Management of Submucosal Myomas Not Completely Resected

PERSONIFICATION OF VISUAL DIAGNOSTIC METHODS IN WOMEN WITH SUBMUCOSAL UTERINE FIBROIDS: A RETROSPECTIVE CLINICAL ANALYSIS

OBJECTIVE

The aim: To determine the parameters of perioperative application of radiographic methods for visual diagnosis in women with submucous uterine fibroids.

PATIENTS AND METHODS

Materials and methods: We conducted a retrospective analysis of the data from 200 medical records of women with submucous uterine fibroids (SUF).

RESULTS

Results: Preoperatively, nodes were diagnosed by ultrasound as follows: solitary nodes - SM0 type - 65 (46%) near the fundus; SMІ - 41 (29%) on the anterior or posterior wall; SMІІ - 35 (25%) on the lateral walls of the uterus and in the cornual areas of the fallopian tubes; multiple in combinations: О3-4 / SMІ - 16 (27.0%) and О3-6 / SMІІ - 14 (24.0%); with localization: О3-4 / SM0 - mainly in the fundus - 49%, О3-4 / SMІ and О3-4 / SMІІ on the posterior and lateral - 25.0%, 28.0%; О5-6 / SM0 - posterior and fundus - 38.0%, 49.0%; О5-6 / SMІ and О5-6 / SMІІ - posterior and lateral - 45.0% and 37.5%. The maximum average diameter was 20-30 mm, with a quantity of ≤ 3 per individual. When comparing ultrasound and MRI data, discrepancies in the number and localization of nodes were observed in cases of isolated SMІ / SMІІ (on the lateral walls and in the cornual areas of the uterus) at 29.0%; as well as in cases involving combinations of nodes of types О 3-4 / SMІ at 39.0% and О 3-4 / SMІІ at 23.0% (p<0.05). During hysteroscopy, in the group without intraoperative sonography, there were 30% more conversions from hysteroscopic to laparoscopic myomectomy, and 25% more combinations of hysteroscopic myomectomy with laparoscopic monitoring.

CONCLUSION

Conclusions: Hysteroscopic myomectomy with intraoperative sonography is an effective method of treatment for isolated and multiple fibroids of types SMІ/ SMІІ and О3-4/SMІ as well as О3-4/SMІІ.

Successful management of a submucosal fibroid using a hysteroscopic morcellator system in a patient with a history of total proctocolectomy: A case report

Transcervical resection is widely used in the management of submucosal fibroids. However, uterine perforation and thermal bowel injuries are known complications associated with the procedure. This is a case report of a 44-year-old woman who presented with heavy menstrual bleeding and anemia. Magnetic resonance imaging and hysteroscopy revealed multiple fibroids, including a submucosal type 1 fibroid. She had previously undergone a total proctocolectomy with intestinal pouch-anal anastomosis for ulcerative colitis. Because there was a high risk of permanent colostomy in the event of a bowel injury, an electrode-free, operative hysteroscopy using the Intrauterine Bigatti Shaver (IBS), a hysteroscopic morcellator system, was employed to prevent thermal bowel injury. The fibroid was completely removed using the IBS system with no complications. Therefore, we recommend the electrode-free use of a hysteroscopic morcellator system in patients with a history of extensive pelvic surgery.