1
|
Ciebiera M, Kociuba J, Ali M, Madueke-Laveaux OS, Yang Q, Bączkowska M, Włodarczyk M, Żeber-Lubecka N, Zarychta E, Corachán A, Alkhrait S, Somayeh V, Malasevskaia I, Łoziński T, Laudański P, Spaczynski R, Jakiel G, Al-Hendy A. Uterine fibroids: current research on novel drug targets and innovative therapeutic strategies. Expert Opin Ther Targets 2024; 28:669-687. [PMID: 39136530 DOI: 10.1080/14728222.2024.2390094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 08/05/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Uterine fibroids, the most common nonmalignant tumors affecting the female genital tract, are a significant medical challenge. This article focuses on the most recent studies that attempted to identify novel non-hormonal therapeutic targets and strategies in UF therapy. AREAS COVERED This review covers the analysis of the pharmacological and biological mechanisms of the action of natural substances and the role of the microbiome in reference to UFs. This study aimed to determine the potential role of these compounds in UF prevention and therapy. EXPERT OPINION While there are numerous approaches for treating UFs, available drug therapies for disease control have not been optimized yet. This review highlights the biological potential of vitamin D, EGCG and other natural compounds, as well as the microbiome, as promising alternatives in UF management and prevention. Although these substances have been quite well analyzed in this area, we still recommend conducting further studies, particularly randomized ones, in the field of therapy with these compounds or probiotics. Alternatively, as the quality of data continues to improve, we propose the consideration of their integration into clinical practice, in alignment with the patient's preferences and consent.
Collapse
Affiliation(s)
- Michal Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
- Warsaw Institute of Women's Health, Warsaw, Poland
- Development and Research Center of Non-Invasive Therapies, Pro-Familia Hospital, Rzeszow, Poland
| | - Jakub Kociuba
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
- Warsaw Institute of Women's Health, Warsaw, Poland
| | - Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | | | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Monika Bączkowska
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Marta Włodarczyk
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
- Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Natalia Żeber-Lubecka
- Department of Gastroenterology, Hepatology and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
- Department of Genetics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Elżbieta Zarychta
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Ana Corachán
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - Samar Alkhrait
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Vafaei Somayeh
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | | | - Tomasz Łoziński
- Development and Research Center of Non-Invasive Therapies, Pro-Familia Hospital, Rzeszow, Poland
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszow, Poland
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Piotr Laudański
- Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, Warsaw, Poland
- Women's Health Research Institute, Calisia University, Kalisz, Poland
- OVIklinika Infertility Center, Warsaw, Poland
| | - Robert Spaczynski
- Center for Gynecology, Obstetrics and Infertility Treatment, Poznan, Poland
- Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| |
Collapse
|
2
|
Lulseged BA, Ramaiyer MS, Michel R, Saad EE, Ozpolat B, Borahay MA. The Role of Nanomedicine in Benign Gynecologic Disorders. Molecules 2024; 29:2095. [PMID: 38731586 PMCID: PMC11085148 DOI: 10.3390/molecules29092095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Nanomedicine has revolutionized drug delivery in the last two decades. Nanoparticles appear to be a promising drug delivery platform in the treatment of various gynecological disorders including uterine leiomyoma, endometriosis, polycystic ovarian syndrome (PCOS), and menopause. Nanoparticles are tiny (mean size < 1000 nm), biodegradable, biocompatible, non-toxic, safe, and relatively inexpensive materials commonly used in imaging and the drug delivery of various therapeutics, such as chemotherapeutics, small molecule inhibitors, immune mediators, protein peptides and non-coding RNA. We performed a literature review of published studies to examine the role of nanoparticles in treating uterine leiomyoma, endometriosis, PCOS, and menopause. In uterine leiomyoma, nanoparticles containing 2-methoxyestradiole and simvastatin, promising uterine fibroid treatments, have been effective in significantly inhibiting tumor growth compared to controls in in vivo mouse models with patient-derived leiomyoma xenografts. Nanoparticles have also shown efficacy in delivering magnetic hyperthermia to ablate endometriotic tissue. Moreover, nanoparticles can be used to deliver hormones and have shown efficacy as a mechanism for transdermal hormone replacement therapy in individuals with menopause. In this review, we aim to summarize research findings and report the efficacy of nanoparticles and nanotherapeutics in the treatment of various benign gynecologic conditions.
Collapse
Affiliation(s)
- Bethlehem A. Lulseged
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (B.A.L.); (M.S.R.)
| | - Malini S. Ramaiyer
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (B.A.L.); (M.S.R.)
| | - Rachel Michel
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Eslam E. Saad
- Department of Gynecology and Obstetrics, Johns Hopkins University, 720 Rutland Ave, Baltimore, MD 21205, USA;
| | - Bulent Ozpolat
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA;
| | - Mostafa A. Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University, 720 Rutland Ave, Baltimore, MD 21205, USA;
| |
Collapse
|
3
|
Aggarwal H, Aggarwal H, Wanjari A. Unnecessary Hysterectomies Among Premenopausal Women in Developed and Developing Countries: A Critical Review of Steps Taken to Improve Women's Health. Cureus 2023; 15:e49943. [PMID: 38179386 PMCID: PMC10765271 DOI: 10.7759/cureus.49943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Women with pelvic organ disease often require a hysterectomy for better health. Still, in countries like India, there are many challenges for them as they are subjected many a time to unnecessary hysterectomies. Through this article, we suggest many ways to address this menace, such as proper health education and sensitization of women of premenopausal age group by health workers and mass media. Many preventable hysterectomies can be avoided if we guide women about their pathology before giving consent for surgery. Role enhancement of health agencies and nongovernmental organizations for early identification of such women in the society of all segments, stopping the greed of various health institutions using government-sponsored insurance health schemes for personal gain, and law enforcement by courts and health departments should also be our main focus. This study aims to review nonsurgical procedures adopted to decrease unnecessary hysterectomies and make suitable directions by government and lawful agencies to curb this menace. All states and union territories received the "Guidelines to Prevent Unnecessary Hysterectomies" recommendations from the Ministry of Health and Family Welfare for compliance. The recommendations suggest creating hysterectomy monitoring committees at the district, state, and federal levels. The duration of hospital stays and associated expenditures can decrease by performing minimally invasive treatments as outpatient operations. Minimally invasive options may shape the future of gynecology in developed nations.
Collapse
Affiliation(s)
- Hitaishi Aggarwal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Hardik Aggarwal
- Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Anil Wanjari
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
4
|
Frisch EH, Mitchell J, Yao M, Llarena N, Omosigho UR, DeAngelo L, Arakelian M, Bradley L, Falcone T. The Impact of Fertility Goals on Long-term Quality of Life in Reproductive-aged Women Who Underwent Myomectomy versus Hysterectomy for Uterine Fibroids. J Minim Invasive Gynecol 2023; 30:642-651. [PMID: 37044261 DOI: 10.1016/j.jmig.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
STUDY OBJECTIVE The objective of this study is to compare quality of life (QOL) for myomectomy with hysterectomy 1 to 5 years after surgical management for fibroids. This study evaluated the difference in QOL in a population of women of reproductive age, including those who desire fertility. DESIGN A retrospective cohort study. INTERVENTIONS Not applicable. SETTING A large academic hospital. PATIENTS A total of 142 women who underwent hysterectomy or myomectomy in 2015 to 2020. Included patients were women aged 18 years or older who underwent surgical intervention owing to uterine fibroids. MEASUREMENTS AND MAIN RESULTS The 36-Item Short Form Health Survey (SF-36) provides a total score as a single measure of health-related QOL. The Uterine Fibroid Symptom Quality of Life Questionnaire for Hysterectomy and Myomectomy (UFS-QOL) is a patient-reported outcome measure of fibroid symptoms and health-related QOL after hysterectomy and myomectomy. There was no significant difference in SF-36 QOL scores in women after myomectomy who desired fertility compared with those who did not desire fertility, except in the social functioning domain (p = .025). UFS-QOL scores in women after myomectomy who desired fertility were not significantly different compared with women after myomectomy who did not desire fertility (p = .37). There were no significant differences between women who underwent myomectomy and hysterectomy in overall QOL scores on the SF-36 (p = .13) and UFS-QOL scores (p = .16). CONCLUSION Myomectomy is not associated with significant differences in measures of general health and QOL compared with hysterectomy, making it a viable fibroid management option for women who desire fertility. Our study highlights the importance of discussing fertility goals and QOL when counseling patients for surgical fibroid treatment.
Collapse
Affiliation(s)
- Emily H Frisch
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena).
| | - Jameson Mitchell
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Meng Yao
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Natalia Llarena
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Ukpebo R Omosigho
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Lydia DeAngelo
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Miranda Arakelian
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Linda Bradley
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| | - Tommaso Falcone
- ObGyn and Women's Health Institute (Drs. Frisch, Llarena, Omosigho, Bradley, and Falcone); and Quantitative Health Sciences (Mr. Yao), Cleveland Clinic Foundation, Cleveland, Ohio; Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio (Mr. Mitchell, Ms. DeAngelo, and Ms. Arakelian); HRC Fertility, Pasadena, California (Dr. Llarena)
| |
Collapse
|
5
|
Cappelli A, Mosconi C, Cocozza MA, Brandi N, Bartalena L, Modestino F, Galaverni MC, Vara G, Paccapelo A, Pizzoli G, Villa G, Seracchioli R, Renzulli M. Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids of Different Sizes: A Single Center Experience. J Pers Med 2023; 13:906. [PMID: 37373895 DOI: 10.3390/jpm13060906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The present study aimed to evaluate the clinical and radiological 1-year outcomes of uterine artery embolization (UAE) performed in a selected population of women with symptomatic myomas and who do not wish to conceive. Between January 2004 and January 2018, a total of 62 patients with pre-menopausal status and with no wish to conceive in the future underwent UAE for the treatment of symptomatic fibroids. All the patients underwent magnetic resonance imaging (MRI) and/or transvaginal ultrasonography (TV-US) before and after the procedure at 1-year follow-up. Clinical and radiological parameters were recorded, stratifying the population into 3 groups according to the size of the dominant myoma (group 1: <50 mm; group 2: ≥50 and ≤80 mm; group 3: >80 mm). Mean fibroid diameter was significantly reduced (42.6% ± 21.6%) at 1-year follow-up, with excellent improvements in terms of both symptoms and quality of life. No significant difference was observed regarding baseline dimension and the number of myomas. No major complications were reported (2.5%). The present study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids in pre-menopausal women with no desire to conceive.
Collapse
Affiliation(s)
- Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Maria Adriana Cocozza
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Laura Bartalena
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Maria Cristina Galaverni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alexandro Paccapelo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gloria Pizzoli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gioia Villa
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| |
Collapse
|
6
|
Dumitrașcu MC, Nenciu CG, Nenciu AE, Călinoiu A, Neacșu A, Cîrstoiu M, Șandru F. Laparoscopic myomectomy - The importance of surgical techniques. Front Med (Lausanne) 2023; 10:1158264. [PMID: 37020679 PMCID: PMC10067888 DOI: 10.3389/fmed.2023.1158264] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 04/07/2023] Open
Abstract
Laparoscopy is a routine procedure for benign gynecological tumors. Although the laparoscopic approach for myomas is a common procedure, it can be challenging. To improve outcomes, research regarding port access, suture type, morcellation, and complication management remains ongoing. Myomectomy is the main surgical option for patients seeking uterus-sparing procedures to maintain future fertility. The laparoscopic technique is the most important in these cases, given that possible complications can impact fertility and pregnancy outcomes. Herein, we reviewed and collated the available data regarding different suture techniques, including advantages, difficulties, and possible long-term impacts.
Collapse
Affiliation(s)
- Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Cătălin-George Nenciu
- Department of Obstetrics and Gynecology, “St. John” Emergency Clinical Hospital of Bucharest, Bucharest, Romania
| | - Adina-Elena Nenciu
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Amalia Călinoiu
- Department of Internal Medicine, “Prof. Dr. Agripa Ionescu” Emergency Hospital, Bucharest, Romania
| | - Adrian Neacșu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, Bucharest, Romania
- Department of Obstetrics and Gynecology, “St. John” Emergency Clinical Hospital of Bucharest, Bucharest, Romania
| | - Monica Cîrstoiu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Florica Șandru
- Department of Dermatology, Carol Davila’ University of Medicine and Pharmacy, Bucharest, Romania
- Department of Dermatology, Elias Emergency University Hospital, Bucharest, Romania
| |
Collapse
|
7
|
McKain L, Edsall K, Dufour R, Lickert C. Treatment Patterns in Patients with Uterine Fibroids With and Without a Diagnosis of Heavy Menstrual Bleeding: Results from a Large U.S. Claims Database. J Womens Health (Larchmt) 2023; 32:332-340. [PMID: 36413048 PMCID: PMC9993160 DOI: 10.1089/jwh.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: This retrospective database analysis describes clinical characteristics and treatment patterns of U.S. women with a diagnosis for uterine fibroids (UF), both with and without heavy menstrual bleeding (HMB). Materials and Methods: Two cohorts aged 18-50 years with an incident UF diagnosis, comprising women with and without claims for HMB (UF-HMB and UF-only), were identified from the IQVIA PharMetrics® Plus database (January 1, 2010-December 31, 2019). The index date was the first UF claim following diagnosis; treatment patterns were documented for postindex years 1 and 2 and the full duration of postindex follow-up. Also identified were claims for symptoms or signs potentially associated with UF. Outcomes were the proportion of patients treated with pharmacologic therapies of interest and gynecologic procedures. Logistic regression was used to identify factors associated with postdiagnosis hysterectomy and hormonal therapy. Results: A total of 66,313 (71.8%) women were included in the UF-HMB cohort (mean age [standard deviation]) 42.6 [5.4] years), and 26,068 (28.2%) in the UF-only cohort (41.8 [6.3]). Median follow-up was ∼4 years. Pain was the most common symptom (42.7% in patients with UF-HMB and 36.6% with UF-only); also common were abnormal bleeding (15.6%, 11.5%) and fatigue (22.2%, 15.5%). Within 1 year of UF diagnosis, 28.8% and 49.2% of women with UF-HMB and UF-only, respectively, had no claims for relevant pharmacologic or surgical treatment. In logistic regression, multiple factors were associated with a higher likelihood of receiving hysterectomy or hormonal therapy. Conclusions: Patients with UF-HMB were more likely to receive UF treatment, either surgical or pharmacologic, than women with UF-only. Apart from HMB, pain was the most commonly documented symptom of UF.
Collapse
Affiliation(s)
- Laura McKain
- Medical Affairs, Myovant Sciences, Inc., Brisbane, California, USA
| | - Kaitlyn Edsall
- Life Sciences Practice, Charles River Associates, Boston, Massachusetts, USA
| | - Robert Dufour
- Medical Affairs, Myovant Sciences, Inc., Brisbane, California, USA
| | | |
Collapse
|
8
|
Theis M, Tonguc T, Savchenko O, Nowak S, Block W, Recker F, Essler M, Mustea A, Attenberger U, Marinova M, Sprinkart AM. Deep learning enables automated MRI-based estimation of uterine volume also in patients with uterine fibroids undergoing high-intensity focused ultrasound therapy. Insights Imaging 2023; 14:1. [PMID: 36600120 PMCID: PMC9813298 DOI: 10.1186/s13244-022-01342-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/02/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is used for the treatment of symptomatic leiomyomas. We aim to automate uterine volumetry for tracking changes after therapy with a 3D deep learning approach. METHODS A 3D nnU-Net model in the default setting and in a modified version including convolutional block attention modules (CBAMs) was developed on 3D T2-weighted MRI scans. Uterine segmentation was performed in 44 patients with routine pelvic MRI (standard group) and 56 patients with uterine fibroids undergoing ultrasound-guided HIFU therapy (HIFU group). Here, preHIFU scans (n = 56), postHIFU imaging maximum one day after HIFU (n = 54), and the last available follow-up examination (n = 53, days after HIFU: 420 ± 377) were included. The training was performed on 80% of the data with fivefold cross-validation. The remaining data were used as a hold-out test set. Ground truth was generated by a board-certified radiologist and a radiology resident. For the assessment of inter-reader agreement, all preHIFU examinations were segmented independently by both. RESULTS High segmentation performance was already observed for the default 3D nnU-Net (mean Dice score = 0.95 ± 0.05) on the validation sets. Since the CBAM nnU-Net showed no significant benefit, the less complex default model was applied to the hold-out test set, which resulted in accurate uterus segmentation (Dice scores: standard group 0.92 ± 0.07; HIFU group 0.96 ± 0.02), which was comparable to the agreement between the two readers. CONCLUSIONS This study presents a method for automatic uterus segmentation which allows a fast and consistent assessment of uterine volume. Therefore, this method could be used in the clinical setting for objective assessment of therapeutic response to HIFU therapy.
Collapse
Affiliation(s)
- Maike Theis
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Tolga Tonguc
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Oleksandr Savchenko
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sebastian Nowak
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Wolfgang Block
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,grid.15090.3d0000 0000 8786 803XDepartment of Radiotherapy and Radiation Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Florian Recker
- grid.15090.3d0000 0000 8786 803XDepartment of Gynaecology and Gynaecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Markus Essler
- grid.15090.3d0000 0000 8786 803XDepartment of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Alexander Mustea
- grid.15090.3d0000 0000 8786 803XDepartment of Gynaecology and Gynaecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Ulrike Attenberger
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Milka Marinova
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,grid.15090.3d0000 0000 8786 803XDepartment of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Alois M. Sprinkart
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| |
Collapse
|
9
|
Improvement of fibroid-associated symptoms and quality of life after US-guided high-intensity focused ultrasound (HIFU) of uterine fibroids. Sci Rep 2022; 12:21155. [PMID: 36476975 PMCID: PMC9729612 DOI: 10.1038/s41598-022-24994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Uterine fibroids are the most common benign uterine tumors and can cause various severe symptoms as abnormal menstrual bleeding or pelvic pain. Therefore, the primary objective in the treatment of uterine fibroids is a sufficient symptom relief. Ultrasound (US)-guided High-intensity focused ultrasound (HIFU) is an effective non-invasive treatment strategy for ablation of uterine fibroids that can achieve a significant tumor volume reduction. The aim of the study is to evaluate if US-guided HIFU treatment can reduce fibroid-associated symptoms leading to an improvement of health-related quality of life. Fifty-five women with symptomatic uterine fibroids underwent US-guided HIFU ablation. Clinical evaluation was performed on the basis of the Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire (UFS-QOL) at baseline, 6 weeks, 3, 6, 9 and 12 months after HIFU. Imaging follow-up included contrast-enhanced ultrasound (CEUS) and contrast-enhanced MRI. A significant reduction of the Symptom Severity Scale (SSS) was observed between 6 weeks and 12 months after HIFU (49.9 ± 19.4 at baseline vs. 42.2 ± 20.1 at 6 weeks and 23.6 ± 12.7 at 12 months after treatment, p < 0.001) correlating with a significant improvement (p < 0.001) of Health-related Quality of Life (HRQL) (52.5 ± 22.7 at baseline vs. 59.8 ± 22 at 6 weeks and 77.9 ± 17.3 at 12 months after treatment). Significant postinterventional improvement was observed in every subscale of HRQL. In the majority of patients, only minor, short-lasting and self-limiting side effects were observed, e.g. soft tissue edema of the anterior lower abdominal wall in the acoustic pathway or transient moderate lower abdominal pain as during menstruation. One patient with a very large fibroid experienced strong short-lasting pain after the procedure; two patients experienced post-procedurally a transient sciatic nerve irritation. US-guided HIFU of uterine fibroids reduces disease-related symptoms and improves health-related quality of life.
Collapse
|
10
|
Characteristics of Submucous Myomas and the Risk of Anemia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111652. [PMID: 36422191 PMCID: PMC9699579 DOI: 10.3390/medicina58111652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Uterine fibroids still represent the most common indication for hysterectomy for benign pathologies. In the United States, more than 479,000 hysterectomies are performed annually, 46.6% for myomas and 47.7% in women aged from 18 to 44 years. By applying appropriateness criteria to this procedure, it has been estimated that overuse ranges from 16 to 70%. One of the main reasons that induce patients and gynecologists to consider hysterectomy is represented by severe anemia. Materials and Methods: This is a retrospective cohort study of 202 patients with uterine fibroids diagnosed by transvaginal ultrasound who underwent a hysteroscopic procedure. Myoma grade, size, location, and number were assessed by transvaginal scan and office hysteroscopy and correlated to the pre-treatment hemoglobin level. Results: Univariate analysis showed that anemia does not have a statistically significant association with myoma number and with age considered as a numerical predictor. In the patients with myoma type 0, there is a possibility of 81% having anemia regardless of menorrhagia. On the contrary, in patients with myoma type 1 or type 2, the possibility of having anemia varies according to the presence or absence of menorrhagia. If there is menorrhagia, the risk of moderate anemia is only present for myomas >60 mm. Conclusions: The results of this study may contribute to defining objective criteria for the management of submucous myomas and anemia. Our data suggest that submucosal myomas type 0 >10 mm should always be treated, putting patients at risk for anemia. Myomas type 2 and 3 should be treated for the risk of anemia in the presence of menorrhagia episodes or if > of 60 mm. Adequate management of anemia and myomas could reduce the rate of unnecessary hysterectomies.
Collapse
|
11
|
Chen L, Chen H, Yang Q, Jiang Y, Liu L, Yu H, Chen Y, Li J, Chen N, Wang H, Wang Q. Guizhi Fuling Capsule inhibits uterine fibroids growth by modulating Med12-mediated Wnt/β-Catenin signaling pathway. JOURNAL OF ETHNOPHARMACOLOGY 2022; 290:115115. [PMID: 35181487 DOI: 10.1016/j.jep.2022.115115] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Guizhi Fuling Capsule (GFC) is a famous traditional Chinese medicine (TCM) formula recorded in Synopsis of the Golden Chamber, which has achieved obvious effects in the treatment of uterine fibroids (UFs). AIM OF STUDY Mediator complex subunit 12 (Med12) mutations were closely related to UFs in 85% of fibroid cases. The Wnt/β-Catenin signaling pathway plays an important role in the occurrence and development of UFs. This study aims to explore the pharmacological mechanism of GFC against UFs in which the Med12-mediated Wnt/β-Catenin pathway is involved. MATERIALS AND METHODS Med12 was silenced in uterine fibroid cells (UFCs) using a lentivirus-based Med12 gene-specific RNA interference (RNAi) strategy. Cell proliferation was performed by CCK-8 assay, cell apoptosis and cell cycle were measured by flow cytometry. The rat model of UFs was established by injecting estradiol benzoate and progesterone. Forty-eight rats were divided into six groups, the low-dose GFC (L-GFC) group, the medium-dose GFC (M-GFC) group and the high-dose GFC (H-GFC) group were intragastrically treated with GFC solution at 0.25 g/kg, 0.50 g/kg and 1.00 g/kg per day for 8 weeks, the positive control (PC) group was administrated with mifepristone (2.70 mg/kg/day), the normal control (NC) group and the model control (MC) group were given equal volume of normal saline once a day for 8 weeks. The histopathological changes of uterine tissues were evaluated by H&E staining. The expression of Med12 in uterine tissues were detected by immunohistochemistry. The protein and mRNA levels of associated genes were evaluated by western bolt and real time-PCR, respectively. Related indicators involved in Wnt/β-Catenin pathway, such as Wnt1, β-Catenin, Cyclin D1, TCF1/TCF7 and C-myc, were compared among different groups. RESULTS The Wnt/β-Catenin signaling pathway was inhibited after Med12 gene was knocked out in UFCs. GFC-containing serum could induce cell apoptosis, make the cell cycle stagnated in G0/G1 phase to inhibiting the proliferation and reduce the expression of Wnt1, β-Catenin, Cyclin D1, TCF1/TCF7, and C-myc in control-shRNA cells, while had no significant effect on Med12-shRNA cells. Compared with the MC group, the weight, endometrial thickness, and pathological structure of the uterus in the GFC treated groups were significantly improved. The expression of Med12, Wnt1, β-Catenin, Cyclin D1, TCF1/TCF7, and C-myc that related to Wnt/β-Catenin pathway in the GFC treated groups were decreased with the increase of dosage administration. CONCLUSIONS GFC inhibited UFs growth, which was directly associated with Med12 modulated Wnt/β-Catenin signaling pathway. This study provided new perspective to understand the therapeutic mechanism of UFs.
Collapse
Affiliation(s)
- Linwei Chen
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, PR China; Department of Science and Technology, Taizhou Hospital Affiliated to Nanjing University of Chinese Medicine, Taizhou, 225300, PR China.
| | - Honglin Chen
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, PR China.
| | - Qiaowei Yang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, PR China.
| | - Yong Jiang
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, PR China.
| | - Lunyuan Liu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, PR China.
| | - Hui Yu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, PR China.
| | - Yan Chen
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, 210023, PR China; Department of Science and Technology, Taizhou Hospital Affiliated to Nanjing University of Chinese Medicine, Taizhou, 225300, PR China.
| | - Jindong Li
- Department of Pharmacy, Taizhou People's Hospital, Taizhou, 225300, PR China.
| | - Nan Chen
- Department of Science and Technology, Taizhou Hospital Affiliated to Nanjing University of Chinese Medicine, Taizhou, 225300, PR China.
| | - Hua Wang
- Department of Pharmacy, Taizhou People's Hospital, Taizhou, 225300, PR China.
| | - Qin Wang
- Department of Science and Technology, Taizhou Hospital Affiliated to Nanjing University of Chinese Medicine, Taizhou, 225300, PR China.
| |
Collapse
|
12
|
Włodarczyk M, Nowicka G, Ciebiera M, Ali M, Yang Q, Al-Hendy A. Epigenetic Regulation in Uterine Fibroids-The Role of Ten-Eleven Translocation Enzymes and Their Potential Therapeutic Application. Int J Mol Sci 2022; 23:2720. [PMID: 35269864 PMCID: PMC8910916 DOI: 10.3390/ijms23052720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Uterine fibroids (UFs) are monoclonal, benign tumors that contain abnormal smooth muscle cells and the accumulation of extracellular matrix (ECM). Although benign, UFs are a major source of gynecologic and reproductive dysfunction, ranging from menorrhagia and pelvic pain to infertility, recurrent miscarriage, and preterm labor. Many risk factors are involved in the pathogenesis of UFs via genetic and epigenetic mechanisms. The latter involving DNA methylation and demethylation reactions provide specific DNA methylation patterns that regulate gene expression. Active DNA demethylation reactions mediated by ten-eleven translocation proteins (TETs) and elevated levels of 5-hydroxymethylcytosine have been suggested to be involved in UF formation. This review paper summarizes the main findings regarding the function of TET enzymes and their activity dysregulation that may trigger the development of UFs. Understanding the role that epigenetics plays in the pathogenesis of UFs may possibly lead to a new type of pharmacological fertility-sparing treatment method.
Collapse
Affiliation(s)
- Marta Włodarczyk
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland;
- Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Grażyna Nowicka
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland;
- Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Michał Ciebiera
- The Center of Postgraduate Medical Education, Second Department of Obstetrics and Gynecology, 01-809 Warsaw, Poland;
| | - Mohamed Ali
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo 11566, Egypt;
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (Q.Y.); (A.A.-H.)
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (Q.Y.); (A.A.-H.)
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; (Q.Y.); (A.A.-H.)
| |
Collapse
|
13
|
A Call-to-Action for Clinicians to Implement Evidence-Based Best Practices When Caring for Women with Uterine Fibroids. Reprod Sci 2022; 29:1188-1196. [PMID: 35178678 PMCID: PMC8853611 DOI: 10.1007/s43032-022-00877-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/06/2022] [Indexed: 11/12/2022]
Abstract
Uterine fibroids are common benign tumors that occur in up to 80% of women. Approximately half of the women affected experience considerable physical, psychological, and economic burdens and impact on quality of life due to symptoms such as heavy menstrual bleeding, pelvic pain, and infertility. Several medical and surgical options are available to treat uterine fibroids; however, healthcare providers may benefit from practical guidance in the development of individualized treatment plans based on a personalized approach. Medical treatments and minimally invasive procedures are generally preferred by most patients before considering more invasive, higher risk surgical interventions. In general, patient-centered, uterine-preserving procedures may be prioritized based on the patient’s goals and the clinical scenario. Occasionally, hysterectomy may be the preferred treatment option for some patients who require definitive treatment. This call-to-action highlights recent challenges to patient care, including radical shifts in physician–patient interactions due to the COVID-19 pandemic and recent changes to evidence-based, clinically approved therapies. This report also reviews contemporary recommendations for women’s health providers in the diagnosis and medical and surgical management of uterine fibroids. This call-to-action aims to empower healthcare providers to optimize the quality of care for women with uterine fibroids utilizing the best available evidence and best practices.
Collapse
|
14
|
Cavaliere AF, Vidiri A, Gueli Alletti S, Fagotti A, La Milia MC, Perossini S, Restaino S, Vizzielli G, Lanzone A, Scambia G. Surgical Treatment of "Large Uterine Masses" in Pregnancy: A Single-Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212139. [PMID: 34831895 PMCID: PMC8618779 DOI: 10.3390/ijerph182212139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
Uterine myomas or uterine fibroids are the most common benign uterine masses affecting women. The management of large myoma during pregnancy is challenging, and surgical treatment is a possible option. We report nine cases of pregnant women affected by uterine masses larger than 10 cm, who underwent surgical treatment during the second trimester of pregnancy. In all cases, the masses were preconceptionally unknown and diagnosed during the first trimester. In eight cases, no maternal and fetal complications arose during or after surgical treatment and delivery occurred at full term of pregnancy. In one case, spontaneous abortion was recorded. In all cases, histologic diagnosis demonstrated the benign nature. Women affected by large uterine masses diagnosed for the first time in pregnancy could be taken into consideration for surgical treatment in a referral center during the second trimester.
Collapse
Affiliation(s)
- Anna Franca Cavaliere
- Obstetrics and Gynaecology Unit, Santo Stefano Hospital, AUSL Toscana Centro, 59100 Prato, Italy
- Correspondence: ; Tel.: +39-338-315-3054
| | - Annalisa Vidiri
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.V.); (M.C.L.M.); (S.P.); (A.L.); (G.S.)
| | - Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.A.); (A.F.)
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.A.); (A.F.)
| | - Maria Concetta La Milia
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.V.); (M.C.L.M.); (S.P.); (A.L.); (G.S.)
| | - Silvia Perossini
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.V.); (M.C.L.M.); (S.P.); (A.L.); (G.S.)
| | - Stefano Restaino
- Division of Obstetrics and Gynecology, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (S.R.); (G.V.)
| | - Giuseppe Vizzielli
- Division of Obstetrics and Gynecology, University Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (S.R.); (G.V.)
| | - Antonio Lanzone
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.V.); (M.C.L.M.); (S.P.); (A.L.); (G.S.)
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Scambia
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.V.); (M.C.L.M.); (S.P.); (A.L.); (G.S.)
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.A.); (A.F.)
| |
Collapse
|
15
|
Mulita F, Liolis E, Kehagias D, Tchabashvili L, Kaplanis C, Iliopoulos F, Perdikaris I, Kehagias I. An enormous pelvic tumor in a 46-year-old woman with an elevated serum CA 125 level, what lies beneath it? Investigation of uterine tumors in postmenopausal women. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:154-157. [PMID: 34703417 PMCID: PMC8525254 DOI: 10.5114/pm.2021.109773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023]
Abstract
Abdominal and pelvic pain with an associated pelvic mass is a very common emergency situation. There is always a management dilemma for most emergency physicians regarding these patients. A 46-year-old postmenopausal woman was admitted to our emergency department (ED) with complaints of massive abdominal distention. Abdominal and pelvis magnetic resonance imaging (MRI) was performed, which revealed a huge pelvic abdominal mass. All tumor markers were within normal limits. However, the ovarian cancer antigen (CA 125) level was elevated. As there was a strong suspicion of malignancy, the patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Her final histopathology report was suggestive of uterine leiomyoma. Uterine leiomyomas are the most common benign uterine tumors in women. Surgical treatment is the gold standard, especially for older women with severe symptoms and no desire for future fertility. Although the combination of a pelvic tumor and a high-level of CA 125 arouses suspicion of gynecological malignancy, other benign conditions should always be considered in the differential diagnosis. There is limited evidence to support an association between elevated CA 125 levels and uterine fibroids so far. However, conditions such as the coexistence of adenomyosis and tumor size can affect the level of this marker in uterine fibroids.
Collapse
Affiliation(s)
- Francesk Mulita
- Corresponding author: Dr. Francesk Mulita, Department of Surgery, General University Hospital of Patras, Rio, Greece , e-mail:
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Nicolás I, Martínez-Zamora MÁ, Gracia M, Carrion A, Feixas G, Bernal L, Quintas L, Rius M, Castelo-Branco C, Carmona F. Management of symptomatic uterine fibroids after ulipristal acetate suspension and identification of high risk patients for surgery at 6-months of follow-up. Gynecol Endocrinol 2021; 37:831-835. [PMID: 34044726 DOI: 10.1080/09513590.2021.1929152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The use of ulipristal acetate (UPA) was indicated for the treatment of uterine fibroids. Following UPA suspension in March 2020, some patients presented worsening and required surgery. We aimed to identify patients at high-risk for undergoing surgery after UPA suspension. METHODS We evaluated 85 women receiving intermittent UPA treatment until March 2020. Following UPA suspension, patients received other medical treatments or surgery. The clinico-pathological features were recoded and a quality of life health survey was completed by patients at the time of UPA suspension and at 6-months thereafter. RESULTS After the suspension of UPA, 17 of the 85 patients receiving intermittent UPA (20%) required surgery, and 68 (80%) required other medical treatments. Patients who underwent surgery were younger and had greater fibroid volume. CONCLUSIONS In our series, 20% of clinically stable patients receiving intermittent UPA required surgery following UPA suspension. These women should be considered for future medical strategies.
Collapse
Affiliation(s)
- Inmaculada Nicolás
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - María Ángeles Martínez-Zamora
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ana Carrion
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Georgina Feixas
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Laura Bernal
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lara Quintas
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Camil Castelo-Branco
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clínic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| |
Collapse
|
17
|
Ghafarzadeh M, Shakarami A, Yari F, Marzban Rad Z. The role of anti-proliferative effects of atorvastatin on uterine fibroids: findings from a clinical study. Gynecol Endocrinol 2021; 37:721-724. [PMID: 33960277 DOI: 10.1080/09513590.2021.1922884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM Uterine myomas/fibroids are one of the most common benign tumors of the reproductive system in women. Given pleiotropic effects of statins, the aim of this study is to evaluate the therapeutic effects of atorvastatin on uterine fibroids in women of reproductive age. MATERIALS AND METHODS This randomized clinical study included 90 women aged 35-45 years with uterine fibroids. The patients were randomly allocated into the intervention group (received one tablet, 20 mg of atorvastatin every day for three months) and placebo. Ultrasound was performed every month, and the change in the size of fibroids was recorded for each patient. At the end of the study, the data obtained were analyzed using SPSSv22 and a p value < .05 was considered statistically significant. RESULTS The mean age in the placebo and intervention group was 39.63 ± 36.3 and 40.35 ± 3.32 years, respectively. The number and location of the tumor was comparable for the two groups. We observed a statically significant reduction in fibroid size from the treatment initiation until completion of three months, (41.06 ± 6.68 mm3 vs 35.16 ± 6.67 mm3) p = .0001. However, the decrease in fibroid size from 1st month to the 3rd month was not statistically significant, p = .189 (36.71 ± 5.54 mm3 vs 35.16 ± 6.67 mm3). CONCLUSION This study shows that treatment with atorvastatin might positively reduce the size of fibroids. The decrease was only statistically significant during the first month. Further studies with a detailed analysis of the intervention's clinical impact are required to consider statins as a therapeutic tool.
Collapse
Affiliation(s)
- Masoumeh Ghafarzadeh
- Department of Obstetrics and Gynecology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Amir Shakarami
- Department of Cardiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Yari
- Department of Reproductive Health, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Zahra Marzban Rad
- Department of Obstetrics and Gynecology, School of Medicine, Aja University of Medical Sciences, Tehran, Iran
| |
Collapse
|
18
|
The importance of compression sonoelastography in improving the diagnostics of the pathology of myometrium. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The diversity of the clinical picture and the asymptomatic nature of the clinical manifestations of myometrial pathology cause difficulties in diagnosis. There is a lack of reliable diagnostic criteria for this pathology, in particular, imaging, especially with the simultaneous combination of adenomyosis and leiomyoma.
The aim of the research. Determination of the possibility of compression sonoelastography in the diagnosis of myometrial pathology and determination of its sonoelastography characteristics in leiomyoma and adenomyosis, as well as comparison of sonoelastography results with histological data.
Materials and methods. Elastography images of 155 patients with adenomyosis and leiomyoma, as well as combined pathology, were analyzed, the elastography diagnosis of which was confirmed by histological examination.
Results. Leiomyoma and adenomyosis had different elastography characteristics (strain ratios) with different color mapping; their specific characteristics and main differences are determined. Based on sonoelastography, the majority of patients (n=30) were suspected of having uterine fibroids, 14 had adenomyosis, and 42 had adenomyosis and fibroids. Sonoelastography revealed histological signs of adenomyosis in 3 patients with uterine leiomyoma.
Conclusions. Ultrasound examination using compression sonoelastography in such pathological conditions of the myometrium as adenomyosis and leiomyoma, as well as unchanged myometrium, makes it possible to determine changes in the degree of elasticity of the myometrium in the corresponding pathology. Sonoelastography allows the identification of clear distinguishing features of fibroids and adenomyosis. The unchanged myometrium has a certain elasticity, which can be equated to a specific numerical value – the coefficient of deformation. This indicator has different meanings in myoma and adenomyosis, which makes it possible to differentiate these pathological conditions of the myometrium. Compression sonoelastography is able to identify clear distinguishing features of leiomyoma and adenomyosis, and consistency of diagnoses based on sonoelastography and histology is significant but not optimal.
Collapse
|
19
|
Hsieh CH, Lu YY, Liang SY. The health concerns related to hysterectomy among Taiwanese women with uterine fibroids- a mixed-methods study. Women Health 2021; 61:581-590. [PMID: 34187330 DOI: 10.1080/03630242.2021.1938791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to assess health concerns after hysterectomy from different perspectives among Taiwanese women with uterine fibroids. A mixed-methods was used in this study. In a cross-sectional study, 95 patients completed a structured questionnaire (Health Concern Questionnaire-HCQ). Face-to-face interviews with 5 patients were implemented for the qualitative component from OBS-GYN outpatient departments at two hospitals in Northern Taiwan. Participants who met the following criteria, 20 years of age or older, conscious alert without mental disturbances were recruited to this study. Descriptive statistics were calculated for social demographic variables and HCQ. A content analysis was used to analyze the qualitative data. The mean age was 46.28 of 95 patients. Findings of the present study showed that the most health concerns among patients with UFs after hysterectomy are hysterectomy-related complications, follow by impacts on daily life, body image and female identity, and intimacy and sexual relations. The findings of qualitative interviews supported the above findings. In addition, the information needs of post-operative self-care were identify in this qualitative interviews. The results of this research study could help healthcare professionals to address women's health concerns and provide adequate care for Taiwanese women with uterine fibroids after hysterectomy.
Collapse
Affiliation(s)
- Chun-Hsin Hsieh
- Nurse Practitioner, MSN, Department of Nursing, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Yu-Ying Lu
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Yuan Liang
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| |
Collapse
|
20
|
Łoziński T, Ludwin A, Filipowska J, Zgliczyńska M, Węgrzyn P, Kluz T, Ciebiera M. Oxytocin and Misoprostol With Diclofenac in the Preparation for Magnetic Resonance-Guided High-Intensity Ultrasound Treatment of Symptomatic Uterine Fibroids: A Prospective Cohort Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1573-1585. [PMID: 33785226 DOI: 10.1016/j.ultrasmedbio.2021.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
Uterine fibroids (UFs) are very common benign tumors of the female reproductive tract. According to recent reports, magnetic resonance-guided high-intensity ultrasound (MR-HIFU) appears to be a well-tolerated and efficient treatment option for UFs. However, MR-HIFU still presents several limitations. The treatment is rarely associated with achieving complete non-perfused volume (NPV). Not all patients are qualified for a final procedure, and selected women obtain very good results in such treatment. The primary objective of this experimental study was to assess the effect of transvaginal misoprostol and intravenous oxytocin preparation on UF volume change, sonication time and NPV after MR-HIFU procedure in women of reproductive age with symptomatic UFs. Secondary outcomes included the effect on the peri-procedural effectiveness of misoprostol and oxytocin. This study enrolled 247 women with symptomatic UFs; based on gynecologic examinations and magnetic resonance imaging (MRI) scans, 128 women qualified for MR-HIFU without pharmacologic treatment, 57 women qualified for the misoprostol/diclofenac group and 62 women qualified for the oxytocin group. Pharmacologic pre-treatment improved NPV compared with non-pharmacologic treatment (average NPV: controls 61.9% ± 25.8%; oxytocin 76.8% ± 20.7%; misoprostol/diclofenac 85.2% ± 15.1%; average sonication time: controls 120 min ± 56.4%; oxytocin 111 min ± 45.4%; misoprostol/diclofenac 80 min ± 47.7%). Statistical analysis did not reveal significant intergroup differences in UF volume changes after 6 mo (controls: n = 40, 37.4% ± 27.5%; oxytocin n = 25, 45.8% ± 31%; misoprostol/diclofenac n = 19, 33.4% ± 23.2%). The misoprostol/diclofenac group, which achieved the highest NPV immediately after the MR-HIFU procedure, was characterized by the lowest UF volume change percentages 6 mo later. The administration of vasoconstrictor drugs (oxytocin and misoprostol/diclofenac) to support MR-HIFU in UF treatment is a new issue that may improve the total effectiveness of this method. Randomized controlled trials are necessary to estimate the real effect of vasoconstrictors on MR-HIFU.
Collapse
Affiliation(s)
- Tomasz Łoziński
- Department of Obstetrics and Gynecology Pro-Familia Hospital, Rzeszów, Poland.
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Kraków, Poland
| | - Justyna Filipowska
- Department of Obstetrics and Gynecology Pro-Familia Hospital, Rzeszów, Poland; Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | - Magdalena Zgliczyńska
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Piotr Węgrzyn
- Department of Obstetrics and Perinatology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Kluz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Rzeszów, Poland
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
21
|
Tonoyan NM, Chagovets VV, Starodubtseva NL, Tokareva AO, Chingin K, Kozachenko IF, Adamyan LV, Frankevich VE. Alterations in lipid profile upon uterine fibroids and its recurrence. Sci Rep 2021; 11:11447. [PMID: 34075062 PMCID: PMC8169782 DOI: 10.1038/s41598-021-89859-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/30/2021] [Indexed: 11/09/2022] Open
Abstract
Uterine fibroids (UF) is the most common (about 70% cases) type of gynecological disease, with the recurrence rate varying from 11 to 40%. Because UF has no distinct symptomatology and is often asymptomatic, the specific and sensitive diagnosis of UF as well as the assessment for the probability of UF recurrence pose considerable challenge. The aim of this study was to characterize alterations in the lipid profile of tissues associated with the first-time diagnosed UF and recurrent uterine fibroids (RUF) and to explore the potential of mass spectrometry (MS) lipidomics analysis of blood plasma samples for the sensitive and specific determination of UF and RUF with low invasiveness of analysis. MS analysis of lipid levels in the myometrium tissues, fibroids tissues and blood plasma samples was carried out on 66 patients, including 35 patients with first-time diagnosed UF and 31 patients with RUF. The control group consisted of 15 patients who underwent surgical treatment for the intrauterine septum. Fibroids and myometrium tissue samples were analyzed using direct MS approach. Blood plasma samples were analyzed using high performance liquid chromatography hyphened with mass spectrometry (HPLC/MS). MS data were processed by discriminant analysis with projection into latent structures (OPLS-DA). Significant differences were found between the first-time UF, RUF and control group in the levels of lipids involved in the metabolism of glycerophospholipids, sphingolipids, lipids with an ether bond, triglycerides and fatty acids. Significant differences between the control group and the groups with UF and RUF were found in the blood plasma levels of cholesterol esters, triacylglycerols, (lyso) phosphatidylcholines and sphingomyelins. Significant differences between the UF and RUF groups were found in the blood plasma levels of cholesterol esters, phosphotidylcholines, sphingomyelins and triacylglycerols. Diagnostic models based on the selected differential lipids using logistic regression showed sensitivity and specificity of 88% and 86% for the diagnosis of first-time UF and 95% and 79% for RUF, accordingly. This study confirms the involvement of lipids in the pathogenesis of uterine fibroids. A diagnostically significant panel of differential lipid species has been identified for the diagnosis of UF and RUF by low-invasive blood plasma analysis. The developed diagnostic models demonstrated high potential for clinical use and further research in this direction.
Collapse
Affiliation(s)
- Narine M Tonoyan
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, 117997, Russian Federation
| | - Vitaliy V Chagovets
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, 117997, Russian Federation
| | - Natalia L Starodubtseva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, 117997, Russian Federation
- Moscow Institute of Physics and Technology, Moscow Region, 141700, Russian Federation
| | - Alisa O Tokareva
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, 117997, Russian Federation
- V.L. Talrose Institute for Energy Problems of Chemical Physics, Russia Academy of Sciences, Moscow, 119991, Russian Federation
| | - Konstantin Chingin
- Jiangxi Key Laboratory for Mass Spectrometry and Instrumentation, East China University of Technology, Nanchang, 330013, China
| | - Irena F Kozachenko
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, 117997, Russian Federation
| | - Leyla V Adamyan
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, 117997, Russian Federation
| | - Vladimir E Frankevich
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, 117997, Russian Federation.
| |
Collapse
|
22
|
Shon J, Zou P, Tran D, Seo SK, Lu Y. Clinical Pharmacology at the Intersection of Women's Health and Regulation: Drug Development Considerations for Uterine Fibroids. J Clin Pharmacol 2020; 60 Suppl 2:S39-S48. [PMID: 33274511 DOI: 10.1002/jcph.1736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Jihong Shon
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Peng Zou
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Doanh Tran
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Shirley K Seo
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Yanhui Lu
- Office of Clinical Pharmacology, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| |
Collapse
|
23
|
Ciebiera M, Vitale SG, Ferrero S, Vilos GA, Barra F, Caruso S, Laganà AS, Sierant A, Cianci A, Jakiel G. Vilaprisan, a New Selective Progesterone Receptor Modulator in Uterine Fibroid Pharmacotherapy-Will it Really be a Breakthrough? Curr Pharm Des 2020; 26:300-309. [PMID: 31985366 DOI: 10.2174/1381612826666200127092208] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Vilaprisan (VPR) is a new orally available selective progesterone receptor modulator (SPRM), with anti-proliferative activity against uterine fibroids (UFs). It definitively causes suppression of ovulation and inhibition of proliferation of endometrial, myometrial and UF cells. PURPOSE This review aims to summarize current knowledge on VPR from all studies, including clinical trials, conducted to date and to contextualize the potential role of VPR in future medical regimens for the treatment of UFs. METHODS We performed a literature search in PubMed US National Library of Medicine and Google Scholar databases. Both databases were extensively searched for all original and review articles/book chapters as well as congress abstracts published in English until July 2019. The use of VPR for UF therapy was identified by using the keywords: "uterine fibroids" and "vilaprisan". RESULTS In phase I and II clinical trials, VPR was shown to be effective in ameliorating UF-related clinical symptoms, especially abnormal or excessive uterine bleeding and in shrinking UFs. The tolerability of VPR is roughly similar to that of ulipristal acetate (UPA) and it tends to be more favorable than that of GnRH-agonists. CONCLUSION Presently, all trials examining the utility of VPR for the treatment of UF are halted; likely, due to the recently reported cases of hepato-toxicity with UPA, in addition to non reassuring toxicology results from preclinical long-term testing on rodents, carried out in parallel with late stage testing on humans. An accurate summary of robust data related to the safety of VPR is urgently needed to draw definitive conclusions on the future clinical development of this drug for UF therapy.
Collapse
Affiliation(s)
- Michal Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Salvatore G Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - George A Vilos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Salvatore Caruso
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Antonio S Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Antoni Sierant
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Antonio Cianci
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
24
|
Mehdizadehkashi A, Tahermanesh K, Rokhgireh S, Astaraei V, Najmi Z, Rakhshande M, Allahqoli L, Ahmadi Pishkuhi M, Alkatout I, Chaichian S. Uterine Isthmus Tourniquet during Abdominal Myomectomy: Support or Hazard? A Randomized Double-Blind Trial. Gynecol Obstet Invest 2020; 85:396-404. [PMID: 32937634 DOI: 10.1159/000510512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES A tourniquet has been suggested as a useful means of reducing massive hemorrhage during myomectomy. However, it is not clear whether the restricted perfusion affects the ovaries. In the present study, we examined the effect of a tourniquet on ovarian reserve and blood loss during myomectomy. MATERIALS AND METHODS In a randomized double-blind clinical trial, fertile nonobese patients scheduled for abdominal myomectomy at Rasool-e-Akram Hospital from February 2018 to June 2019 were randomized to a tourniquet (n = 46) or a non-tourniquet group (n = 35). Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured before and 3 months after surgery, blood loss was recorded during surgery, and serum levels of hemoglobin (Hb) were recorded before surgery, 6 h and 3 days after surgery. SPSS version 21 was used for statistical analysis. RESULTS Demographic, obstetric, and myoma characteristics were similar in the 2 groups (p > 0.05). The mean baseline values of AMH and FSH did not differ between groups (p > 0.05). After surgery, only FSH was higher in the control group (p = 0.043). Despite the time taken to fasten and open the tourniquet, the mean operating time was shorter in the tourniquet group (p < 0.001). Blood loss was higher in the control group (p = 0.005). The drop in Hb levels at 6 h after surgery was higher in the non-tourniquet group (p = 0.002). Blood loss was significantly associated with the duration of surgery (r = 0.523, p < 0.001). CONCLUSION The use of a tourniquet during abdominal myomectomy significantly reduced the mean volume of blood loss compared to the non-tourniquet group, while it did not prolong the duration of surgery, nor reduced the ovarian reserve. A tourniquet is a safe and efficient measure during abdominal myomectomy.
Collapse
Affiliation(s)
| | - Kobra Tahermanesh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vahideh Astaraei
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Najmi
- Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehrnoosh Rakhshande
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Allahqoli
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahin Ahmadi Pishkuhi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Alkatout
- Campus Kiel, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - Shahla Chaichian
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran,
| |
Collapse
|
25
|
Wang CY, Xia JG, Chen WH, Lu YF, Han ZH, Wang Q. Value of Dyna CT in guiding embolization during transarterial uterine artery embolization of fibroids. Exp Ther Med 2020; 20:1353-1358. [PMID: 32742370 PMCID: PMC7388317 DOI: 10.3892/etm.2020.8875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 03/17/2020] [Indexed: 11/17/2022] Open
Abstract
The present study aimed to assess the usefulness of Dyna CT during transarterial uterine artery embolization (UAE) of fibroids. A total of 65 patients with symptomatic submucosal and intramural fibroids scheduled for transarterial UAE at the First People's Hospital of Changhou between May 2016 and September 2018 were included. Dyna CT and routine digital subtraction angiography (DSA) were performed in all patients during angiographic embolization of the bilateral internal iliac arteries. The visualization qualities of uterine artery origin and fibroids, as imaged by Dyna CT, were compared with DSA anterior-posterior images. Dyna CT provided excellent 3-dimensional visualization of vascular structures of the bilateral internal iliac arteries and uterine artery origin. Dyna CT was primarily useful in patients with overlapped uterine arteries or complex vascular anatomies on DSA anterior-posterior images (Dyna CT 100% vs. DSA anterior-posterior 69.2%, P=0.03). However, stained fibroids were identified in 57/65 cases (87.7%) by Dyna CT, and in all of the cases (100%) by DSA anterior-posterior imaging (P=0.03). Dyna CT is not suitable for procedural evaluation when used alone for transarterial UAE of fibroids. However, Dyna CT is an excellent supplement to DSA anterior-posterior imaging, as it provides additional information to aid in treatment planning.
Collapse
Affiliation(s)
- Cao-Ye Wang
- Department of Interventional Radiology, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213003, P.R. China
| | - Jin-Guo Xia
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Wen-Hua Chen
- Department of Interventional Radiology, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213003, P.R. China
| | - Yi-Feng Lu
- Department of Interventional Radiology, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213003, P.R. China
| | - Zong-Hong Han
- Department of Interventional Radiology, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213003, P.R. China
| | - Qi Wang
- Department of Interventional Radiology, The First People's Hospital of Changzhou, Changzhou, Jiangsu 213003, P.R. China
| |
Collapse
|
26
|
Jokimaa V, Virtanen J, Kujari H, Ala-Nissilä S, Rantanen V. A Mayer-Rokitansky-Kuster-Hauser patient with leiomyoma and dysplasia of neovagina: a case report. BMC WOMENS HEALTH 2020; 20:157. [PMID: 32723331 PMCID: PMC7388509 DOI: 10.1186/s12905-020-01026-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/19/2020] [Indexed: 12/22/2022]
Abstract
Background Most patients with congenital uterus and vaginal aplasia (i.e., Mayer–Rokitansky–Kuster–Hauser [MRKH] syndrome) have rudimentary pelvic uterine structures that contain smooth muscle. Although leiomyomas and dysplasia of vaginal mucosa are relatively common in the general population, they are rare in MRKH patients. Data on the vulnerability of neovaginas to HPV-associated dysplasia are limited. Case presentation A rare case of an MRKH patient with two gynaecological conditions detected during long-term gynaecological follow-up is presented. At the age of 21, the patient was treated for HPV-associated neovaginal dysplasia. At the age of 47, a pelvic leiomyoma was detected with transvaginal ultrasound and confirmed with magnetic resonance imaging. Conclusion A Pap smear or human papillomavirus testing is indicated in sexually active MRKH women. Uterine rudiments contain smooth muscle, which facilitates the development of oestrogen-dependent diseases, such as leiomyomas and adenomyosis. Although magnetic resonance imaging is recommended in cases of a pelvic mass, easily attainable and cost-efficient transvaginal ultrasound offers high diagnostic accuracy in patients with a surgically created neovagina and is suitable for the patients’ follow-up. Guidelines for the gynaecological follow-up of MRKH patients are warranted.
Collapse
Affiliation(s)
- Varpu Jokimaa
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland.
| | - Johanna Virtanen
- Department of Radiology, Turku University Hospital and University of Turku, 20521, Turku, Finland
| | - Harry Kujari
- Institute of Biomedicine, Research Center for Cancer, Infections and Immunity, University of Turku, 20014, Turku, Finland.,Department of Pathology, Turku University Hospital, 20521, Turku, Finland
| | - Seija Ala-Nissilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
| | - Virpi Rantanen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
| |
Collapse
|
27
|
El-Agwany AS. Surgical Approaches for Common Gynecologic and Obstetrics Surgeries. Indian J Surg Oncol 2020; 11:201-203. [PMID: 32523263 DOI: 10.1007/s13193-019-00987-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/11/2019] [Indexed: 11/25/2022] Open
Abstract
Common obstetrics and gynecology operations have different approaches and techniques and variations in the procedure. We aimed to discuss different approaches and variations in the techniques of the procedures as cystectomy, myomectomy, laparoscopy entry technique, sacrospinous ligament fixation, uretherocele, and rupture uterus.
Collapse
Affiliation(s)
- Ahmed Samy El-Agwany
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- El-Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| |
Collapse
|
28
|
Olalla S, Monleon J, Cristóbal I, Cañete ML. WITHDRAWN: Diagnostic evaluation of uterine myomas. Eur J Obstet Gynecol Reprod Biol 2020:S0301-2115(20)30091-9. [PMID: 32088072 DOI: 10.1016/j.ejogrb.2020.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 11/24/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
Collapse
Affiliation(s)
- Sofia Olalla
- Ginecologia y Obstetricia, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Monleon
- Ginecologia y Obstetricia, Hosptal La Fe, Valencia, Spain
| | - Ignacio Cristóbal
- Ginecologia y Obstetricia, Hospital Clínico San Carlos, Madrid, Spain.
| | | |
Collapse
|
29
|
Fornazari VAV, Salazar GMM, Vayego SA, Nunes TF, Goncalves B, Szejnfeld J, Bonduki CE, Goldman SM, Szejnfeld D. Impact of uterine contractility on quality of life of women undergoing uterine fibroid embolization. CVIR Endovasc 2019; 2:36. [PMID: 32027002 PMCID: PMC6966384 DOI: 10.1186/s42155-019-0080-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background Although changes in uterine contractility pattern after uterine fibroid embolization (UFE) has already been assessed by cine magnetic resonance imaging (MRI), their impact on quality of life outcomes has not been evaluated. The purpose of this study was to evaluate the impact of uterine contractility on the quality of life of women undergoing UFE measured by the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL). Results A total of 26 patients were included. MRI scans were acquired 30–7 days before and 6 months after UFE for all patients. The UFS-QOL was applied in person on first MRI exam day and 1 year after UFE and the outcomes were analyzed according to the groups of evolution pattern of uterine contractility: Group A: Unchanged Uterine Contractility Pattern, 38%; Group B: Favorable Modified Uterine Contractility Pattern, 50%; and Group C: Loss of Uterine Contractility, 11%. All UFE patients presented a reduction in the mean score for symptoms and increase in mean scores on quality of life. All patients in this cohort presented a reduction in mean symptom score and increase in the mean score of quality of life subscales. Group A had more relevant complaints regarding their sense of self-confidence; Group B presented worse sexual function scores before UFE, which improved after UFE compared to Group A. Conclusions Significant improvement in symptoms, quality of life, and uterine contractility was observed after UFE in women of reproductive age with symptomatic fibroids. Functional uterine contractility seems to have a positive impact on quality of life and sexual function in this population. Level of evidence Level 3, Non-randomized controlled cohort/follow-up study.
Collapse
Affiliation(s)
- Vinicius Adami Vayego Fornazari
- Interventional Radiology and Endovascular Surgery, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil.
| | - Gloria Maria Martinez Salazar
- Department of Simulation and Patient Experience, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St #290, Boston, MA, 02114, USA
| | - Stela Adami Vayego
- Department of Statistics, Universidade Federal do Paraná (UFPR), Rua General Carneiro, 370, Centro, Curitiba, PR, 81531-990, Brazil
| | - Thiago Franchi Nunes
- Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal do Mato Grosso do Sul (UFMS), Av. Sen. Filinto Müler, 355, Vila Ipiranga, Campo Grade, MS, 79080-190, Brazil
| | - Belarmino Goncalves
- Angiography Section Clinical Interventional Radiology Department, Instituto Portugues de Oncologia (IPO-Porto), R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - Jacob Szejnfeld
- Department of Diagnostic Imaging, Escola Paulista de Medicina (EPM), UNIFESP, Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Claudio Emilio Bonduki
- Outpatient Clinics of Arterial Embolization of Uterine Myoma and Cardiovascular Diseases and Thromboembolism, Gynecological Endocrinology Course, Department of Gynecology, EPM, UNIFESP, Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Suzan Menasce Goldman
- Department of Diagnostic Imaging, EPM, UNIFESP, Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Denis Szejnfeld
- Interventional Radiology and Endovascular Surgery, UNIFESP, Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| |
Collapse
|
30
|
Braný D, Dvorská D, Grendár M, Ňachajová M, Szépe P, Lasabová Z, Žúbor P, Višňovský J, Halášová E. Different methylation levels in the KLF4, ATF3 and DLEC1 genes in the myometrium and in corpus uteri mesenchymal tumours as assessed by MS-HRM. Pathol Res Pract 2019; 215:152465. [PMID: 31176573 DOI: 10.1016/j.prp.2019.152465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/13/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023]
Abstract
Mesenchymal tumours of the corpus uteri comprise common benign lesions - leiomyomas and very rare malignant variants - sarcomas. It can be difficult to distinguish between the particular types of mesenchymal tumours pre-surgically. Primarily, leiomyomas and the very aggressive leiomyosarcomas can be easily misdiagnosed when using only imaging devices. Therefore, a reliable non-invasive marker for these tumour types would provide greater certitude for patients that the lesion remains benign. Our collection comprises 76 native leiomyomas, an equal number of healthy myometrium samples and 49 FFPE samples of various types of sarcomas. The methylation level was assessed by MS-HRM method and we observed differences in the methylation level between healthy, benign and (semi)malignant tissues in the KLF4 and DLEC1 genes. The mean methylation levels of leiomyomas compared to myometrium and leiomyosarcomas were 70.7% vs. 6.5% vs. 39.6 % (KLF4) and 66.1% vs. 14.08% vs. 37.5% (DLEC1). The ATF3 gene was differentially methylated in leiomyomatous and myometrial tissues with 98.1% compared to 76.6%. The AUC values of the predictive logistic regression model for discrimination between leiomyomas and leiomyosarcomas based on methylation levels were 0.7829 (KLF4) and 0.7719 (DLEC1). Finally, our results suggest that there should be distinct models for the methylation events in benign leiomyomas and sarcomas, and that the KLF4 and DLEC1 genes can be considered potential methylation biomarkers for uterine leiomyomas.
Collapse
Affiliation(s)
- Dušan Braný
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
| | - Dana Dvorská
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
| | - Marián Grendár
- Bioinformatic Unit, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava
| | - Marcela Ňachajová
- Department of Gynaecology and Obstetrics, Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava
| | - Peter Szépe
- Department of Pathological Anatomy, Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava
| | - Zora Lasabová
- Division of Oncology, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava
| | - Pavol Žúbor
- Department of Gynaecology and Obstetrics, Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava
| | - Jozef Višňovský
- Department of Gynaecology and Obstetrics, Martin University Hospital, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava
| | - Erika Halášová
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| |
Collapse
|
31
|
Massive Leiomyomatous Uterine Proliferation Following Kidney Transplantation: A Case Report and Literature Review. Case Rep Transplant 2019; 2018:3874937. [PMID: 30622829 PMCID: PMC6304196 DOI: 10.1155/2018/3874937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022] Open
Abstract
Uterine fibroids are the most common benign uterine tumors affecting > 50% of premenopausal women. The incidence, burden and symptoms from uterine fibroids are higher in women of African descent compared to Caucasians. Despite increasing number of African American females being evaluated for and undergoing kidney transplantation (KT), perioperative management guidelines for uterine fibroids currently do not exist. We present a case of a 40 y/o African American female with known symptomatic uterine fibroids preoperatively and medically managed, who underwent a successful KT and 4 years later progressively developed massive leiomyomatous uterine proliferation, causing a complete lateral displacement of the transplanted kidney with severe hydronephrosis, transplant ureteral obstruction and secondary urinary tract infections with bacteremia. This obstruction required a percutaneous nephrostomy tube placement followed by an interval transabdominal hysterectomy, which was complicated by transplant ureteral transection requiring ureteral reimplantation, resulting in prolonged hospitalization, follow-up and outpatient antibiotic regimen. There is a need for management guidelines for uterine fibroids incidentally encountered during the KT evaluation process to avoid similar preventable post-KT complications in patient populations most commonly affected. Literature review and perioperative management/surveillance strategies are provided.
Collapse
|
32
|
Yu O, Scholes D, Schulze-Rath R, Grafton J, Hansen K, Reed SD. A US population-based study of uterine fibroid diagnosis incidence, trends, and prevalence: 2005 through 2014. Am J Obstet Gynecol 2018; 219:591.e1-591.e8. [PMID: 30291840 DOI: 10.1016/j.ajog.2018.09.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/24/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite considerable public health burden, uterine fibroid population-based incidence estimates are few. Secular trends over time are even more limited. OBJECTIVE We sought to evaluate the incidence, 10-year secular trends, and prevalence of uterine fibroid diagnoses and describe the proportion of symptomatic women. STUDY DESIGN We performed a retrospective population-based cohort study of women, aged 18-65 years, enrolled 2005 through 2014 in Kaiser Permanente Washington. Uterine fibroid diagnoses identified by International Classification of Diseases, Ninth Revision codes and potential covariates were extracted from computerized databases. Women with prior hysterectomy and, for incidence estimates, women with prior fibroid diagnoses were excluded. Linear trends in incidence rates over the 10-year study period were evaluated using Poisson regression models. Rates and trend tests were examined for all women, by age groups, and by race/ethnicity. RESULTS Associated International Classification of Diseases, Ninth Revision symptom-related codes were observed in 90% of incident cases. Incidence rates for fibroid diagnoses were highest for the age group 45-49 years, 240.3 per 10,000 woman-years in 2014, and for black women across all years. Overall age-adjusted estimated incidence rates declined during the 10-year study interval, from 139.4 per 10,000 woman-years in 2005 to 101.4 in 2014 (P value trend .0008). Overall prevalence in 2014 was 9.6%, and was highest among women aged 50-54 years (15.9%). Black women had higher prevalence (18.5%) than other racial/ethnic groups. CONCLUSION We found a decreasing trend of new uterine fibroid diagnoses among predominantly symptomatic women ages 18-65 years in a recent 10-year interval. This finding was due, perhaps in part, to secular trends of decreasing hysterectomies. Nonetheless, uterine fibroids remain a common health burden, with a prevalence of nearly 10%. Rates are disproportionately high and occur at younger ages for black women, and possibly for other non-white racial/ethnic groups. These findings are of concern, as current available long-term medical therapies remain limited.
Collapse
|
33
|
Kameda S, Toyoshima M, Tanaka K, Fujii O, Iida SI, Yaegashi N, Murakami T, Hoshi K. Utility of Laparoscopic Uterine Myomectomy as a Treatment for Infertility with No Obvious Cause Except for Uterine Fibroids. Gynecol Minim Invasive Ther 2018; 7:152-155. [PMID: 30306033 PMCID: PMC6172875 DOI: 10.4103/gmit.gmit_2_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/24/2018] [Accepted: 08/20/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives: Uterine fibroids are capable of causing infertility, but there are no definite criteria for which laparoscopic uterine myomectomy (LM) is known to be beneficial. To investigate the usefulness of LM, we examined pregnancy rates in patients with infertility with no obvious cause except for the presence of uterine fibroids. Materials and Methods: We retrospectively reviewed the clinical records at Suzuki Memorial Hospital between June 2010 and August 2014. We found 60 eligible patients (LM group, 46; non-LM group, 14). The criteria for performing LM were a maximal fibroid diameter of 40 mm or more or the presence of >4 fibroids. Results: The duration of infertility before the first visit was significantly longer in the LM group; although there was no significant difference in the mean patient age and body mass index. Pregnancy was achieved in 45.7% of patients (21/46) in the LM group and 28.6% (4/14) in the non-LM group. There were no pregnancies in patients with >10 fibroids. The postoperative pregnancy rate in the LM group was comparable to previously reported pregnancy rates. Conclusions: Our criteria for performing LM in patients with no obvious cause for infertility except for uterine fibroids seem appropriate, especially when the fibroids are large and the number of fibroids is between 4 and 9. However, our results suggest that the effectiveness of LM is low in patients with 10 or more uterine fibroids.
Collapse
Affiliation(s)
- Satomi Kameda
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kohei Tanaka
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Osamu Fujii
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Shu-Ichi Iida
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Kazuhiko Hoshi
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| |
Collapse
|
34
|
Evaluation of Uterine Contractility by Magnetic Resonance Imaging in Women Undergoing Embolization of Uterine Fibroids. Cardiovasc Intervent Radiol 2018; 42:186-194. [PMID: 30151796 DOI: 10.1007/s00270-018-2053-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess uterine contractility using ultrafast magnetic resonance imaging (cine MRI) before and after uterine fibroid embolization (UFE). MATERIALS AND METHODS This is a prospective study of uterine contractility in 26 patients (age 30-41 years) undergoing UFE for symptomatic uterine fibroids. Cine MRI was performed before and 6 months after UFE. Two radiologists evaluated uterine contractility and classified it as absent, ordered, or disordered. Patients were then grouped into three distinct patterns of progression: unchanged contractility (group A), modified contractility (B), and loss of contractility (C). These findings were then confronted with factors that might have interfered with uterine contractility pattern (uterine volume, location of dominant fibroid, fibroid/myometrium index, and fibroid necrosis pattern). RESULTS Of the 26 patients, 8 (30.7%) had no contractility before the procedure, while 18 (69.2%) exhibited some form of contractility (11 [61%] ordered, 7 [39%] disordered). All 8 patients who had no contractility at baseline exhibited contractility after UFE (5 ordered, 3 disordered). Of the 11 who had ordered contractility at baseline, 9 remained ordered and 2 lost contractility after UFE. Of the 7 with disordered contractility at baseline, 1 remained disordered, 5 progressed to ordered contractility, and 1 lost contractility. Overall, 10 patients (38%) had no change in contractility after UFE (group A), 13 (50%) had a positive change (group B), and 3 (11%) lost contractility (group C). The potential interference factors assessed had no statistically significant effect in any group. CONCLUSION In women of reproductive age with symptomatic fibroids, uterine contractility improved significantly after UFE. LEVEL OF EVIDENCE Level 3-non-randomized controlled cohort/follow-up study.
Collapse
|
35
|
Mirowska-Allen KL, Kong KKY, Ang WC. Unplanned hysterectomy following myomectomy at a tertiary institution: A case series and review of the literature. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518783664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Myomectomy is the gold standard uterine-sparing treatment for fibroids. However, the procedure is often complicated by blood loss. In rare cases, haemorrhage may be so severe that a conversion to hysterectomy is warranted. The aim of our study was to investigate the rates of and the clinical reasoning behind unplanned hysterectomies following attempted myomectomies at our institution. Methods: All patients who underwent an open or laparoscopic myomectomy at the Royal Women’s Hospital were identified using a gynaecology unit database, maintained from January 2004 to December 2013. Records for patients whose surgeries were unexpectedly converted to a hysterectomy were examined. A review of the literature was also performed, investigating the rates of unplanned hysterectomies following myomectomies. Results: Of the 1501 myomectomies performed, six resulted in an unplanned hysterectomy; an incidence rate of 0.4%. Fibroids were either intramural or pedunculated with the median number of tumours per patient being 2.5 (interquartile range: 1–6). The largest tumour for each patient varied significantly from 4.0 × 3.2 cm to 29.0 × 25.0 cm. In all cases, despite being strongly advised to have a planned hysterectomy, patients insisted on having a myomectomy. Two patients underwent conversion to hysterectomy intraoperatively while the remainder required a return to theatre. Difficulty achieving intraoperative haemostasis (n = 2), and the development of postoperative bleeding and coagulopathy (n = 4) were reasons cited for proceeding to hysterectomy. Conclusion: The rate of conversion from myomectomy to hysterectomy at our institution was low at 0.4%. In all cases, the reason for conversion was difficulty with haemostasis, despite infrequent use of haemostatic agents, and coagulopathy.
Collapse
Affiliation(s)
- Kelly L Mirowska-Allen
- The University of Melbourne, Parkville, VIC, Australia
- The Northern Hospital, Epping, VIC, Australia
| | - Karen KY Kong
- Gynaecology Department, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - W Catarina Ang
- The University of Melbourne, Parkville, VIC, Australia
- Gynaecology Department, The Royal Women’s Hospital, Parkville, VIC, Australia
| |
Collapse
|
36
|
Nusair B, Maaita M, Taso O, Almasaleha A, Abdelazim IA, Faza MA. Management of Fibroids in Resource-Limited Settings. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2018. [DOI: 10.1007/s13669-018-0240-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|