Classification of Uterine Fibroids and Correlation with Surgical Outcome

Abstract

Uterine leiomyomas (fibroids) can lead to a variety of different symptoms, depending on their location, size and number. Submucous fibroids can cause abnormal uterine bleeding (AUB), heavy menstrual bleeding, recurrent pregnancy loss (RPL) and subfertility. Various treatment options include medical or surgical treatments such as hysteroscopic myomectomy, excision by laparoscopy or laparotomy. Additionally, interventional radiological techniques like uterine artery embolization (UAE) or magnetic resonance (MR)-guided focused ultrasound (MR-FU) ablation can be utilized. The wide range of possible treatments warrants an appropriate assessment of patients in choosing suitable intervention. A thorough patient history and examination with ultrasound and/or other imaging is fundamental in the assessment of patients. Hysteroscopic myomectomy has been demonstrated to reduce AUB, increase pregnancy rates and can reduce first and second trimester abortion rates. It is the preferred treatment of choice for many submucous myomas due to its minimally invasive approach and efficacy. To fully restore intracavitary anatomy, the knowledge of hysteroscopic resection techniques as a main surgical treatment option is pivotal. This chapter will present symptoms and disease patterns of submucous myomas, imaging methods, classification of myomas, surgical outcomes of hysteroscopic myomectomy and will highlight possible complications of hysteroscopic surgery for myomas.