  
Uterine Fibroids ◽  
Intraoperative Ultrasound ◽  
Precise Determination ◽  
The State ◽  
Reproductive Age ◽  
New Technique ◽  
Hysteroscopic Myomectomy ◽  
A New Technique

Objective. To study the state of the myometrium and the endometrium after hysteroscopic myomectomy of uterine fibroid using 2D/3D transvaginal echography in patients of reproductive age. Patients and methods. We examined 90 patients of reproductive age with submucous uterine fibroid, who underwent 117 one-, two- or three-step hysteroscopic resections performed with a new technique of transcervical myomectomy. 3D transvaginal echography was performed in all patients with target assessment of the fibroid type and the intended resection site, and also with subsequent assessment of its changes. Results. A new technique of fibroid resection with rigid loops was elaborated. New options for noninvasive 3D-US in preoperative diagnosis of uterine fibroids have been determined. Owing to 3D-US, the state of the endometrium, myometrium at the «resection site» were studied for the first time. Indications for one-, two- and tree-step resections have been specified. Conclusion. 3D transvaginal echography at the stage of planning hysteroscopic myomectomy allows not only a more precise determination of the fibroid type, assessment of its location and size, but also prediction of the length of operative intervention, the likelihood of multi-step resection and a risk of developing postoperative complications, as well as recommendation of other surgical treatments. Intraoperative ultrasound surgical navigation was introduced, which in combination with an appropriate resection technique permits to enhance the safety of surgical procedure. Depending on the echographic image of the endometrium and myometrium at the «resection site», specific recommendations have been formulated on management of the postoperative period that can permit to prevent the formation of synechiae and to determine precise terms of possible pregnancy occurrence. Key words: infertility, hysteroscopic myomectomy, resection site, uterine fibroid, reproductive age, submucosal fibroid, ultrasound examination, 3D-US

scholarly journals A Study on the Diagnostic Abilities of Ultrasound Scans in Assessing the Uterine Fibroids Against Magnetic Resonance Imaging Findings in the Same Subject Population

2021 ◽  
Author(s):  
Bedoor Al Omran ◽  
Amal Mohamed Mehad ◽  
Simbarashe Matoi ◽  
Seemal Maqsood Abdul Qadir ◽  
Ayomide Peluola ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Uterine Fibroids ◽  
Ultrasound Scan ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Female Patients ◽  
Submucosal Fibroids ◽  
Size Type ◽  
Matching Score

Abstract Background: This study was designed to evaluate the matching percentage among findings of the ultrasound scans to the magnetic resonance imaging in women with fibroids in Bahrain.Methods: This descriptive, retrospective study was conducted from January 2016 to December 2018 including all the female patients referred from the Gynaecological Department to the Radiological Department in the Bahrain Defense Force Hospital for magnetic resonance imaging and ultrasound scan for fibroid evaluation.The data collected included their age, parity and nationality. The StatsDirect software was used to analyze the fibroids according to the site, size, type and number. Results: The average age of the recruited 205 female patients for the study was 43 years, with 81.5%as Bahraini citizens and a mean parity of 2.3. Ultrasound scan findings matched the Magnetic Resonance Imaging in the posterior fibroid sites in 52.5% of cases, followed by anterior (38.1%) and fundal (21.8%). For fibroid size, Ultrasound scans matched Magnetic Resonance Imaging findings in 83.3% for fibroids between >5 to ≤ 10 cm, in 78.3% for fibroids between >2 to ≤ 5cm, and in 36.8% for fibroids sized ≤ 2 cm. Fibroids more than 10cm in size were in agreement for 33.33% of fibroids. Submucosal fibroids matched in just 29.4% of cases, but for the subserosal fibroids, it was 44.8%. The matching score for more than 4 fibroids was 61.8%, followed by single fibroids (54.8%) and lastly for two fibroids (34.8%).Conclusions: Fibroid site and size had the highest matching rates amongst all the categories.

Results of infertility treatment using ART methods in patients who underwent myomectomy: risk factors for repeated unsuccessful ART programs

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 44-49
Author(s):  
Irena F. Kozachenko ◽  
Veronika Y. Smolnikova ◽  
Leila V. Adamyan
Keyword(s):  
Risk Factors ◽  
Uterine Fibroids ◽  
Uterine Cavity ◽  
Art Programs ◽  
Hysteroscopic Myomectomy ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Art Program ◽  
Adverse Pregnancy

Aim. To evaluate the results of treatment of patients with uterine fibroids and infertility with ineffective art programs in the anamnesis and to identify possible risk factors for repeated art failures. Materials and methods. 510 patients with uterine fibroids and infertility were examined and surgically treated prior to the ART program. Myomectomy was performed using various approaches: laparoscopic access in 250 patients, laparotomic access in 70 patients, hysteroscopic myomectomy in 100 patients, and combined access (laparoscopic and hysteroscopic) in 90 women. Results. Primary infertility was observed in 38.0%, secondary in 62.0% of patients. The average duration of infertility was 4.41.9 years. ART had in history 54.5% of patients. During the follow-up period up to 2 years, 24.3% of women had recurrent uterine fibroids. After carrying out of surgical treatment and the following ART pregnancy was achieved in 44.3% of patients. Pregnancies ended in childbirth in 58.8% of cases, which exceeded the total share (41.6%) of adverse pregnancy outcomes (ectopic pregnancy, abortions, spontaneous miscarriages at various times) by 1.4 times. Conclusion. Risk factors for repeated ART failures in patients who have undergone myomectomy are: age over 40 years; duration of infertility for more than 5 years and the presence of 3 or more ineffective IVF attempts in the history; the presence of previous surgical interventions such as uterine artery embolization and FUS-ablation; the presence of submucous fibroids, a dominant node located close to the uterine cavity and myoma with signs of blood supply disorders; the combination of uterine fibroids with external genital endometriosis and chronic endometritis.

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