Uterine submucosal leiomyomas: modern diagnosis and miniinvasive surgery

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.

Hysteroscopy as a Primary Tool in Exploration and Treatment of Infertility: Single Center Experience in Western Romania

(1) Background: Infertility is a disease that affects millions of individuals worldwide. Intrauterine lesions are common in infertile women, hysteroscopy being considered the gold standard for assessing them, even if in routine clinical practice indirect imaging techniques are the first-line investigative tools. The aim of the study was to evaluate hysteroscopic findings among women with unexplained infertility and to analyze fertility outcomes after operative hysteroscopy; (2) Methods: a retrospective cohort study was conducted among 198 women with infertility that had undergone hysteroscopy as the first step of their infertility workup. (3) Results: The median age of the participants was 34 years, 67.7% of them being diagnosed with primary infertility. The most common abnormalities were endometrial polyps, uterine synechiae and uterine fibroids. In addition, pregnancy rates were 23.1% after hysteroscopic polypectomy, 11.1% after hysteroscopic myomectomy and 23.8% after uterine synechiae resection; (4) Conclusions: Endometrial polyps were the most common uterine abnormality found in women with infertility. Hysteroscopic interventions appeared to increase pregnancy rates and outcomes among these women.

Hysteroscopic Myomectomy for Submucosal Myoma: Literature Review

Uterine myomas are usually asymptomatic, although, most women with submucous myoma have severe symptom including abnormal uterine bleeding and infertility. Hysteroscopic myomectomy is a minimally invasive surgery and is a key benefit to patient care. Patient with submucous myoma no longer requires hysterotomy. Hysteroscopic myomectomy became the gold standard treatment in women who desire to preserve fertility. Complete removal of myoma in one-step procedure should be considered. Pre-operative optimization with cervical ripening agents including osmotic dilators such as laminaria tents and prostaglandin such as misoprostol and dinoprostone is important and decrease the risk of cervical trauma as well as uterine perforation. During the procedure, low viscosity isotonic conductive media such as normal saline are recommended to use with bipolar resectoscope and mechanical morcellator, and fluid deficit should be closely monitored at a minimum of 10-minute intervals. Resectoscope is usually used with slicing technique for resection of myoma. Morcellator can be used as it is easy to use, reduces risk of perforation, and reduces non-electrical currents. However, there is a limited utility in type 2 myoma. In addition, hyaluronic acid and polyethylene oxidesodium carboxymethylcellulose gel may reduce intrauterine adhesion after hysteroscopic myomectomy. Keywords: Hysteroscopy; Morcellation; Myoma; Uterine myomectomy