The management of uterine leiomyomas (original) (raw)
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Interventional Uterine-Sparing Therapies for Leiomyomas: A Commentary on Myolysis
Journal of Obstetrics and Gynaecology Canada, 2020
Uterine leiomyomas (myomas, fibroids) are very common in premenopausal women and frequently are associated with abnormal uterine bleeding, bulk effects, and reproductive issues. In women who wish to retain their uterus and/or to enhance or retain fertility, interventional therapies have been introduced, including radiofrequency, laser (chromo), cryotherapy, and magnetic resonance (MR)−guided high-intensity focused ultrasound (MRgHIFU) myolysis. In formulating this commentary, all modalities of myolysis from systematic reviews, randomized controlled clinical trials, and observational studies through December 2018 were reviewed. There are only two treatment modalities available in Canada: the laparoscopic radiofrequency volumetric thermal ablation of fibroids (RFVTA) and MRgHIFU systems. In women who wish to enhance or retain their fertility, the safety and efficacy of radiofrequency and HIFU myolysis have not been clearly established, and these treatments should be offered only after extensive counselling and informed consent. Given the recent concerns regarding the incidence of undiagnosed malignant tumours, the lack of histological confirmation before or after these therapies for symptomatic fibroids mandates a thorough process of informed patient consent before any such interventions.
Guideline No. 389-Medical Management of Symptomatic Uterine Leiomyomas – An Addendum
Journal of Obstetrics and Gynaecology Canada, 2019
It is SOGC policy to review the content 5 years after publication, at which time the document may be reaffirmed or revised to reflect emergent new evidence and changes in practice. CHANGE IN PRACTICE 1. Prolonged medical management of fibroid symptoms is safe and effective. 2. Women treated with ulipristal acetate should undergo liver monitoring. 3. Attempts should be made to correct anemia (hemoglobin <120) prior to elective gynaecologic surgery. This Addendum has been prepared by the authors, reviewed by the Society of Obstetricians and Gynaecologists of Canada (SOGC) Clinical Practice Gynaecology and Guideline Management and Oversight Committees, and approved by the Board of the SOGC.
Clinical Presentation & Operative Treatment of Leiomyoma of Uterus and its Outcome
Chattagram Maa-O-Shishu Hospital Medical College Journal, 2014
Introduction: Uterine leiomyoma is remarkably common, however only a subset of women have their fibroids clinically detected, symptomatic, or warrant surgical treatment. Mode of treatment depends on age of the patients, number, size and site of the myoma and also fertility status of the patients. Materials & methods: To evaluate the sociodemographic, clinical characteristics, management outcome and its determinants in BSMMU, Dhaka, Bangladesh, the study was carried out. 50 patients of diagnosed leiomyoma admitted in the BSMMU, Dhaka was selected for the study. Clinical profile, type of surgery and postoperative follow up findings were noted. Data was analyzed by computer based software SPSS -18. Results: The common complaints among the 50 patients were progressive menorrhagia (70%), abdominal swelling (50%), infertility (24%), weight in pelvis (38%), weakness/dizziness or syncopal attack after menstrual period (26%) and recurrent miscarriages (12%). The average uterine size at presentation was 15±9.7 weeks. The majority (70%) of the women presented with multiple leiomyomata. The commonest anatomical position of the myomas were multiple positions and intramural(80%). Total abdominal hysterectomy with or without bilateral sulphingo ophorectomy according to age was the commonest surgical procedure performed in thirty two (64%) cases. Myomectomy was done in 12(24%) cases and laparoscopic assisted vaginal hysterectomy was done in also 6(12%) of patients. Postoperative complications occurred in 24%(12) of the women. The most common complications were postoperative pyrexia 12%, blood loss warranting transfusion 8%, wound infection 10% and prolonged hospital stay 6%. Conclusion: Uterine fibroid is common in our environment and most of the patients had regular menstrual cycle with progressive menorragia. Its removal is commonly associated with post-operative pyrexia, blood loss, and anemia and wound infection. Preoperative correction of anemia appropriate use of antibiotics and strict hemostasis and asepsis can reduce these complications.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2012
To compare short-term morbidity and quality of life after laparoscopic hysterectomy (LH) and laparoscopic myomectomy (LM) for the treatment of symptomatic uterine leiomyomas. We performed a prospective, observational study of women who were eligible for both surgical procedures. After informed consent was obtained, each participant was asked to complete the SF-12v2 Health Survey before surgery and to repeat it seven days and 28 days after surgery. Data on short-term morbidities, such as operative time, blood loss, length of hospital stay, and surgical complications, were collected by an obstetrician-gynaecologist. Women who underwent LH were compared by non-parametric statistical analyses with those who underwent LM. Sixty-one women were recruited between January 1 and December 31, 2008, including 40 who underwent LM and 21 LH. Women who underwent LH were older, had higher parity, and were less likely to have infertility than those who chose LM. Median LH operative time of 223 minut...
Medical Treatment of Uterine Leiomyoma
Reproductive Sciences, 2012
Uterine leiomyomas (also called myomata or fibroids) are the most common gynecologic tumors in the United States. The prevalence of leiomyomas is at least 3 to 4 times higher among African American women than in white women. Pathologically, uterine leiomyomas are benign tumors that arise in any part of the uterus under the influence of local growth factors and sex hormones, such as estrogen and progesterone. These common tumors cause significant morbidity for women and they are considered to be the most common indication for hysterectomy in the world; they are also associated with a substantial economic impact on health care systems that amounts to approximately $2.2 billion/year in the United States alone. Uterine myomas cause several reproductive problems such as heavy or abnormal uterine bleeding, pelvic pressure, infertility, and several obstetrical complications including miscarriage and preterm labor. Surgery has traditionally been the gold standard for the treatment of uterine leiomyomas and has typically consisted of either hysterectomy or myomectomy. In recent years, a few clinical trials have evaluated the efficacy of orally administered medications for the management of leiomyoma-related symptoms. In the present review, we will discuss these promising medical treatments in further detail.
Therapeutic approach of uterine leiomyoma; choosing the most appropriate surgical option
Journal of Clinical and Investigative Surgery, 2021
The most common benign pelvic tumor in young women is uterine leiomyoma. It is often asymptomatic, but can cause symptoms such as pelvic-abdominal pain, vaginal bleeding, urinary and intestinal transit disorders. If there is a suspicion of malignancy, it is necessary to perform fractional uterine curettage to establish the histopathological diagnosis.The surgical treatment of uterine leiomyoma includes several procedures: myomectomy, subtotal or total hysterectomy. The procedure will be chosen depending on the patient's particularities: BMI, uterine size, leiomyoma location, surgical history or other associated pathologies.Laparoscopic hysterectomy has a 45-minute shorter duration of intervention than vaginal hysterectomy, and the conversion rate to the open procedure is lower.Laparoscopically treated cases have fewer postoperative complications compared to other surgical procedures and have a shorter hospitalization and recovery time.The recurrence rate of uterine leiomyoma is ...
Uterine Leiomyoma: Available Medical Treatments and New Possible Therapeutic Options
The Journal of Clinical Endocrinology & Metabolism, 2013
Context: Uterine leiomyomas (fibroids or myomas) are benign tumors of the uterus and are clinically apparent in up to 25% of reproductive-age women. Heavy or abnormal uterine bleeding, pelvic pain or pressure, infertility, and recurrent pregnancy loss are generally associated with leiomyoma. Although surgical and radiological therapies are frequently used for the management of this tumor, medical therapies are considered the first-line treatment of leiomyoma.
European Radiology, 2010
Objective To compare uterine artery embolisation (UAE) and hysterectomy for the treatment of leiomyomas at 2-year follow-up in a prospective, randomised, single-centre study. Methods Fifty-seven symptomatic patients were randomised to UAE (n = 27) or hysterectomy (n = 30). Complications, recovery, reinterventions and satisfaction with treatment were recorded. Primary endpoint was improvement of symptoms. Analyses were performed by intent-to-treat and per protocol. Results Two hysterectomy patients (7%) developed major complications. Hospital discharge occurred earlier after UAE than after hysterectomy (p p p = 0.173). In 12/18 (67%) UAE patients menorrhagia was completely resolved or reduced. Improvement of pressure symptoms was reported significantly more by UAE patients than by hysterectomy patients (19/20 [95%] versus 18/26 [69%], respectively; p = 0.029). Five (19%) UAE patients underwent additional interventions due to worsening symptoms. Twenty-four (89%) UAE patients and 29 (97%) hysterectomy patients would have chosen treatment again (p = 0.336). Conclusion UAE gave relief of symptoms (apart from menorrhagia) comparable to hysterectomy with less severe complications, but with an increased rate of secondary interventions. UAE may be the preferable treatment especially for patients with pressure symptoms.
Fertility and Sterility, 2009
Objective: To determine the optimal surgical approach when patients are treated with laparoscopic uterine vessel occlusion (LUVO) combined with myomectomy in the management of women with symptomatic uterine fibroids. Design: An observational study. Setting: Medical centers. Patient(s): One hundred thirty-one patients with symptomatic myomas underwent LUVO plus laparoscopic myomectomy (LM; LUVOþLM) (n ¼ 49) or LUVO plus ultra-mini laparotomy UMLT-M (LUVOþUMLT-M) (n ¼ 82). Intervention(s): Myomectomy through laparoscopy or UMLT access. Main Outcome Measure(s): The outcome was measured by comparing surgical techniques, and 3-year follow-up, including symptom control and reintervention (hysterectomy or myomectomy), in both groups. Result(s): General characteristics of the patients were similar in both groups, except the number of myomas.
Fibroids (uterine myomatosis, leiomyomas)
Clinical evidence, 2007
IntroductionBetween 5-77% of women may have fibroids, depending on the method of diagnosis used. Fibroids may be asymptomatic, or may present with menorrhagia, pain, infertility, or recurrent pregnancy loss. Risk factors for fibroids include obesity, having no children, and no long-term use of the oral contraceptive pill. Fibroids tend to shrink or fibrose after the menopause.Methods and outcomesWe conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: medical treatment alone; preoperative medical treatments for women scheduled for surgery; and surgical treatments in women with fibroids? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). ResultsWe found 41 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.ConclusionsIn this systematic review we present information relating to the effectiveness and safety of the following interventions: gonadorelin analogues (with progestogen, raloxifene, tibolone, or combined oestrogen-progestogen); hysterectomy (plus oophorectomy); hysteroscopic resonance-focused ultrasound; laparoscopic myomectomy; laparoscopically assisted vaginal hysterectomy; rollerball endometrial ablation; thermal balloon ablation; thermal myolysis with laser; total abdominal hysterectomy; total abdominal myomectomy; total laparoscopic hysterectomy; total vaginal hysterectomy.