Vaginal Myomectomy for Prolapsed Submucous Fibroid: It is Not Only About Size

Background: Hysteroscopy an endoscopic procedure for visualization of uterine cavity may be extensively used in both primary and secondary infertility and abnormal uterine bleeding for evaluating intrauterine pathology. The objectives of this study were to visualize and identity intrauterine pathology in both primary and secondary infertility and abnormal uterine bleeding (AUB) by hysteroscopic evaluation and to perform hysteroscopic guided therapeutic procedures like endometrial currettage, polypectomy, adhesiolysis.Methods: Hysteroscopic evaluation of uterine cavity for any intrauterine pathology in AUB and Infertility. Adhesiolysis, polypectomy, endometrial biopsy misplaced copper T removal were carried out under hysteroscopic vision.Results: Intrauterine synechia in 20.51%, Submucous fibroid in 5.13%, bicornuate uterus, endometrial hyperplasia and endometrial polyp were seen in 2.56% patient each were detected in infertility group while 81.95% cases with AUB had abnormal intrauterine pathology commonest being endometrial hyperplasia in 33.33% followed by endometrial polyps in 23.81% cases, submucous fibroid and misplaced copper T in 9.52% each and intrauterine synechia in 4.76% patient. Endometrial biopsy and polypectomy was done in 23.80% each with AUB, misplaced copper T removal in 9.52% and adhesiolysis in 4.76% patient with AUB.Conclusions: Hysteroscopy remains gold standard for evaluating intrauterine lesions in abnormal uterine bleeding and infertility. A safe, simple minimally invasive procedure not only diagnostic but therapeutic modality for adhesiolysis, endometrial biopsy/curettage, polypectomy, misplaced copper T removal under direct vision with minimal complication within reach of every Gynaecologist thereby reducing burden of major surgical intervention.

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Uterine submucosal leiomyomas: modern diagnosis and miniinvasive surgery

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/6.2.2 ◽

2021 ◽

Vol 6 (2) ◽

pp. 88-93

Author(s):

Oana Denisa Balalau ◽

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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.

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Towards uterine inversion: Illustration of a gradual process through three cases of submucous myoma

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v1i2.2398 ◽

1970 ◽

Vol 1 (2) ◽

pp. 51-54

Author(s):

Kesang D Bista ◽

Ashma Rana ◽

Geeta Gurung ◽

Neelam Pradhan ◽

Archana Amatya

Keyword(s):

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Menopausal Woman ◽

Post Menopausal Woman ◽

Submucous Myoma ◽

Uterine Inversion ◽

Gradual Process ◽

Post Menopausal ◽

Uterine Fundus ◽

Vaginal Myomectomy

How the largest of the large (> 10 x 8 cms) sub mucous myoma arising from the fundus uteri successively promotes the occurrence of non puerperal uterine inversion over the years as depicted through 3 different illustrations imitating a gradual process; first by forming an indentation in the uterine fundus then progressively causing more dimpling in the verge of uterine inversion until finally giving rise to a full blown picture of complete uterine inversion where the uterine fundus is driven beyond the level of introitus with the consequences of prolapsed incarcerated myoma in a post menopausal woman. A total abdominal hysterectomy and bilateral salpingoophorectomy were performed on all of these 3 women 2 perimenopausal and a postmenopausal; the latter was first facilitated by vaginal myomectomy further supplemented by division of the inversion ring posteriorly as described by Haultain. Key words: Non puerperal uterine inversion, submucous fundal myoma, vaginal myomectomy. doi:10.3126/njog.v1i2.2398 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 51-54 Nov-Dec 2006

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Evaluation of the diagnostic accuracy of transvaginal sonography versus hysteroscopy in detection of submucous myomas in peri and postmenopausal women with abnormal uterine bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213856 ◽

2021 ◽

Vol 10 (10) ◽

pp. 3885

Author(s):

Kushla Pathania ◽

Surbhi Sharma

Keyword(s):

Diagnostic Accuracy ◽

Postmenopausal Women ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Transvaginal Sonography ◽

Cross Sectional ◽

Predictive Values ◽

Menopausal Women ◽

Submucous Fibroid ◽

Post Menopausal

Background: Abnormal uterine bleeding is a very common gynaecological condition that affects all age groups. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation. Aim was to evaluate the diagnostic accuracy of transvaginal sonography versus hysteroscopy in detection of submucous myomas in peri and postmenopausal women with abnormal uterine bleeding.Methods: The present study was prospective cross sectional study conducted in the Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child Indira Gandhi Medical College Shimla for period of one year w.e.f. 1st May 2018 to 30th April 2019. The study was started after hospital ethical committee approval. 76 patients peri and post-menopausal women were enrolled in the study after taking written consent.Results: On TVS- all the study subjects underwent TVS examination, submucous fibroid was detected in 10 subjects (n= 76) i.e. 13.1% (all perimenopausal). On hysteroscopy submucous fibroid was detected in 11 (14.4%) subjects, on histopathology it was confirmed in 11 subjects (14.4%). Out of 11, 8 patients underwent hysterectomy, 1 myomectomy, 2 patients had hysteroscopic removal of fibroid. 1 subject with AUB-LSM was wrongly diagnosed as AUB-P. Sensitivity, specificity, positive and negative predictive values of transvaginal sonography versus hysteroscopy was 90.09%, 100%, 100%, 98.5% respectively.Conclusions: TVS is an important initial modality for evaluating the patient of AUB. It is quick, simple, painless, least invasive, less expensive and readily available procedure and does not need full bladder like TAS. On the other hand, hysteroscopy has a better diagnostic accuracy as it provides the option of see and treat which is recommended for peri and post-menopausal women with AUB.

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