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Chen R, Su Z, Yang L, Xin L, Yuan X, Wang Y. The effects and costs of laparoscopic versus abdominal myomectomy in patients with uterine fibroids: a systematic review and meta-analysis. BMC Surg 2020; 20:55. [PMID: 32192462 PMCID: PMC7083063 DOI: 10.1186/s12893-020-00703-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Abdominal myomectomy (AM) and laparoscopic myomectomy (LM) are commonly see surgery for the uterine fibroids, several randomized controlled trials (RCTs) have compared the role of AM and LM, the results remained inconsistent. Therefore, we attempted this meta-analysis to analyze the role of LM versus AM in patients with uterine fibroids. METHODS We searched PubMed et al. databases from inception date to July 31, 2019 for RCTs that compared LM versus AM in patients with uterine fibroids. Two authors independently screened the studies and extracted data from the published articles. Summary odd ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for each outcome by means of fixed- or random-effects model. RESULTS Twelve RCTs with a total of 1783 patients were identified, with 887 patients for and 897 patients for AM. Compared with AM, LM could significantly decrease the blood loss (OR = - 29.78, 95% CI -57.62- - 0.95), shorten the duration of postoperative ileus (OR = - 10.91, 95% CI -18.72- - 3.11), reduce the length of hospital stay (OR = - 1.57, 95% CI -2.05- - 1.08), but LM was associated with longer duration of operation (OR = 16.10, 95% CI 6.52-25.67) and higher medical cost (OR = 17.61, 95% CI 7.34-27.88). CONCLUSIONS LM seems to be a better choice for patients with uterine fibroids, more related studies are needed to identify the role of LM and AM for the treatment of uterine fibroids.
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Affiliation(s)
- Ruixin Chen
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Zhiying Su
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Lingling Yang
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Luping Xin
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Xiaodong Yuan
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Yanlong Wang
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China.
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Vitale SG, Ferrero S, Caruso S, Barra F, Marín-Buck A, Vilos GA, Vitagliano A, Török P, Ciebiera M, Cianci A. Ulipristal Acetate Before Hysteroscopic Myomectomy: A Systematic Review. Obstet Gynecol Surv 2020; 75:127-135. [DOI: 10.1097/ogx.0000000000000764] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Yang J, Song YJ, Na YJ, Kim HG. Two-port myomectomy using bag-contained manual morcellation: A comparison with three-port myomectomy using power morcellation. Taiwan J Obstet Gynecol 2019; 58:423-427. [PMID: 31122536 DOI: 10.1016/j.tjog.2019.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility and safety of two-port myomectomy using bag-contained manual morcellation compared to three-port myomectomy using power morcellation. MATERIAL AND METHODS A retrospective chart review was conducted for 428 cases of either two-port or three-port laparoscopic myomectomy performed by single operator in the university hospital between January 2011 and December 2016. RESULTS The cohorts of three-port myomectomy with power morcellation was consisted of two hundred and forty-eight patients. One hundred and eighty patients underwent two-port myomectomy with manual morcellation in contained bag. Two-port group showed shorter hospital stay (5.16 ± 1.39 d vs. 4.83 ± 1.19 d, p = 0.001), less estimated blood loss (61.8 ± 58.2 mL vs. 50.2 ± 52.4 mL, p = 0.001), and higher hemoglobin level at postoperative day 1 (10.7 ± 1.17 g/dL vs. 11.0 ± 1.14 g/dL, p = 0.028) with statistical significance. Morcellation time (25.8 ± 9.30 min vs. 18.9 ± 10.11 min, p = 0.001) and total operative time (82.4 ± 30.19 min vs. 76.4 ± 25.47 min, p = 0.047) were also significantly shorter in two-port group. There were no identified spillages of fibroids, ruptures of specimen bag during manual morcellation in two-port myomectomy. In both groups, there were no cases of leiomyosarcoma diagnosed postoperatively. CONCLUSION Two-port laparoscopic myomectomy with bag-contained manual morcellation is a feasible and safe alternative for three-port with power morcellation. Its surgical outcomes were shown to be superior to conventional laparoscopic myomectomy according to our study but further evaluation in near future is needed.
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Affiliation(s)
- Juseok Yang
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Yong Jin Na
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Hwi Gon Kim
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea.
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Łoziński T, Filipowska J, Ludwin A, Ciebiera M. The outcome of magnetic resonance-guided high-intensity ultrasound for clinically symptomatic submucosal uterine fibroid performed accidentally in very early pregnancy: a case report. Int J Hyperthermia 2019; 36:975-979. [DOI: 10.1080/02656736.2019.1660002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Tomasz Łoziński
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszow, Poland
| | - Justyna Filipowska
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszow, Poland
- Faculty of Medicine, Institute of Nursing and Health Sciences, University of Rzeszow, Rzeszow, Poland
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
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Lebovitz O, Orvieto R, James KE, Styer AK, Brown DN. Predictors of reproductive outcomes following myomectomy for intramural fibroids. Reprod Biomed Online 2019; 39:484-491. [DOI: 10.1016/j.rbmo.2019.04.130] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Moawad GN, Tyan P, Awad C. Technique for Tissue Containment and Extraction in the Complex Minimally Invasive Myomectomy Setting. J Minim Invasive Gynecol 2019; 26:809-810. [DOI: 10.1016/j.jmig.2018.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/19/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
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Łoziński T, Filipowska J, Gurynowicz G, Zgliczyńska M, Kluz T, Jędra R, Skowyra A, Ciebiera M. The effect of high-intensity focused ultrasound guided by magnetic resonance therapy on obstetrical outcomes in patients with uterine fibroids – experiences from the main Polish center and a review of current data. Int J Hyperthermia 2019; 36:582-590. [DOI: 10.1080/02656736.2019.1616117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tomasz Łoziński
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszów, Poland
| | - Justyna Filipowska
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszów, Poland
- Faculty of Medicine, Institute of Nursing and Health Sciences, University of Rzeszów, Rzeszów, Poland
| | - Grzegorz Gurynowicz
- Division of Perinatology and Women’s Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | - Magdalena Zgliczyńska
- Students’ Scientific Association at the First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Kluz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Rzeszów, Poland
| | - Robert Jędra
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Artur Skowyra
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
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Yendru KS, Yelamanchi SD, Vaddiraju GB. Hysteroscopic Resection of Submucous Fibroids in Symptomatic Women. J Obstet Gynaecol India 2019; 69:166-172. [PMID: 30956472 DOI: 10.1007/s13224-018-1139-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/17/2018] [Indexed: 10/14/2022] Open
Abstract
Objective This study was conducted at Swapna Health Care (a tertiary centre for endoscopy), to analyse the outcome of hysteroscopic resection of submucous fibroids in 125 symptomatic women. Materials and Methods A total of 125 women were diagnosed with submucous fibroids between 1994 and 2017, 83 presented with AUB, 31 with infertility and four with RPL. Seven postmenopausal women had thickened endometrium on routine transvaginal ultrasonography, and hysteroscopy showed submucous fibroids. Results Out of 83 with AUB, 68 were premenopausal and 15 were postmenopausal. All these patients underwent submucous fibroid resection by hysteroscopy. Out of 83, 75 (90.4%) had total relief from AUB and did not need any further management. Only eight patients needed hysterectomy after submucous fibroid resection. Thirty-one patients came for infertility. Twenty-five patients followed infertility treatment with us after SMFR. 32% of our infertile patients conceived (8/25). Conclusions Submucous fibroid resection is a safe procedure, giving good results in symptomatic women with AUB and infertility. Hence, all gynaecologists should be trained in diagnostic and operative hysteroscopy and should be able to offer this option to their patients in the spectrum of choices available.
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Ding W, Zhang X, Qu P. An Efficient Conservative Treatment Option for Cervical Pregnancy: Transcatheter Intra-Arterial Methotrexate Infusion Combined with Uterine Artery Embolization Followed by Curettage. Med Sci Monit 2019; 25:1558-1565. [PMID: 30814484 PMCID: PMC6404629 DOI: 10.12659/msm.913262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the clinical outcomes of conservative treatments for cervical ectopic pregnancy (CEP). MATERIAL AND METHODS The series of CEP cases at our hospital between 2009 and 2016 were reviewed retrospectively. The patients were treated using systemic methotrexate infusion (MTX group, n=9), angiographic uterine artery embolization (UAE group, n=11), or transcatheter intra-artery methotrexate infusion combined with UAE (UAE+MTX group, n=13). Clinical outcomes, complications, and fertility were evaluated. RESULTS The median serum β-hCG was 6449 mIU/mL for MTX group, 17384 mIU/mL for UAE group, and 21361 mIU/mL for UAE+MTX group. The difference was statistically significant. In the MTX group, 1 patient developed hepatotoxicity and 2 patients occurred continuous vaginal bleeding during curettage. These 3 patients were successfully treated with emergency UAE. In the UAE group, 2 patients had vaginal re-bleeding on postoperative day 17 and 26, respectively, and received a second UAE procedure. In the UAE+MTX group, no patients developed severe complications. Moreover, a quick regression of serum β-hCG level, shortened recovery of normal menstruation, rapid cervical mass elimination, and a short hospital stay were observed in patients of the UAE+MTX group. CONCLUSIONS The triple therapy of transcatheter intra-arterial methotrexate infusion combined with UAE followed by immediate curettage is feasible and advantageous in treating CEP.
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Affiliation(s)
- Wei Ding
- Tianjin Medical University, Tianjin, China (mainland).,Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China (mainland)
| | - Xiaona Zhang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Pengpeng Qu
- Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China (mainland)
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Tseng CH. Metformin use is associated with a lower risk of uterine leiomyoma in female type 2 diabetes patients. Ther Adv Endocrinol Metab 2019; 10:2042018819895159. [PMID: 31897287 PMCID: PMC6920594 DOI: 10.1177/2042018819895159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 11/24/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Whether metformin may reduce the risk of uterine leiomyoma in type 2 diabetes patients has not been investigated. This retrospective cohort study compared the risk of uterine leiomyoma in ever versus never users of metformin. METHODS Female patients with new-onset type 2 diabetes during 1999-2005 were enrolled from the reimbursement database of Taiwan's National Health Insurance and followed up from 1 January 2006 until 31 December 2011. Analyses were conducted in a propensity score (PS) matched-pair cohort of 10,998 ever users and 10,998 never users of metformin. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using the PS. RESULTS A total of 321 never users and 162 ever users developed uterine leiomyoma during follow up, with respective incidence of 704.65 and 329.82 per 100,000 person-years. The overall hazard ratio was 0.467 (95% confidence interval: 0.387-0.564). The hazard ratios for the first (<23.3 months), second (23.3-53.1 months), and third (>53.1 months) tertiles of cumulative duration were 0.881 (0.685-1.132), 0.485 (0.367-0.642), and 0.198 (0.134-0.291), respectively; and were 0.751 (0.576-0.980), 0.477 (0.360-0.632), and 0.277 (0.198-0.386), respectively, for the first (<655,000 mg), second 655,000-1,725,500 mg), and third (>1,725,500) tertiles of cumulative dose. Sensitivity analyses after excluding users of sulfonylurea, users of estrogen, users of insulin, users of incretin-based therapies during follow up, patients with irregular drug refills, patients who discontinued the use of metformin, patients who received metformin prescription less than four times, or redefining uterine leiomyoma by using 'diagnostic code' plus 'procedure codes' consistently supported a lower risk of uterine leiomyoma in ever users of metformin. CONCLUSION Metformin use is associated with a lower risk of uterine leiomyoma.
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Britten JL, Malik M, Lewis TD, Catherino WH. Ulipristal Acetate Mediates Decreased Proteoglycan Expression Through Regulation of Nuclear Factor of Activated T-Cells (NFAT5). Reprod Sci 2018; 26:184-197. [PMID: 30567472 DOI: 10.1177/1933719118816836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Nuclear factor of activated T-cells (NFAT5) is a tissue specific, osmoadaptive transcription factor essential for the control of hydration homeostasis in mammalian cells. Nuclear factor of activated T-cells regulates osmolyte transporters aldo-keto reductase family 1 member B1 (AKR1B1) and solute carrier family 5 member 3 (SLC5A3) to maintain fluid equilibrium in cells. The osmotic potential of the extracellular matrix of leiomyomas is attributed to the role of proteoglycans. In leiomyoma cells, NFAT5 is overexpressed compared to myometrial cells. The selective progesterone receptor modulator, ulipristal acetate, has been reported to decrease the size of leiomyomas in clinical trials. When treated with ulipristal acetate, both patient leiomyoma tissue and leiomyoma cells grown in 3-dimensional cultures show a decrease in the expression of NFAT5 protein, solute transporters AKR1B1 and SLC5A3, and results in an associated decline in the expression of proteoglycans, versican, aggrecan, and brevican. In summary, ulipristal acetate induces changes in leiomyoma cell osmoregulation which result in a decrease in proteoglycan expression.
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Affiliation(s)
- Joy L Britten
- 1 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Minnie Malik
- 1 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Terrence D Lewis
- 1 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,2 Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - William H Catherino
- 1 Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,2 Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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Stępniak A. Uterine artery embolization in the treatment of symptomatic fibroids - state of the art 2018. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2018; 17:141-143. [PMID: 30766459 PMCID: PMC6372851 DOI: 10.5114/pm.2018.81733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
Uterine fibroids are considered to be the most common benign tumours in females. The vast majority of these tumours are incidental findings and do not require any treatment. Symptomatic fibroids, with ailments such as abnormal uterine bleeding, dysmenorrhoea, pelvic pain, impaired urination, bowel dysfunction, infertility, and recurrent pregnancy loss, are indicated for medical treatment. Surgery remains a first-line treatment of symptomatic uterine fibroids; however, minimally invasive techniques and pharmacological management have become more available and popular. Among minimally invasive techniques uterine artery embolization (UAE) is the most well-established uterine preserving treatment. UAE was first introduced in obstetrics and gynaecology in 1987 and since then many studies have shown the safety and efficacy of UAE in fibroid treatment with low rates of complications. In this review we present a novel approach to UAE, which reflects the current state of knowledge based on recent clinical trials and long-term post-procedural follow-up.
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Affiliation(s)
- Anna Stępniak
- 3 Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
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Benton A, Sood S, Wagner S, Newell J, Harkins G. Disseminated Peritoneal Leiomyomatosis Following Hysteroscopic Leiomyoma Morcellation. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Benton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Shelly Sood
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
| | - Stephen Wagner
- Departments of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Jordan Newell
- Departments of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Gerald Harkins
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Guida M, Maffucci D, Iannuzzi G, Giordano M, Luciano G, Di Benedetto L, Cantarella R, Rescigno A, Giugliano L. Successful pregnancy after uterine artery embolization for uterine arterovenous malformation: a rare case report. Int J Womens Health 2018; 10:745-750. [PMID: 30538584 PMCID: PMC6254590 DOI: 10.2147/ijwh.s182131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective This paper reports on a rare case of pregnancy after uterine artery embolization (UAE) for uterine arteriovenous malformation (AVM). Debate exists about persistence of fertility in women after UAE. Adverse effects of this technique can modify both uterine echostructure, inducing necrosis and infarction, endometrial atrophy and uterine artery rupture, and ovarian reserve, causing persistent amenorrhea. Ovarian reserve appears to be affected by UAE in pre-menopausal women. However, younger ovaries (according to biological ovarian age) exhibit a greater capacity for recovery after ovarian damage. Therefore, larger studies are needed for more conclusive results. Case report A 28-year-old woman was admitted to our department due to life-threatening uterine bleeding, resulting in tachycardia, pallor, and sweating. The patient came with a history of two spontaneous miscarriages. After sonography and computed tomography, AVMs were identified at uterine fundus and anterior wall. Conclusion The pathogenesis of infertility after UAE is not yet known. The peculiarity of this case was that, only few months later, the patient became pregnant and gave birth to a live fetus at 37 weeks with cesarean delivery.
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Affiliation(s)
- M Guida
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - D Maffucci
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - G Iannuzzi
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - M Giordano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - G Luciano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
| | - L Di Benedetto
- Università degli studi di Roma "La Sapienza" - Dipartimento di Scienze Medico-Chirurgiche e di Medicina Traslazionale - Facoltà di Medicina e Psicologia Azienda Ospedaliera Sant' Andrea, Rome, Italy
| | - R Cantarella
- Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - A Rescigno
- Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - L Giugliano
- Università degli studi di Salerno - Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Salerno, Italy,
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Unsuspected Diagnosis of Uterine Leiomyosarcoma after Laparoscopic Myomectomy in an Isolated Bag. Case Rep Obstet Gynecol 2018; 2018:6342081. [PMID: 30013804 PMCID: PMC6022265 DOI: 10.1155/2018/6342081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/24/2018] [Indexed: 12/27/2022] Open
Abstract
Minimally invasive techniques are generally applied for patients suspected of having benign fibroids if medical treatment is insufficient. On the other hand, sometimes some occult carcinomas of uterus like leiomyosarcomas may be reported for the patients' applied morcellation. This condition is rare but outcomes are clinically significant. Fragmentation of occult sarcoma in the abdominal cavity without isolation bag results in widespread and poor survival. In this article, we report a case of 37-year-old woman suffering from pain due to unexpected leiomyosarcoma. Laparoscopic myomectomy was performed with power morcellation in an isolated bag. Although isolation bag is generally reported to be preventive, recurrence of sarcoma was seen at 5th month of follow-up. Even though morcellation within a bag seems to block wide spreading, dispersion of tumor cannot be stopped and more investigations have to be done.
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Oxytocin Administration in High-Intensity Focused Ultrasound Treatment of Myomata. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7518026. [PMID: 30057909 PMCID: PMC6051281 DOI: 10.1155/2018/7518026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/07/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
Objectives The aim of the study was to evaluate the clinical efficacy of magnetic resonance-guided High-Intensity Focused Ultrasound (HIFU) in patients with symptomatic uterine fibroids (myomata) after application of oxytocin. Methods 156 women with symptomatic uterine fibroids were treated using MR-guided HIFU procedure. 51 patients had additional IV administration of 40 IU of oxytocin in 5% Glucose or 0,9% NaCl solution during therapy. Before and after the procedure we performed MR and measured initial perfused volume, final perfused volume, nonperfused volume (NPV), and treated volume ratio (TVR). The follow-up was up to 15 months to assess efficacy of treatment and relief of symptoms. Results Nonperfused volume was statistically significantly larger in oxytocin group than in control group (p=0.0019). The remaining parameters did not show significant difference between both groups. Conclusion Oxytocin administration seems to improve efficiency of HIFU therapy although further research is required to assess its value. This study' clinical registration number is DRKS00014794.
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Maheux-Lacroix S, Nesbitt-Hawes E, Deans R, Won H, Budden A, Adamson D, Abbott JA. Endometriosis fertility index predicts live births following surgical resection of moderate and severe endometriosis. Hum Reprod 2018; 32:2243-2249. [PMID: 29040471 DOI: 10.1093/humrep/dex291] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/24/2017] [Indexed: 01/02/2023] Open
Abstract
STUDY QUESTION Can live birth be accurately predicted following surgical resection of moderate-severe (Stage III-IV) endometriosis? SUMMARY ANSWER Live births can accurately be predicted with the endometriosis fertility index (EFI), with adnexal function being the most important factor to predict non-assisted reproductive technology (non-ART) fertility or the requirement for ART (www.endometriosisefi.com). WHAT IS KNOWN ALREADY Fertility prognosis is important to many women with severe endometriosis. Controversy persists regarding optimal post-operative management to achieve pregnancy and the counselling of patients regarding duration of conventional treatments before undergoing ART. The EFI is reported to correlate with expectant management pregnancy rate, although external validation has been performed without specifically addressing fertility in women with moderate and severe endometriosis. STUDY DESIGN, SIZE, DURATION Retrospective cohort study of 279 women from September 2001 to June 2016. PARTICIPANTS/MATERIALS, SETTINGS, METHODS We included women undergoing laparoscopic resection of Stage III-IV endometriosis who attempted pregnancy post-operatively. The EFI was calculated based on detailed operative reports and surgical images. Fertility outcomes were obtained by direct patient contact. Kaplan-Meier model, log rank test and Cox regression were used for analyses. MAIN RESULTS AND THE ROLE OF CHANCE The follow-up rate was 84% with a mean duration of 4.1 years. A total of 147 women (63%) had a live birth following surgery, 94 of them (64%) without ART. The EFI was highly associated with live births (P < 0.001): for women with an EFI of 0-2 the estimated cumulative non-ART live birth rate at five years was 0% and steadily increased up to 91% with an EFI of 9-10, while the proportion of women who attempted ART and had a live birth, steadily increased from 38 to 71% among the same EFI strata (P = 0.1). A low least function score was the most significant predictor of failure (P = 0.003), followed by having had a previous resection (P = 0.019) or incomplete resection (P = 0.028), being older than 40 compared to <35 years of age (P = 0.027), and having leiomyomas (P = 0.037). LIMITATIONS REASONS FOR CAUTION The main limitation of this study is its retrospective design. Imprecision was higher with low EFI due to smaller sample size in this subgroup. Finally, the EFI is somewhat subjective and could be prone to intra- and inter-observer variations. WIDER IMPLICATIONS OF THE FINDINGS Women with a high EFI score have excellent fertility prognosis and may be advised to try to become pregnant with timed intercourse compared to women with a low score, for which prompt referral to ART seems more reasonable. Other prognostic factors can be used to guide the management of women with an intermediate EFI score. These data follow women over many years post-resection and represent longitudinal fertility data rarely demonstrated in such a cohort. The location and impact of lesions on the ability of the adnexa to function seems crucial for the fertility prognosis and should be further investigated. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the GRACE Research funds. S.M.-L. is the recipient of a Training Award from the Fonds de Recherche Quebec-Sante. D.A. is the primary author of the Endometriosis Fertility Index. All authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Maheux-Lacroix
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - E Nesbitt-Hawes
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - R Deans
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - H Won
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - A Budden
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
| | - D Adamson
- GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia.,Palo Alto Medical Foundation Fertility Physicians of Northern California, 2581 Samaritan Drive, San Jose, CA 95124, USA
| | - J A Abbott
- School of Women's and Children's Health, UNSW, Barker St, Sydney, NSW 2031, Australia.,GRACE Unit, Royal Hospital for Women, Barker St, Sydney, NSW 2031, Australia
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Singh SS, Belland L, Leyland N, von Riedemann S, Murji A. The past, present, and future of selective progesterone receptor modulators in the management of uterine fibroids. Am J Obstet Gynecol 2018; 218:563-572.e1. [PMID: 29274830 DOI: 10.1016/j.ajog.2017.12.206] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 12/12/2022]
Abstract
Uterine fibroids are common in women of reproductive age and can have a significant impact on quality of life and fertility. Although a number of international obstetrics/gynecology societies have issued evidence-based clinical practice guidelines for the management of symptomatic uterine fibroids, many of these guidelines do not yet reflect the most recent clinical evidence and approved indication for one of the key medical management options: the selective progesterone receptor modulator class. This article aims to share the clinical experience gained with selective progesterone receptor modulators in Europe and Canada by reviewing the historical development of selective progesterone receptor modulators, current best practices for selective progesterone receptor modulator use based on available data, and potential future uses for selective progesterone receptor modulators in uterine fibroids and other gynecologic conditions.
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Czuczwar P, Stepniak A, Milart P, Paszkowski T, Wozniak S. Comparison of the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve - an observational study. J Ovarian Res 2018; 11:45. [PMID: 29859107 PMCID: PMC5984745 DOI: 10.1186/s13048-018-0420-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To assess and compare the influence of three fibroid treatment options: supracervical hysterectomy, ulipristal acetate and uterine artery embolization on ovarian reserve. METHODS Prospective, observational, open-label study performed at the 3rd Chair and Department of Gynecology of the Medical University of Lublin, Poland. Premenopausal Caucasian women with symptomatic uterine fibroids were recruited into 3 groupspatients qualified for supracervical hysterectomies; patients qualified for preoperative ulipristal acetate (UPA) treatment scheduled for supracervical hysterectomies or myomectomies; patients qualified for uterine artery embolization (UAE). The following markers of ovarian reserve were investigated: antral follicle count (AFC), anti-Mullerian hormone (AMH), inhibin B (INHB), follicle stimulating hormone (FSH) and estradiol (E2). These markers were assessed before and 3 months after supracervical hysterectomies, before and 3 months after UAEs, and before and after 3 months of UPA treatment, before the scheduled surgeries. Baseline characteristics (age, parity, dominant fibroid volume, hemoglobin level, BMI, as well as AFC, AMH, INHB, FSH and E2) were compared between the study groups by Kruskall-Wallis ANOVA. Pre- and post-interventional values of AFC, AMH, INHB, FSH and E2 in the studied groups were compared with the Wilcoxon matched pairs test. RESULTS Twenty-six, 27 and 30 patients were included in the final analysis in the supracervical hysterectomy, UPA and UAE groups, respectively. Three months after supracervical hysterectomy INHB and E2 significantly decreased, while AFC, AMH and FSH remained unchanged. After 3 months of UPA treatment the values of all the assessed markers of ovarian reserve were not significantly different in comparison to baseline. Conversely, three months after UAE the values of AFC, AMH, INHB, and E2 were significantly decreased, while FSH was significantly increased. CONCLUSIONS Of the compared fibroid treatment methods UAE seems to have the greatest impact on ovarian function and should not be offered to patients concerned about their ovarian function. Supracervical hysterectomy did not affect the most accurate markers of ovarian reserve, and therefore appears to be safe in terms of ovarian function. UPA did not change any of the studied markers of ovarian reserve and seems a reasonable option when ovarian function is concerned.
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Affiliation(s)
- Piotr Czuczwar
- 3rd Department of Gynecology of the Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Anna Stepniak
- 3rd Department of Gynecology of the Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Pawel Milart
- 3rd Department of Gynecology of the Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Tomasz Paszkowski
- 3rd Department of Gynecology of the Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
| | - Slawomir Wozniak
- 3rd Department of Gynecology of the Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland
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70
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Chen H, Athreya S. Systematic review of uterine artery embolisation practice guidelines: are all the guidelines on the same page? Clin Radiol 2018; 73:507.e9-507.e15. [DOI: 10.1016/j.crad.2017.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/06/2017] [Indexed: 11/15/2022]
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Rattray DD, Weins L, Regush LC, Bowen JM, O'Reilly D, Thiel JA. Clinical outcomes and health care utilization pre- and post-laparoscopic radiofrequency ablation of symptomatic fibroids and laparoscopic myomectomy: a randomized trial of uterine-sparing techniques (TRUST) in Canada. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:201-212. [PMID: 29670382 PMCID: PMC5894744 DOI: 10.2147/ceor.s155038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study was to compare laparoscopic ultrasound-guided radiofrequency ablation of fibroids (Lap-RFA) and laparoscopic myomectomy in terms of 1) health care utilization and 2) serious complication rates. The secondary objectives were comparison of subject responses to validated symptom and quality-of-life questionnaires. We hypothesized that Lap-RFA health care utilization and clinical outcomes would not be worse than those of laparoscopic myomectomy in the aggregate. Patients and methods Post-market, randomized, prospective, multicenter, longitudinal, non-inferiority interventional comparative evaluation of health care utilization and clinical outcomes in premenopausal women with symptomatic uterine fibroids who desired uterine conservation was conducted. Both procedures were planned as outpatient day surgeries. Health care resource utilization was measured during the procedure day and at 1 week, 1 and 3 months post-surgery. Symptom severity and quality of life were based on patients' responses to the Uterine Fibroid Symptom Severity and Quality-of-Life Questionnaire, EuroQol-5D-visual analog scale general health status and menstrual impact questionnaires, and time from work. Results Forty-five participants provided written informed consent and were enrolled (Lap-RFA, n=23; myomectomy, n=22) in Canada. Hospitalization time (primary endpoint) was 6.7±3.0 hours for the Lap-RFA group and 9.9±10.7 hours for the myomectomy group (Wilcoxon, p=0.0004). Intraoperative blood loss was lesser for Lap-RFA subjects: 25.2±21.6 versus 82.4±62.5 mL (p=0.0002). Lap-RFA procedures took lesser time than myomectomy procedures: 70.0 versus 86.5 minutes (p=0.018), and Lap-RFA required -34.9% (130 fewer) units of surgical equipment. At 3 months, both cohorts reported the same significant symptom severity reduction (-44.8%; p<0.0001). Lap-RFA subjects also took lesser time from work: 11.1±7.6 versus 18.5±10.6 days (p=0.0193). One myomectomy subject was hospitalized overnight after experiencing a 20-second asystole during the procedure. One Lap-RFA subject underwent a reintervention. The combined per patient direct and indirect costs of the two procedures were comparable: Lap-RFA (CAD $5,224.96) and myomectomy (CAD $5,321.96). Conclusion Compared to myomectomy, Lap-RFA is associated with significantly lesser intraoperative blood loss, shorter procedure and hospitalization times, lesser consumption/use of disposable and reusable surgery equipment, reduced health care resource utilization, and faster return to work through 3 months posttreatment. Direct and indirect costs of Lap-RFA and myomectomy are comparable.
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Affiliation(s)
- Darrien D Rattray
- Department of Gynecology, Regina General Hospital, Regina, SK, Canada
| | - Laura Weins
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Regina, SK, Canada
| | - Lexy C Regush
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Regina, SK, Canada
| | - James M Bowen
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Programs for Assessment of Technology in Health (PATH), Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Daria O'Reilly
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Programs for Assessment of Technology in Health (PATH), Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - John A Thiel
- Department of Gynecology, Regina General Hospital, Regina, SK, Canada.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Regina, SK, Canada
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72
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Behbehani S, Polesello S, Hasson J, Silver J, Son WY, Dahan M. The Effect of Intramural Myomas Without an Intracavity Component on In Vitro Fertilization Outcomes in Single Fresh Blastocyst Transfer Cycles. J Minim Invasive Gynecol 2018. [PMID: 29530836 DOI: 10.1016/j.jmig.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE To assess clinical pregnancy rate (CPR) and live birth rate (LBR) in the presence of non-cavity-deforming intramural myomas in single fresh blastocyst transfer cycles. DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING Academic fertility center. PATIENTS A total of 929 fresh single blastocyst transfer cycles were included, 94 with only non-cavity-distorting intramural myomas and 764 without myomas. Cleavage embryo transfers were excluded to reduce bias based on embryo quality. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS CPR and LBR were assessed. There were no differences noted in gravidity, parity, or body mass index between patients with myomas and those without myomas. Women with myomas required higher doses of gonadotropins (mean, 2653 ± 404 IU vs 2350 ± 1368 IU; p = .04) than women without myomas. However, the total number of mature oocytes collected and the total number of blastocysts created were similar. CPR (47% vs 32%; p = .005) and LBR (37.8% vs 25.5%; p = .02) were lower in patients who had intramural myomas compared with those without myomas. CPR and LBR were significantly reduced in the presence of even 1 myoma (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.33-0.83 and OR, 0.56; 95% CI, 0.35-0.92, respectively). In patients with myomas >1.5 cm, LBR was also significantly reduced, even after adjusting for age, smoking, quality of embryo transferred, antral follicle count, and dose of gonadotropins (OR, 0.53; 95% CI, 0.29-0.97). This LBR finding was not significant if all myomas were included (including those <1.5 cm in diameter), but CPR was still significantly reduced. CONCLUSION Relatively small (>1.5 cm) non-cavity-distorting intramural myomas negatively affect CPR and LBR in in vitro fertilization cycles, even in the presence of only 1 myoma.
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Affiliation(s)
| | | | - Joseph Hasson
- McGill University Health Center, Montreal, Quebec, Canada
| | - Justin Silver
- McGill University Health Center, Montreal, Quebec, Canada
| | - Weon-Young Son
- McGill University Health Center, Montreal, Quebec, Canada
| | - Michael Dahan
- McGill University Health Center, Montreal, Quebec, Canada
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Ouyang ZB, Quan S. Regarding "anti-Müllerian hormone levels before and after uterine artery embolization". MINIM INVASIV THER 2018; 27:373-374. [PMID: 29504431 DOI: 10.1080/13645706.2018.1445640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Zhen-Bo Ouyang
- a Department of Gynecology , Guangdong Second Provincial General Hospital , Guangzhou , China
| | - Song Quan
- b Department of Obstetrics and Gynecology , Nanfang Hospital, Southern Medical University , Guangzhou , China
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Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Prevention and Management of Complications in Laparoscopic Myomectomy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8250952. [PMID: 29693017 PMCID: PMC5859837 DOI: 10.1155/2018/8250952] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 02/04/2018] [Indexed: 11/18/2022]
Abstract
Myomectomy aims to preserve fertility, treat abnormal uterine bleeding, and alleviate pain. It should cause minimal damage to the endometrium, while being tolerable and durable, and reduce the incidence of myoma recurrence and complications including bleeding, hematoma, adhesions, and gravid uterus perforation. Training and experience are crucial to reduce complications. The surgical strategy depends on imaging information on the myomas. The position of the optical and secondary ports will determine the degree of ergonomic surgery performance, time and difficulty of myoma enucleation, and the suturing quality. Appropriate hysterotomy length relative to myoma size can decrease bleeding, coagulation, and suturing times. Bipolar coagulation of large vessels, while avoiding carbonization and myometrium gaps after suturing, may decrease the risk of myometrial hematoma. Quality surgery and the use of antiadhesive barriers may reduce the risk of postoperative adhesions. Slow rotation of the beveled morcellator and good control of the bag could reduce de novo myoma and endometriosis. Low intra-abdominal CO2 pressure may reduce the risk of benign and malignant cell dissemination. The benefits a patient gains from laparoscopic myomectomy are greater than the complication risks of laparoscopic morcellation. Recent publications on laparoscopic myomectomies demonstrate reduced hospitalization stays, postoperative pain, blood loss, and recovery compared to open surgery.
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Affiliation(s)
- V. Tanos
- University of Nicosia Medical School, Nicosia, Cyprus
- European Academy for Gynecological Surgery (Nicosia Branch), 55-57 Andrea Avraamidi St., Strovolos, 2024 Nicosia, Cyprus
- Aretaeio Hospital, Strovolos, Nicosia, Cyprus
| | - K. E. Berry
- St George's, University of London MBBS Programme at the University of Nicosia Medical School, Nicosia, Cyprus
| | - M. Frist
- St George's, University of London MBBS Programme at the University of Nicosia Medical School, Nicosia, Cyprus
| | - R. Campo
- European Society Gynaecological Endoscopy, Leuven, Belgium
- The European Academy for Gynecological Surgery, Leuven, Belgium
- Life Expert Centre, Schipvaartstraat 4, 3000 Leuven, Belgium
| | - R. L. DeWilde
- European Society Gynaecological Endoscopy, Leuven, Belgium
- Cahir Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
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75
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Brennan A, Hickey M. Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas. Med J Aust 2018; 208:90-95. [PMID: 29385977 DOI: 10.5694/mja17.00726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/26/2017] [Indexed: 01/30/2023]
Abstract
Abnormal uterine bleeding refers to any change in the regularity, frequency, heaviness or length of menstruation. There are several potential causes for bleeding disturbance, the two most common being primary endometrial dysfunction and fibroids. Management of abnormal uterine bleeding involves both medical and surgical options and will largely depend on a patient's fertility plans. The use of levonorgestrel-releasing intrauterine devices for heavy menstrual bleeding is increasing in Australia, and they are considered first-line medical management for women accepting of hormonal therapies. Tranexamic acid, non-steroidal anti-inflammatory drugs, the combined oral contraceptive pill and oral progestins offer alternatives. Hysterectomy offers a definitive surgical approach to abnormal uterine bleeding and is associated with high levels of patient satisfaction. Women wishing to preserve their fertility, or avoid hysterectomy, may be offered myomectomy. Submucosal fibroids should be removed via hysteroscopy in symptomatic or infertile patients. Intramural and subserosal fibroids may be removed via an open or laparoscopic approach. There are several minimally invasive options, including uterine artery embolisation, magnetic resonance-guided focused ultrasound and endometrial ablation, but patients should be aware that there is insufficient evidence to ensure fertility preservation with these procedures and further research is needed. Areas for additional research include cost-effectiveness of treatments and quality of life comparisons between management options using patient reported outcome measures to evaluate patient satisfaction.
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Shue S, Radeva M, Falcone T. Comparison of Long-Term Fertility Outcomes after Myomectomy: Relationship with Number of Myomas Removed. J Minim Invasive Gynecol 2018; 25:1002-1008. [PMID: 29371170 DOI: 10.1016/j.jmig.2018.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE To determine if the number of myomas removed during myomectomy for symptomatic relief affects long-term fertility outcomes in reproductive-aged women. DESIGN Retrospective cohort survey study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS One hundred forty-four patients who underwent myomectomy for symptomatic myomas and attempted to conceive afterward. INTERVENTION Questionnaire mailed to reproductive-aged women who received robotic, laparoscopic, or abdominal myomectomy. MEASUREMENTS AND MAIN RESULTS Patients with >6 myomas removed were less likely to achieve pregnancy after myomectomy than patients with ≤6 myomas removed (22.9% vs 70.8%, respectively; p < .001). To achieve pregnancy, 45% of those with >6 myomas removed (vs 17.6% of those with ≤6 myomas removed) relied on fertility treatment (clomiphene citrate, letrozole, intrauterine insemination, or in vitro fertilization). Of those with >6 myomas removed who became pregnant, 45.5% had a term birth, 45.5% miscarried, and 9.1% had an ectopic pregnancy. Of those with ≤6 myomas removed who became pregnant, 61.8% had a term birth, 23.5% had a preterm birth, and 13.2% miscarried. CONCLUSION The number of myomas removed during myomectomy significantly affects fertility. Women with >6 myomas removed were less likely to become pregnant, more likely to require fertility treatment, and less likely to have a term birth when compared with women with ≤6 myomas removed.
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Affiliation(s)
- Shirley Shue
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Milena Radeva
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Tommaso Falcone
- Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
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77
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Robot-assisted myomectomy. Best Pract Res Clin Obstet Gynaecol 2018; 46:113-119. [PMID: 29103894 DOI: 10.1016/j.bpobgyn.2017.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022]
Abstract
Uterine fibroids are the most common tumors of the uterus and the female pelvis and are associated with substantial morbidity for several women. In women with a wish to preserve fertility, a myomectomy is the surgical procedure of choice when medical therapy is inadequate. Despite evidence that minimally invasive surgery is preferable to laparotomy, most myomectomies are still performed by laparotomy. Robotic surgery was introduced to overcome some of the difficulties associated with laparoscopic surgery. A myomectomy is a suture-intensive surgery where the properties of a surgical robot have been suggested to be of particular value. Robotic myomectomy is feasible and safe, with similar outcome to laparoscopic surgery, although a robotic procedure is associated with a higher cost. The introduction of robotic surgery has expanded the indications for minimally invasive myomectomy to more complex cases previously performed by laparotomy. Randomized trials comparing different approaches to myomectomy are yet to be published. More studies are needed to determine the patients in whom a robotic approach is most beneficial, both in terms of patient outcomes and cost efficiency.
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78
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Milazzo GN, Catalano A, Badia V, Mallozzi M, Caserta D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res 2017; 43:1789-1804. [PMID: 28892210 DOI: 10.1111/jog.13437] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/21/2017] [Accepted: 05/28/2017] [Indexed: 02/02/2023]
Abstract
AIM Summarize the results of the many, but often underpowered, studies on pregnancy complicated by myoma or myomectomy. METHODS Survey of the electronic PubMed database for the last two decades was conducted. We selected reviews, meta-analyses, case series, case reports, clinical studies only with statistical analysis, and guidelines from scientific societies. RESULTS Delaying childbearing leads to an increased incidence of pregnancy complicated by fibroids or previous myomectomy. Approximately 10-30% of pregnant women with myomas develop complications during gestation, at delivery and in puerperium. Submucosal, retroplacental, large and multiple myomas have a greater risk of complications. Cervical myomas, although rare, need careful management. The location and size of the fibroids should be assessed from the first trimester. Despite the increased risk of cesarean section, fibroids are not a contraindication to labor, unless they obstruct the birth canal or other obstetric conditions coexist. Myomectomy during pregnancy, in selected cases, is feasible and safe. Myomectomy cannot be considered a prophylactic measure prior to conception, but has to be individualized. Uterine rupture after myomectomy generally occurs in the third trimester or during labor and some associated risk factors have been identified. There is no consensus on the optimal interval between myomectomy and conception. CONCLUSIONS Pregnancy in patients with fibroids or previous myomectomy should be considered as high risk, requiring a maternal-fetal medicine specialist. To date available literature is inconsistent on evidence-based management. Further research is needed for definitive recommendations.
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Affiliation(s)
- Giusi Natalia Milazzo
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Angelica Catalano
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Valentina Badia
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Maddalena Mallozzi
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Donatella Caserta
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
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Laparoscopy or laparotomy as the way of entrance in myoma enucleation. Arch Gynecol Obstet 2017; 296:709-720. [PMID: 28819682 DOI: 10.1007/s00404-017-4490-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/07/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Uterine myomas are the main cause of benign uterine diseases in premenopausal women. Objective of the present paper is to investigate the current best treatment modalities of myomas, depending on age of the patient and her desire to preserve fertility, as well as on clinical presentation of this pathology, such as size, number, and location of fibroids and, furthermore, on surgical experience of the gynecologist. METHODS The design of our work is a systematic literature review of existing studies, reviews, and meta-analysis conducted in PubMed and Cochrane Library to identify relevant literature. Commonly, the myomectomy is to be recommended in women desiring to preserve fertility when myomas are associated with symptoms such as excessive bleeding, pelvic discomfort, or palpable abdominally fibroids. The decision of surgical approach for myomectomy should be individualized, depending on size and location, as well as on surgeon's experience. The different modalities of myomectomy, laparoscopic, hysteroscopic, robotic-assisted, or laparotomic are in detail presented in the paper, according to Society of Obstetricians and Gynecologists of Canada (SOGC) clinical practice guidelines and taking into consideration possible concerns of myomectomy such as uterine rupture, development of adhesions, and myomas' recurrence.
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80
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Ciavattini A, Delli Carpini G, Moriconi L, Clemente N, Orici F, Boschi AC, Montik N, Mazzanti L. The association between ultrasound-estimated visceral fat deposition and uterine fibroids: an observational study. Gynecol Endocrinol 2017; 33:634-637. [PMID: 28332865 DOI: 10.1080/09513590.2017.1302418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Uterine fibroids are the most common neoplasm of the genital tract in reproductive women. Obesity holds a role as risk factor for uterine fibroids, through hormonal and inflammatory mechanisms. Visceral fat is a hormonally active tissue, so an increase in visceral fat may be considered as a risk factor, through the increased production of inflammatory mediators. The aim of the study was, therefore, to evaluate the association between the presence of uterine fibroids and fat tissue distribution, and to assess the efficacy of both anthropometric and instrumental indicators, in particular the sonographic measurement of preperitoneal fat thickness (PFT) and subcutaneous fat thickness (SFT). Study group consisted of childbearing-age women with at least one uterine fibroid with a diameter ≥10 mm (n = 71), all the childbearing-age women who access to the outpatient service of our institution in the same period, without evidence of uterine fibroids, constituted the control group (n = 145). A significantly difference in BMI (p = 0.0034), PFT (p < 0.0001), and SFT (p = 0.0003) emerged. At the multivariate analysis, only PFT showed an independent significant association with the presence of uterine fibroids (p < 0.0001). The ROC curve analysis identified a cut-off value of 6.7 mm of PFT as discriminator for the presence of uterine fibroids.
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Affiliation(s)
| | | | | | - Nicolò Clemente
- a Woman's Health Sciences Department, Gynecologic Section and
| | - Francesca Orici
- a Woman's Health Sciences Department, Gynecologic Section and
| | | | - Nina Montik
- a Woman's Health Sciences Department, Gynecologic Section and
| | - Laura Mazzanti
- b Department of Clinical Sciences, Biochemistry Section , Polytechnic University of Marche , Ancona , Italy
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81
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Armstrong SC, Showell M, Stewart EA, Rebar RW, Vanderpoel S, Farquhar CM. Baseline anatomical assessment of the uterus and ovaries in infertile women: a systematic review of the evidence on which assessment methods are the safest and most effective in terms of improving fertility outcomes. Hum Reprod Update 2017; 23:533-547. [DOI: 10.1093/humupd/dmx019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 07/02/2017] [Indexed: 11/14/2022] Open
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Li JS, Wang Y, Chen JY, Chen WZ. Pregnancy outcomes in nulliparous women after ultrasound ablation of uterine fibroids: A single-central retrospective study. Sci Rep 2017. [PMID: 28638108 PMCID: PMC5479832 DOI: 10.1038/s41598-017-04319-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To explore the impact of high-intensity focused ultrasound (HIFU) ablation of uterine fibroids in nulliparous women on subsequent pregnancy and delivery. A retrospective analysis was conducted of nulliparous women who received HIFU treatment at Chongqing Medical University, Chongqing,China, from January 1, 2010, to January 1, 2015. A total of 189 cases were enrolled, the median follow-up time was three years. Among them,there were 131 cases pregnancy with a total of 133 times,the pregnancy rate was 69.3% (131/189),and the spontaneous conception rate was 95.4% (125/131). Of 131 pregnant women, 19 were on-going pregnancy, terminated pregnancy 114 times,which include 93 times successfully delivery with a 76.3% (87/114) full-term birth rate,and the cesarean section rate was 72.0% (67/93). Of 94 newborns,the average birth weight was (3.3 ± 0.4)kg (range:1.5–4.8 kg), and a pair of them were identical twins. The incidence of complications during pregnancy and delivery were 10.8% (10/93) and 7.5% (7/93),respectively,except one woman failed on-going pregnancy and one woman suffered hysterectomy due to the complications,others all successful pregnant and delivered. Multiple-factor regression analysis found that age and infertility history were the important factors that may affect pregnancy after HIFU (P < 0.01). Nulliparous women who undergo HIFU treatment for uterine fibroids can subsequently have successful pregnancy and delivery safely.
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Affiliation(s)
- Jun Shu Li
- The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing, 400016, China
| | - Yong Wang
- The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing, 400016, China
| | - Jin Yun Chen
- The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing, 400016, China. .,HIFU Center for Tumor Therapy, 1st Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, China.
| | - Wen Zhi Chen
- The State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing Collaborative Innovation Center for Minimally-invasive and Noninvasive Medicine, Chongqing, 400016, China. .,Clinical Center for Tumor Therapy, the Second Affiliated Hospital of Chongqing Medical University, 74 Lin jiang Road, Chongqing, 400010, China.
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Role of robotic surgery in treating fibroids and benign uterine mass. Best Pract Res Clin Obstet Gynaecol 2017; 45:48-59. [PMID: 28551090 DOI: 10.1016/j.bpobgyn.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/22/2017] [Accepted: 04/14/2017] [Indexed: 12/31/2022]
Abstract
Fibroid uterus can be managed medically, surgically, or through non-extirpative procedures, depending on the clinical situation. Myomectomy may be beneficial, especially to those desiring to preserve the uterus and/or fertility, with outcomes comparable to those of hysterectomy, with a laparoscopic approach being favored when feasible. For definitive therapy, hysterectomy can be pursued where the surgical approach should be individualized. Comparison of robotic-assisted laparoscopic approach shows that the robotic approach may be favored for cases with higher complexity and multiple fibroids in myomectomy; however, no clear advantage is seen with hysterectomy at this time, necessitating further research in the area of robotics for hysterectomy in benign uterine mass treatment to justify the cost.
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Abdusattarova K, Mettler L, Alkatout I, Dempfle A. Endoscopic treatment of symptomatic fibroids at reproductive age and beyond. MINIM INVASIV THER 2017; 26:355-361. [DOI: 10.1080/13645706.2017.1312457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Khulkar Abdusattarova
- Department of Gynecology and Obstetrics, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Liselotte Mettler
- Department of Gynecology and Obstetrics, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
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Uterine Fibroids in the Setting of Infertility: When to Treat, How to Treat? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ciavattini A, Delli Carpini G, Serri M, Vignini A, Sabbatinelli J, Tozzi A, Aggiusti A, Clemente N. Hypovitaminosis D and "small burden" uterine fibroids: Opportunity for a vitamin D supplementation. Medicine (Baltimore) 2016; 95:e5698. [PMID: 28033263 PMCID: PMC5207559 DOI: 10.1097/md.0000000000005698] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to evaluate the effect of vitamin D supplementation in women with hypovitaminosis D and "small burden" uterine fibroids.This study focused on 208 women diagnosed with uterine fibroids and concomitant hypovitaminosis D, from January to December 2014. One hundred eight women of the initial study population were diagnosed with "small burden" uterine fibroids. Among them, those who underwent a proper vitamin D supplementation constituted the "study group" (n = 53), while women who spontaneously refused the therapy or did not perform it properly, constituted the "control group" (n = 55). The characteristics of uterine fibroids, the fibroid-related symptoms, and the vitamin D serum levels were evaluated 12 months after the initial diagnosis.In women with uterine fibroids, a negative correlation emerged between the baseline 25-hydroxy-cholecalciferol (25-OH-D3) concentration and both the volume of the largest fibroid (r = -0.18, P = 0.01) and the total volume of fibroids (r = -0.19, P = 0.01). No correlation was found between the baseline 25-OH-D3 levels and the number of fibroids per patient (r = -0.10, P = 0.16). In women of the "study group," a significant increase in the 25-OH-D3 serum level was observed after 12 months of supplementation, and a lower rate of surgical or medical treatment due to the "progression to extensive disease" was reported (13.2% vs 30.9%, P = 0.05).Supplementation therapy with 25-OH-D3 restores normal vitamin D serum levels in women with "small burden" fibroids. In these women, vitamin D supplementation seems to reduce the progression to an extensive disease, and thus the need of conventional surgical or medical therapy.
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Affiliation(s)
- Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Matteo Serri
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Arianna Vignini
- Department of Clinical Sciences, Section of Biochemistry, Biology and Physics, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Sabbatinelli
- Department of Clinical Sciences, Section of Biochemistry, Biology and Physics, Polytechnic University of Marche, Ancona, Italy
| | - Alessandra Tozzi
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Alice Aggiusti
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Nicolò Clemente
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
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Radosa JC, Radosa CG, Mavrova R, Wagenpfeil S, Hamza A, Joukhadar R, Baum S, Karsten M, Juhasz-Boess I, Solomayer EF, Radosa MP. Postoperative Quality of Life and Sexual Function in Premenopausal Women Undergoing Laparoscopic Myomectomy for Symptomatic Fibroids: A Prospective Observational Cohort Study. PLoS One 2016; 11:e0166659. [PMID: 27898669 PMCID: PMC5127523 DOI: 10.1371/journal.pone.0166659] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/01/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Uterine leiomyomas are the most common benign gynecologic tumors. To date laparoscopy myomectomy is the gold standard for treatment of symptomatic fibroids in reproductive-aged women. Detailed counseling about the effects of this procedure on postoperative sexuality and quality of life is important in these patients. However, available data on these subjects are limited and contradictory. The aim of this study was to assess sexual function and quality of life in premenopausal women undergoing laparoscopic myomectomy for symptomatic uterine fibroids. Material and Methods All premenopausal women who underwent laparoscopic myomectomy for symptomatic fibroids between April 2012 and August 2014 at a tertiary university center were enrolled in this prospective observational cohort study. Sexual function and quality of life were assessed for the pre- and postoperative (six months post-operatively) state using two validated questionnaires, the Female Sexual Function Index (FSFI) and the European Quality of Life Five-Dimension Scale (EQ-5D). Results Ninety-five of the 115 (83%) eligible patients completed the study. Overall a significant improvement in quality of life and sexual function was observed in the study cohort: Median FSFI (28 (18.7–35.2)) and EQ-5D scores (1 (0.61–1) after laparoscopic myomectomy were significantly higher than preoperative scores (21.2 (5.2–33.5); 0.9 (0.2–1); p ≤ 0.01). The number, position and localization of the largest fibroids were not correlated with pre- or postoperative sexual function or quality of life. Conclusion Laparoscopic myomectomy might have positive short-term effects on postoperative quality of life and sexual function in premenopausal women suffering from symptomatic fibroids.
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Affiliation(s)
- Julia Caroline Radosa
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
- * E-mail:
| | | | - Russalina Mavrova
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology & Medical Informatics, Saarland University Hospital, Homburg/Saar, Germany
| | - Amr Hamza
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Ralf Joukhadar
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Sascha Baum
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Maria Karsten
- Department of Gynecology, Charite Berlin, Berlin/Germany
| | - Ingolf Juhasz-Boess
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Marc Philipp Radosa
- Department of Gynecology and Obstetrics, Jena University Hospital, Jena, Germany
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Messini CI, Daponte A, Anifandis G, Mahmood T, Messinis IE. Standards of Care in infertility in Europe. Eur J Obstet Gynecol Reprod Biol 2016; 207:S0301-2115(16)30951-4. [PMID: 28029396 DOI: 10.1016/j.ejogrb.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022]
Abstract
Evidence-based medicine is the principal approach to medical practice. There are several debatable issues in infertility, which require clarification. Over the past 20 years, reliable methodology has been developed for the management of infertile couples. This includes high quality diagnostic and therapeutic procedures, which are applied in highly specialised infertility centres. The European Board and College of Obstetrics and Gynaecology (EBCOG) has published Standards of Care for Women's Health in Europe, which should be the cornerstone for the clinicians and service providers in the European Union to establish common protocols within their centres. Each infertility treatment should result in the highest possible success rate and all appropriate measures for the patient's safety should be in place. The treatment protocols should minimise risk of complications, such as ovarian hyperstimulation syndrome (OHSS). The current use of GnRH agonists to trigger final follicle maturation has provided the means for avoiding this syndrome. Additionally, multiple pregnancy rates are still high in assisted reproductive technology (ART). These rates should be reduced by the adoption of single embryo transfer during IVF treatment and by the proper monitoring of ovulation induction protocols. EBCOG Standards of Care for infertility and assisted conception treatment derived from the best available evidence should underpin the provision of high quality infertility services in European countries.
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Affiliation(s)
- Christina I Messini
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - George Anifandis
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Tahir Mahmood
- Department of Obstetrics & Gynaecology, Victoria Hospital, Kirkcaldy, Scotland, UK; European Board and College of Obstetrics & Gynaecology (EBCOG), UK
| | - Ioannis E Messinis
- Department of Obstetrics & Gynaecology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; European Board and College of Obstetrics & Gynaecology (EBCOG), UK.
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Russo M, Suen M, Bedaiwy M, Chen I. Prevalence of Uterine Myomas Among Women with 2 or More Recurrent Pregnancy Losses: A Systematic Review. J Minim Invasive Gynecol 2016; 23:702-6. [DOI: 10.1016/j.jmig.2016.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/27/2016] [Accepted: 03/23/2016] [Indexed: 11/16/2022]
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90
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Viner AC, Menezes MQ. An Overview of the Aetiology, Epidemiology, Symptomatology and Management of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0150-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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91
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Dixit N, Jesner O, Modarres M. Endoscopic Treatment and Power Morcellation of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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92
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Abstract
A debate among gynecologic and reproductive surgeons is whether or not there is a clinical need to treat all intramural myomas. Considerations include myoma size and number, ability to access them, whether or not they compromise the endometrium, and treatment effect on gynecologic, reproductive, and obstetric outcomes. We conducted a detailed study regarding intramural myomas, their prevalence in subject populations, the imaging methods used to detect them, their growth rate, their suspected adverse effects on gynecologic, fertility, and obstetric outcomes, and the effectiveness of various treatment methods. The growing body of evidence reported in the literature supports the need to manage intramural myomas and to treat them appropriately.
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Affiliation(s)
- Mayra J Thompson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruce R Carr
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Urological complications of uterine leiomyoma: a review of literature. Int Urol Nephrol 2016; 48:941-8. [PMID: 26922066 DOI: 10.1007/s11255-016-1248-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/13/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Uterine leiomyomas are common gynecologic tumor in reproductive-aged women, by age 50, diagnosis shared by urologist, gynecologists and radiologists. OBJECTIVE The goal of this article is to review the current literature, study the impact of leiomyoma on female lower urinary tract, examine the cause female sexual dysfunction and provide a comprehensive review of current diagnostic, imaging studies, and current treatment of leiomyoma. METHODS Clinical leiomyoma studies published from 1956 through 2015 were identified using the PubMed search engines and the key words leiomyoma, fibroid in the current literature. Impact of leiomyoma on the lower urinary tract including female sexual dysfunction was reviewed with terms of "urinary retention", "bladder", "urethra", "dyspareunia", "incontinence", "incomplete bladder emptying", "female sexual dysfunction", and "lower urinary tract" to study the urological and sexual effects of leiomyoma. Literature related to leiomyoma was reviewed from 1965 to present. RESULTS Women with uterine leiomyomata complained of pelvic pain, menstrual irregularities, infertility, lower urinary tract symptoms and sexual dysfunction. CONCLUSION Leiomyoma is a common tumor of the uterus that often clinically impacts on the lower urinary tract and results in urological and sexual symptoms. Leiomyoma can compress and grow into and become adherent to the bladder and surrounding pelvic organs or metastasize into peritoneal organs. Leiomyoma can enlarge and compress the urinary bladder, urethra, and lower end of the ureters. Leiomyoma can cause embarrassing sexual dysfunction in females. Current literature of non-surgical and surgical therapy of leiomyoma is described.
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Sancho JM, Delgado VSDLC, Valero MJN, Soteras MG, Amate VP, Carrascosa AA. Hysteroscopic myomectomy outcomes after 3-month treatment with either Ulipristal Acetate or GnRH analogues: a retrospective comparative study. Eur J Obstet Gynecol Reprod Biol 2016; 198:127-130. [PMID: 26871272 DOI: 10.1016/j.ejogrb.2016.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 12/11/2015] [Accepted: 01/02/2016] [Indexed: 11/18/2022]
Abstract
Ulipristal Acetate (UPA) modifies the endometrium, as well as fibroids, and therefore it might make hysteroscopic surgery more difficult. To confirm that pre-treatment with UPA is as safe and effective an option as pre-treatment with GnRH analogues, considered the gold standard. We present the first series of 26 hysteroscopic myomectomies after 3 months treatment with UPA and we compare the results with a series of 24 cases pretreated with GnRH analogues. This was a retrospective cohort study between July 2013 and May 2015. We analyszed patients with submucous myomas >2.5 in diameter. Hysteroscopic myomectomy was performed after 3 months of treatment with either UPA (5mg daily) or the GnRH agonist (3.75mg/month). Both groups were similar in age, myoma initial size and classification. There were no significant differences between UPA and GnRHa treated groups in terms of percentage of myomas resected (93% vs 98%), duration of surgery (38 vs 37min), fluid deficit (200 vs 350ml) and complications. In the surgeon's subjective opinion, UPA treatment was associated with an easier resection. Based on our experience, previous treatment with UPA does not difficult Hhysteroscopic myomectomy. Endometrial changes have no impact on surgery. Safety and feasibility are comparable to hysteroscopic myomectomies with previous treatment with GnRH analogues. This allows us to take advantage of the reduction in size of fibroids before surgery with less side effects.
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Evidence-Based Reviews From Other Sources. J Obstet Gynecol Neonatal Nurs 2015. [DOI: 10.1016/s0884-2175(15)35346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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