Uterine Myoma
Juan Luis Alcázar, María Ángela Pascual, Stefano Guerriero in Ultrasound of Pelvic Pain in the Non-Pregnant Female, 2019
Very rarely, fibroids can cause acute complications, which manifest themselves mainly with acute pelvic pain. The most frequent complications of myomas are acute torsion of a subserosal pedunculated fibroma, acute urinary retention that can induce renal failure, red degeneration mainly during pregnancy, thromboembolism, mesenteric vein thrombosis, and intestinal necrosis.5 These conditions enter in differential diagnosis with twisted adnexa, rupture of ovarian cyst, hemorrhagic corpus luteum, or ectopic pregnancy.5 Pelvic or abdominal pressure is related to the myoma's size with associated urinary symptoms (urine retention and urinary frequency) due to tension on the bladder or intestinal symptoms (bowel obstruction, tenesmus, constipation) due to tension on the bowel. Moreover, it is important to evaluate purulence associated with pain, because these two symptoms may be due to an infection (pyomyoma).6
Computer-Assisted Laparoscopic Myomectomy
John C. Petrozza in Uterine Fibroids, 2020
As with any surgery, careful patient selection is the key to success and to avoiding unanticipated conversion to laparotomy. Each surgeon has his or her own comfort level regarding which patients are appropriate candidates for computer-assisted surgery based on the anticipated difficulty of the procedure. To improve patient selection, we strongly recommend preoperative imaging with magnetic resonance imaging (MRI) [9]. MRI is essential in helping surgeons plan out a procedure by detailing the size and location of each myoma. Furthermore, the images can be displayed throughout the procedure and used intraoperatively as a guide. As a general rule, based on the first 750 such operations performed by our team (with a 0.1% reported conversion to open surgery), patients with fewer than 15 total myomas, with a leading myoma of less than 15 cm in size, are appropriate candidates for robotic myomectomy [3].
Cervical Fibroids
Rooma Sinha, Arnold P. Advincula, Kurian Joseph in FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Enucleation of myoma can be carried out by using a myoma screw or tenaculum where the myoma easily walks out of its bed (Figure 11.4). After complete enucleation, cervical myoma can be removed by morcellation. If complete enucleation is difficult because of large size and deep location or limited pelvic space for traction, the myoma can be morcellated when it is still attached to the uterus [22]. The approach depends on the size and location of the myoma and the expertise or varied practices of different surgeons. Usually, in situ morcellation can cause excessive blood loss; hence, the operator needs good teamwork for faster and safer morcellation.
Serum sestrin 2 levels in patients with uterine leiomyomas
Published in Journal of Obstetrics and Gynaecology, 2022
Meric Kabakci, Nura Fitnat Topbas Selcuki, Zelal Aydin, Kubra Bagci, Cihan Kaya, Pinar Yalcin Bahat
The mean age was 38.7 ± 4.3 years for the myoma group and 36.3 ± 5.4 years for the control group, with no statistically significant difference between them (p = 0.06). Likewise, there was no significant difference between the BMI values of two groups, which were 27 (21–39) and 28 (18–38) for the myoma and control groups, respectively (p = 0.84). The mean gravida was 3 (0–6) for the myoma group and 3 (0–7) for the control group, again with no statistically significant difference (p = 0.21). There was also no significant difference in mean parity, which was 2 (0–6) for the myoma group and 3 (0–6) for the control group (p = 0.11). When gynecological symptoms were analysed, pelvic pain was reported in 20 (64.5%) patients in the myoma group and 18 (60%) patients in the control group, with no significant difference (p = 0.71). Dyspareunia was observed in 12 (38.7%) and 11 (36.7%) women in the myoma and control groups, respectively, with no significant difference (p = 0.86). Meanwhile, menorrhagia differed statistically significantly between groups, affecting 23 (74.2%) patients in the myoma group and 14 (46.7%) patients in the control group (p = 0.02). There was also a significant difference between the groups in terms of family history of myoma. Eighteen (58.1%) patients confirmed a family history in the myoma group, whereas none reported a positive family history in the control group (30, 100%) (p < 0.001). The mean calculated myoma volume for the study group was 180 cm3 (30–1440).
Preliminary study on ultrasound-guided high-intensity focused ultrasound ablation for treatment of broad ligament uterine fibroids
Published in International Journal of Hyperthermia, 2021
Yiran Wang, Yonghua Xu, Felix Wong, Yi Wang, Yu Cheng, Lixia Yang
Two hundred and thirty-six patients with symptomatic uterine fibroids were enrolled and treated with ultrasound-guided HIFU under conscious sedation between January 2017 and December 2018. All patients signed the written informed consent before treatment. The inclusion and exclusion criteria were reported in one of our previous studies [5]. MRI scans confirmed the presence of 13 broad ligament uterine fibroids in 12 patients, and their data were collected retrospectively and analyzed. The patients’ mean age was 38.6 years ± 6.3 years (range 24 − 46 years). These patients had mild to moderate pelvic compression symptoms, including frequent urination, low back pain, and constipation. Among them, there were no other symptoms in five patients, and the remaining seven patients simultaneously with submucosal or intramural myoma and BLUF had menorrhagia, dysmenorrhea, anemia or lower abdominal pain. All patients had contrast-enhanced MRI before, immediately post-operation, and at six months after the procedure. The non-perfusion volume ratio (NPV ratio), reduction of fibroid volumes, symptom changes, adverse events, and complications associated with the HIFU ablation were analyzed.
A novel approach to infertility treatment of advance-age patient with prominent intramural fibroid
Published in Gynecological Endocrinology, 2018
Raoul Orvieto, Eran Zilberberg, Valeria Stella Vanni, Amnom Botchan
Uterine fibroids are the most common benign tumor of the female genital tract, with an estimated prevalence of 20–50% of the reproductive age women [1]. A recent ASRM practice committee guideline has demonstrated that there is insufficient evidence to conclude that myomas reduce the likelihood of achieving pregnancy with or without fertility treatment, nor any evidences that a specific myoma size, number, or location (excluding submucosal myomas or intramural myomas impacting the endometrial cavity contour) is associated with a reduced likelihood to conceive and deliver [2]. Nevertheless, the overall evidence supports the concept that submucosal and intramural fibroids causing intracavity distortion should be treated with myomectomy, whereas subserosal fibroids should be managed expectantly [2–5].