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Tsiampa E, Tsiampas K, Kapogiannis F. Perioperative and reproductive outcomes' comparison of mini-laparotomy and laparoscopic myomectomy in the management of uterine leiomyomas: a systematic review. Arch Gynecol Obstet 2024; 309:821-829. [PMID: 37566224 DOI: 10.1007/s00404-023-07168-5] [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: 03/22/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To evaluate and compare mini-laparotomy (MLPT) with laparoscopic (LPS) myomectomy perioperative and reproductive outcomes. METHODS We systematically searched for related articles in the MEDLINE, Embase, Web of Science and the Cochrane library databases. Nine studies (4 randomized, 3 retrospective, 1 prospective and 1 case-control study) which involved 1723 patients met the inclusion criteria and were considered eligible for inclusion. RESULTS Demographic characteristics were similar between the two groups. LPS was associated with shorter hospital stay (p = 0.04), lower blood loss (p < 0.00001), shorter duration of median ileus (p < 0.00001) and fewer episodes of postoperative fever (p = 0.04). None of the reproductive factors examined (pregnancy rate, preterm delivery, vaginal delivery and delivery with caesarean section) in women diagnosed with unexplained infertility and/or symptomatic leiomyomas reached statistical significance although the results represent a small size effect. CONCLUSION Our analysis demonstrated that LPS seems to be an alternative, safe and reliable surgical procedure for uterine leiomyoma treatment and in everyday practice seems to offer improved outcomes-regarding at least the perioperative period-over MLPT.
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Affiliation(s)
- Eleni Tsiampa
- 2nd Department of Obstetrics and Gynecology, General and Maternity Hospital Helena Venizelou, Christou Vournazou Str. 1, 11521, Athens, Greece.
| | - Konstantinos Tsiampas
- Laparoscopic Department of Obstetrics and Gynecology, Iaso General Hospital, Athens, Greece
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2
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Loss of the repressor REST affects progesterone receptor function and promotes uterine leiomyoma pathogenesis. Proc Natl Acad Sci U S A 2022; 119:e2205524119. [PMID: 36282915 PMCID: PMC9636955 DOI: 10.1073/pnas.2205524119] [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] [Indexed: 02/01/2023] Open
Abstract
Uterine leiomyomas (UL) are benign tumors that arise in the myometrial layer of the uterus. The standard treatment option for UL is hysterectomy, although hormonal therapies, such as selective progesterone receptor modulators, are often used as temporary treatment options to reduce symptoms or to slow the growth of tumors. However, since the pathogenesis of UL is poorly understood and most hormonal therapies are not based on UL-specific, divergent hormone signaling pathways, hallmarks that predict long-term efficacy and safety of pharmacotherapies remain largely undefined. In a previous study, we reported that aberrant expression of repressor element 1 silencing transcription factor/neuron-restrictive silencing factor (REST/NRSF) target genes activate UL growth due to the near ubiquitous loss of REST. Here, we show that ablation of the Rest gene in mouse uterus leads to UL phenotype and gene-expression patterns analogous to UL, including altered estrogen and progesterone signaling pathways. We demonstrate that many of the genes dysregulated in UL harbor cis-regulatory elements bound by REST and progesterone receptor (PGR) adjacent to each other. Crucially, we identify an interaction between REST and PGR in healthy myometrium and present a putative mechanism for the dysregulation of progesterone-responsive genes in UL ensuing in the loss of REST. Using three Rest conditional knockout mouse lines, we provide a comprehensive picture of the impact loss of REST has in UL pathogenesis and in altering the response of UL to steroid hormones.
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Roșu GA, Ionescu CA, Călin FD, Dimitriu M, Pleș L, Matei A, Navolan DB. Prognostic value of the location of submucosal uterine leiomyomas in infertility. Exp Ther Med 2021; 22:1482. [PMID: 34765023 DOI: 10.3892/etm.2021.10917] [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: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
Submucosal fibroid location and size are predictive factors of impaired fertility. Submucosal fibroids cause infertility through several mechanisms including distortion of the endometrial cavity, increased uterine contractility, local inflammation and remodeling of the endometrial blood supply. This is a monocentric, retrospective, cross-sectional study, conducted in the Department of Obstetrics and Gynecology of 'Sf. Pantelimon' Clinical Emergency Hospital, analyzing patients from a 5-year period (January 2015-December 2019). In the present study, the relationship between different characteristics of the submucosal fibroids (among others, location and dimensions) and fertility (birth rates, early pregnancy loss rates) were investigated. This study identified that submucosal and intramural fibroids are risk factors for reduced birth rate compared with subserosal fibroids (P=0.02, RR=2.58, 95% CI 1.03-6.47; P=0.005, RR=1.18, 95% CI 1.02-1.35, respectively). In addition, G2 leiomyomas are risk factors for low birth rate compared with G0 and G1 fibroids (P=0.01, RR=1.95, 95% CI 1.05-3.60). Moreover, the presence of a subserosal fibroid was associated with an increased early pregnancy loss rate (P=0.01, RR=2.14, 95% CI 1.05-4.35). In conclusion, the location and degree of uterine cavity distortion are important factors that alter the normal development of a pregnancy and the birth rate.
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Affiliation(s)
- George-Alexandru Roșu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Crîngu Antoniu Ionescu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Florin Daniel Călin
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Mihai Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Liana Pleș
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics, 'Bucur' Maternity, 'Sf. Ioan' Clinical Emergency Hospital, 040294 Bucharest, Romania
| | - Alexandra Matei
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Dan-Bogdan Navolan
- Department of Obstetrics and Gynecology, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania.,Department of Maternal-Fetal Medicine, 'Dr. Dumitru Popescu' Obstetrics and Gynecology Hospital, 300172 Timisora, Romania
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4
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Chen R, Su Z, Yang L, Xin L, Yuan X, Wang Y. The effects and costs of laparoscopic versus abdominal myomectomy in patients with uterine fibroids: a systematic review and meta-analysis. BMC Surg 2020; 20:55. [PMID: 32192462 PMCID: PMC7083063 DOI: 10.1186/s12893-020-00703-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Abdominal myomectomy (AM) and laparoscopic myomectomy (LM) are commonly see surgery for the uterine fibroids, several randomized controlled trials (RCTs) have compared the role of AM and LM, the results remained inconsistent. Therefore, we attempted this meta-analysis to analyze the role of LM versus AM in patients with uterine fibroids. METHODS We searched PubMed et al. databases from inception date to July 31, 2019 for RCTs that compared LM versus AM in patients with uterine fibroids. Two authors independently screened the studies and extracted data from the published articles. Summary odd ratios(OR) or mean differences(MD) with 95% confidence intervals(CI) were calculated for each outcome by means of fixed- or random-effects model. RESULTS Twelve RCTs with a total of 1783 patients were identified, with 887 patients for and 897 patients for AM. Compared with AM, LM could significantly decrease the blood loss (OR = - 29.78, 95% CI -57.62- - 0.95), shorten the duration of postoperative ileus (OR = - 10.91, 95% CI -18.72- - 3.11), reduce the length of hospital stay (OR = - 1.57, 95% CI -2.05- - 1.08), but LM was associated with longer duration of operation (OR = 16.10, 95% CI 6.52-25.67) and higher medical cost (OR = 17.61, 95% CI 7.34-27.88). CONCLUSIONS LM seems to be a better choice for patients with uterine fibroids, more related studies are needed to identify the role of LM and AM for the treatment of uterine fibroids.
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Affiliation(s)
- Ruixin Chen
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Zhiying Su
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Lingling Yang
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Luping Xin
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Xiaodong Yuan
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China
| | - Yanlong Wang
- Department of Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, NO.10 Zhenhai Road, Siming District, Xiamen, China.
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5
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Ali M, Al-Hendy A. Selective progesterone receptor modulators for fertility preservation in women with symptomatic uterine fibroids. Biol Reprod 2018; 97:337-352. [PMID: 29025038 PMCID: PMC5803778 DOI: 10.1093/biolre/iox094] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022] Open
Abstract
Uterine fibroids (UFs, AKA leiomyoma) are the most important benign neoplastic threat to women's health, with costs up to hundreds of billions of health care dollars worldwide. Uterine fibroids caused morbidities exert a tremendous health toll, impacting the quality of life of women of all ethnicities, especially women of color. Clinical presentations include heavy vaginal bleeding, pelvic pain, bulk symptoms, subfertility, and obstetric complications. Current management strategies heavily lean toward surgical procedures; nonetheless, the choice of treatment is generally subject to patient's age and her desire to preserve future fertility. Women with UF who desire to maintain future fertility potential face a dilemma because of the limited treatment choices that are currently available to help them achieve that goal. Recently, ulipristal acetate the first of the promising family of oral selective progesterone receptor modulators has been approved for UF treatment in Europe, Canada, and several other countries and is under review for possible approval in the USA. In this review article, we discuss recent advances in the management options against UF with a bend toward oral effective long-term treatment alternatives who are particularly suited for those seeking to preserve their future fertility potential. We also explore the transformative concept of primary and secondary UF prevention using these new anti-UF agents. We envision a remarkable shift in the management of UF in future years from surgical/invasive treatment to orally administrated options; clearly, this potential shift will require additional intense clinical research.
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Affiliation(s)
- Mohamed Ali
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.,Clinical Pharmacy department, Faculty of pharmacy, Ain Shams University, Cairo, Egypt
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Tanos V, Berry K. Benign and malignant pathology of the uterus. Best Pract Res Clin Obstet Gynaecol 2018; 46:12-30. [DOI: 10.1016/j.bpobgyn.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023]
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7
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Elsokkary M, Elshourbagy M, Labib K, Mamdouh A, El-Shahawy Y, Nossair WS, Abd El Fattah O, Hemeda H, Sallam S, Khalaf WM, Ali M, Elsayed M, Kotb A, Abdelhadi R, Etman M, Abd El Aleem M, Samy M, Salama A, Abdelhaleem M, Abdelshafy A. Assessment of hysteroscopic role in management of women with recurrent pregnancy loss. J Matern Fetal Neonatal Med 2017; 31:1494-1504. [PMID: 28412850 DOI: 10.1080/14767058.2017.1319925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess the hysteroscopic value in the management of intrauterine lesion in women with recurrent pregnancy loss. METHODS This study was done in Ain Shams Maternity Hospital after the approval of the research Ethics Committee, during the period between August 2014 and December 2015 where 200 nonpregnant women with a history of three or more consecutive unexplained first and second trimester miscarriages before 20 weeks were recruited from recurrent miscarriage clinic. A written informed consent was obtained from all women before participation. RESULTS This current study was conducted in Ain Shams University Maternity Hospital during the period between August 2014 to May 2015 a total of 200 women with history of recurrent miscarriage were included in the study. Regarding the results of this study the mean age was 30.5(5.7), the mean number of previous abortion 3(3-5) the mean number of the first trimesteric abortion was 2 with range (2-2) the mean number of second trimesteric abortion was 2 with range (1-2). In this study, 88% of patients were nullipara. It was also found that hysteroscopic findings were found in 58.5%. Uterine anomalies was present in 21%, including septate uterus and intrauterine adhesion (IUAs) were present in 12.5%. Endometrial polyps were present in 8.5%, bicornute uterus in 4.5%, unicornuate uterus in 4.5% while submucous myomas were present in 7.5%. It was found that 48.5% need hysteroscopic intervention including 21% need septectomy 12.5% need adhesiolysis, 6.5% need myomectomy while 8.5% need polypectomy. The study found that no statistically significant difference between patients with normal hysteroscopic finding and patients with abnormal hysteroscopic finding as regard age, time of previous abortion and number of previous abortion. But there was statistically significant difference as regard number of previous delivery and abnormal HSG. CONCLUSIONS It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.
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Affiliation(s)
- M Elsokkary
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - M Elshourbagy
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - K Labib
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - A Mamdouh
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - Y El-Shahawy
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - Wael S Nossair
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - O Abd El Fattah
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - H Hemeda
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - S Sallam
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - Waleed M Khalaf
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - M Ali
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - M Elsayed
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - A Kotb
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - R Abdelhadi
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - M Etman
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - M Abd El Aleem
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - M Samy
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - A Salama
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - M Abdelhaleem
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
| | - A Abdelshafy
- a Department of Obstetrics and Gynecology , Ain Shams University Maternity Hospital , Cairo , Egypt
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Abstract
Uterine fibroids, also known as uterine leiomyoma (UL), are monoclonal tumors of the smooth muscle tissue layer (myometrium) of the uterus. Although ULs are considered benign, uterine fibroids are the source of major quality-of-life issues for approximately 25% of all women, who suffer from clinically significant symptoms of UL. Despite the prevalence of UL, there is no treatment option for UL which is long term, cost-effective, and leaves fertility intact. The lack of understanding about the etiology of UL contributes to the scarcity of medical therapies available. Studies have identified an important role for sex steroid hormones in the pathogenesis of UL, and have driven the use of hormonal treatment for fibroids, with mixed results. Dysregulation of cell signaling pathways, miRNA expression, and cytogenetic abnormalities have also been implicated in UL etiology. Recent discoveries on the etiology of UL and the development of relevant genetically modified rodent models of UL have started to revitalize UL research. This review outlines the major characteristics of fibroids; major contributors to UL etiology, including steroid hormones; and available preclinical animal models for UL.
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Affiliation(s)
- Michelle M McWilliams
- Department of Molecular and Integrative Physiology, Center for Reproductive Sciences, IRHRM, University of Kansas Medical Center, Kansas
| | - Vargheese M Chennathukuzhi
- Department of Molecular and Integrative Physiology, Center for Reproductive Sciences, IRHRM, University of Kansas Medical Center, Kansas
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McLucas B, Voorhees III WD, Elliott S. Fertility after uterine artery embolization: a review. MINIM INVASIV THER 2015; 25:1-7. [DOI: 10.3109/13645706.2015.1074082] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Conforti A, Mollo A, Alviggi C, Tsimpanakos I, Strina I, Magos A, De Placido G. Techniques to reduce blood loss during open myomectomy: a qualitative review of literature. Eur J Obstet Gynecol Reprod Biol 2015; 192:90-5. [PMID: 26189110 DOI: 10.1016/j.ejogrb.2015.05.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/20/2015] [Accepted: 05/23/2015] [Indexed: 12/01/2022]
Abstract
Open myomectomy is the most adopted surgical strategy in the conservative treatment of uterine fibroids. According to several studies, the likelihood that a woman could develop uterine myomas is estimated around 75% by the age of 50. Open myomectomy is nonetheless a complicated surgery in terms of blood loss and need for transfusion. Many strategies have been published with the aim of limiting intra and post-operative bleeding complications. The scope of this review is to describe in detail the different techniques reported in literature focusing on their validity and safety.
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Affiliation(s)
- Alessandro Conforti
- University Department of Neuroscience, Reproductive Medicine, Odontostomatology - University of Naples "Federico II", Naples, Italy.
| | - Antonio Mollo
- University Department of Neuroscience, Reproductive Medicine, Odontostomatology - University of Naples "Federico II", Naples, Italy
| | - Carlo Alviggi
- University Department of Neuroscience, Reproductive Medicine, Odontostomatology - University of Naples "Federico II", Naples, Italy
| | - Ioannis Tsimpanakos
- University Department of Obstetrics and Gynaecology, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - Ida Strina
- University Department of Neuroscience, Reproductive Medicine, Odontostomatology - University of Naples "Federico II", Naples, Italy
| | - Adam Magos
- University Department of Obstetrics and Gynaecology, Royal Free Hospital, London NW3 2QG, United Kingdom
| | - Giuseppe De Placido
- University Department of Neuroscience, Reproductive Medicine, Odontostomatology - University of Naples "Federico II", Naples, Italy
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Shen Q, Chen M, Wang Y, Zhou Q, Tao X, Zhang W, Zhu X. Effects of Laparoscopic Versus Minilaparotomic Myomectomy on Uterine Leiomyoma: A Meta-analysis. J Minim Invasive Gynecol 2015; 22:177-84. [DOI: 10.1016/j.jmig.2014.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/16/2014] [Accepted: 09/20/2014] [Indexed: 10/24/2022]
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12
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Gambadauro P. Why is age a major determinant of reproductive outcomes after myomectomy in subfertile women? J OBSTET GYNAECOL 2014; 35:658. [PMID: 25517203 DOI: 10.3109/01443615.2014.987116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- P Gambadauro
- a Karolinska Institutet, Stockholm, and Res Medica Sweden , Uppsala , Sweden
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13
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Bøggild A, Langhoff-Roos J, Sundberg K, Istre O. Placenta percreta after transcervical myomectomy. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2013-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background: Large uterine fibroids and placenta percreta are often associated with a hysterectomy.
The case: A 31-year-old nulligravida had a transcervical resection of a large fibroid (158 g) in the anterior wall of the uterus. A subsequent spontaneous pregnancy was complicated by placenta percreta. In late pregnancy, she had an elective cesarean section, the percrete area was resected, and she had an abdominal cerclage for hemostasis and support. Subsequently, she had two term pregnancies with normal placentation.
Conclusion: The woman avoided hysterectomy twice, first for gynecological and second for obstetrical reasons – and had three healthy infants. We conclude that the uterus should be preserved whenever possible in young fertile women.
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Affiliation(s)
- Amalie Bøggild
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Karin Sundberg
- Department of Fetal Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Olav Istre
- Aleris-Hamlet Hospitalet, Denmark, and University of Southern Denmark, Odense, Denmark
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14
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Pundir J, Kopeika J, Harris L, Krishnan N, Uwins C, Siozos A, Khalaf Y, El-Toukhy T. Reproductive outcome following abdominal myomectomy for a very large fibroid uterus. J OBSTET GYNAECOL 2014; 35:37-41. [DOI: 10.3109/01443615.2014.930097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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What is the role of hysteroscopic surgery in the management of female infertility? A review of the literature. Surg Res Pract 2014; 2014:105412. [PMID: 25374944 PMCID: PMC4208506 DOI: 10.1155/2014/105412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/27/2014] [Indexed: 11/17/2022] Open
Abstract
The position of hysteroscopy in current fertility practice is under debate. There are many randomized controlled trials on technical feasibility and patient compliance demonstrating that the procedure is well tolerated and effective in the treatment of intrauterine pathologies. However, no consensus on the effectiveness of hysteroscopic surgery in improving the prognosis of subfertile women is available. A literature review was performed to explore the available information regarding the role of hysteroscopy in the evaluation and management of female infertility as well as to ascertain evidence that treatment of these uterine abnormalities improves fertility. The debate regarding the role of hysteroscopic surgery in the management of female infertility remains as the published studies did not reach a consensus on the benefit of such an intervention in this setting. The randomized trials do not clearly demonstrate that surgical correction of all intrauterine abnormalities improves IVF outcome. However, published observational studies suggest a benefit for resection of submucosal leiomyomas, adhesions, and endometrial polyps in increasing pregnancy rates. More randomised controlled studies are needed to substantiate the effectiveness of the hysteroscopic removal of suspected intrauterine pathology in women with unexplained subfertility or prior to assisted reproductive technology.
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How to differentiate benign from malignant myometrial tumours using MR imaging. Eur Radiol 2013; 23:2306-14. [PMID: 23563602 DOI: 10.1007/s00330-013-2819-9] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/29/2013] [Accepted: 02/17/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE To retrospectively evaluate the ability of magnetic resonance imaging (MRI) to differentiate malignant from benign myometrial tumours. METHODS Fifty-one women underwent MRI before surgery for evaluation of a solitary myometrial tumour. At histopathology, there were 25 uncertain or malignant mesenchymal tumours and 26 benign leiomyomas. Conventional morphological MRI criteria were recorded in addition to b 1,000 signal intensity and apparent diffusion coefficient (ADC). Odds ratios (OR) were calculated for each criterion. A multivariate analysis was performed to construct an interpretation model. RESULTS The significant criteria for prediction of malignancy were high b 1,000 signal intensity (OR = +∞), intermediate T2-weighted signal intensity (OR = +∞), mean ADC (OR = 25.1), patient age (OR = 20.1), intra-tumoral haemorrhage (OR = 21.35), endometrial thickening (OR = 11), T2-weighted signal heterogeneity (OR = 10.2), menopausal status (OR = 9.7), heterogeneous enhancement (OR = 8) and non-myometrial origin on MRI (OR = 4.9). In the recursive partitioning model, using b 1,000 signal intensity, T2 signal intensity, mean ADC, and patient age, the model correctly classified benign and malignant tumours in 47 of the 51 cases (92.4 %). CONCLUSION We have developed an interpretation model usable in routine practice for myometrial tumours discovered at MRI including T2 signal, b 1,000 signal and ADC measurement. KEY POINTS • MRI is widely used to differentiate benign from malignant myometrial tumours. • By combining T2-weighted, b 1,000 and ADC features, MRI is 92.4 % accurate. • DWI may limit misdiagnoses of uterine sarcoma as benign leiomyoma. • Patient age is important when considering a solitary myometrial tumour.
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