Handling cervical myomas

Laparoscopic myomectomy for posterior cervical myoma: authors' experience and strategy

OBJECTIVES

Posterior cervical myoma poses a challenge for gynecologic surgeons, especially in women who want to preserve their fertility. The objective of this study is to summarize our experience with and strategy for this difficult situation.

METHODS

Between July 2019 and June 2021, 13 patients with posterior cervical myoma underwent laparoscopic myomectomy in our department. In addition to using the conventional strategy for laparoscopic myomectomy, other measures such as uterine suspension and preliminary exposure of vital structures, including the uterine artery and ureter, were implemented to enhance safety and improve efficacy. The perioperative outcomes for these patients were retrospectively evaluated.

RESULTS

All surgeries were completed successfully with no conversion to laparotomy. There were no intraoperative complications or needs for blood transfusion. Uterine suspension was performed in all cases, while preliminary exposure of the uterine artery and ureter was performed in nine cases (69.2%). Uterine artery ligation was necessary in two cases. The mean surgical duration was 78.5 ± 12.3 minutes, mean blood loss was 54.2 ± 11.9 mL, and the mean specimen weight was 171.5 ± 59.8 g. Histopathologic analysis revealed leiomyomas in all cases. The postoperative course and follow-up were uneventful.

CONCLUSION

By uterine suspension and preliminary exposure of vital structures, including the uterine artery and ureter, laparoscopic myomectomy for posterior cervical myoma can be performed safely.

Uterine Artery Embolization and Double-J (DJ) Stenting in a Case of Urinary Retention Due to a Massive Cervical Fibroid: A Case Report

In women, the most common solid tumor of the pelvis is a uterine fibroid. A large cervical fibroid can also cause urinary incontinence in women. We report a case of a 45-year-old woman with urinary retention that was initially diagnosed as an anterior wall uterine fibroid in the peripheral health center but turned out to be a massive cervical fibroid. After the initial evaluation, it was determined that the cervical fibroid was huge and impacted the pelvis, and there was a possibility of a torrential operative hemorrhage. Thus, preoperative uterine artery embolization (UAE) was performed to prevent intraoperative blood loss, and Double-J (DJ) stenting was performed to avoid ureteric injury. This was followed by a total abdominal hysterectomy, without facing any intraoperative complications. This case demonstrates the importance of proper clinical assessment and the use of skilled interventional radiology procedures such as UAE and DJ stenting in the treatment of a massive cervical fibroid.

Successful pregnancy after presurgical uterine artery embolization in the management of a very large cervical myoma: A case report

Although fibroids are the most common benign tumors of the uterus in women of reproductive age, cervical fibroids are rarely seen. Since cervical fibroids are located deep in the pelvis, the incidence of complications in surgery is high. Among these complications bleeding is the most common, due to poor access to myoma, difficulty in suturing and repair, and distortion of vital neighboring structures. Each case should be managed individually to minimize bleeding. To decrease bleeding in patients who wish to retain their fertility, intraoperative interventions include vasoconstrictors such as vasopressin and adrenaline, uterotonics such as oxytocin, misoprostol or ergometrines, uterine artery clamping, internal iliac artery balloon occlusion catheters, and tourniquets; preoperative interventions include gonadotropin releasing-hormone analogues and uterine artery embolization. We present a case of a 40-year-old woman who had a large cervical myoma and a desire for future fertility. To overcome technical difficulties and reduce intraoperative bleeding during myomectomy, presurgical uterine artery embolization was performed. The patient conceived spontaneously after the operation and a healthy baby was delivered by cesarean section.

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Cervical myoma is rare.

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Preoperative uterine artery embolization decreases blood loss and helps preserve the uterus during myomectomy.

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In pregnant patients with a history of uterine artery embolization the risk of miscarriage, placental insertion anomalies, postpartum hemorrhage and intrauterine growth restriction is increased.

Total Laparoscopic Hysterectomy for Anterior Cervical Myoma: Possible Significance of Presurgical Assessment by Magnetic Resonance Imaging

Hysterectomy for large uterine anterior cervical myoma is a challenging surgical procedure. We summarize our experience in the management of large uterine anterior cervical myoma. Three patients underwent hysterectomy for uterine anterior cervical myoma with similar sizes and different positions treated by laparoscopic surgery. Total laparoscopic hysterectomy (TLH) for cervical myoma is possible by performing ureterolysis and adopting retrograde hysterectomy. Because the position of myoma is important to determine the difficulty of TLH, we propose to measure the axis between the most caudal point of the myoma and external cervical os and pubococcygeal line as a possible useful method in objectively predicting the difficulty of TLH for large anterior cervical myoma.

Urological complications of uterine leiomyoma: a review of literature

INTRODUCTION

Uterine leiomyomas are common gynecologic tumor in reproductive-aged women, by age 50, diagnosis shared by urologist, gynecologists and radiologists.

OBJECTIVE

The goal of this article is to review the current literature, study the impact of leiomyoma on female lower urinary tract, examine the cause female sexual dysfunction and provide a comprehensive review of current diagnostic, imaging studies, and current treatment of leiomyoma.

METHODS

Clinical leiomyoma studies published from 1956 through 2015 were identified using the PubMed search engines and the key words leiomyoma, fibroid in the current literature. Impact of leiomyoma on the lower urinary tract including female sexual dysfunction was reviewed with terms of "urinary retention", "bladder", "urethra", "dyspareunia", "incontinence", "incomplete bladder emptying", "female sexual dysfunction", and "lower urinary tract" to study the urological and sexual effects of leiomyoma. Literature related to leiomyoma was reviewed from 1965 to present.

RESULTS

Women with uterine leiomyomata complained of pelvic pain, menstrual irregularities, infertility, lower urinary tract symptoms and sexual dysfunction.

CONCLUSION

Leiomyoma is a common tumor of the uterus that often clinically impacts on the lower urinary tract and results in urological and sexual symptoms. Leiomyoma can compress and grow into and become adherent to the bladder and surrounding pelvic organs or metastasize into peritoneal organs. Leiomyoma can enlarge and compress the urinary bladder, urethra, and lower end of the ureters. Leiomyoma can cause embarrassing sexual dysfunction in females. Current literature of non-surgical and surgical therapy of leiomyoma is described.

Hysterosalpingographic features of cervical abnormalities: acquired structural anomalies

Cervical abnormalities may be congenital or acquired. Congenital cervical structural anomalies are relatively uncommon, whereas acquired cervical abnormalities are commonly seen in gynaecology clinics. Acquired abnormalities of the cervix can cause cervical factor infertility and recurrent spontaneous abortion. Various imaging tools have been used for evaluation of the uterine cavity and fallopian tubes. Hysterosalpingography (HSG) is a quick and minimally invasive tool for evaluation of infertility that facilitates visualization of the inner surfaces of the uterine cavity and fallopian tubes, as well as the cervical canal and isthmus. The lesions of the uterine cervix show various imaging manifestations on HSG such as narrowing, dilatation, filling defects, irregularities and diverticular projections. This pictorial review describes and illustrates the hysterosalpingographic appearances of normal variants and acquired structural abnormalities of the cervix. Accurate diagnosis of such cases is considered essential for optimal treatment. The pathological findings and radiopathological correlation will be briefly discussed.