Therapiemöglichkeiten beim Uterus myomatosus - Neue Aspekte 2008

Abstract

Due to the high incidence of uterine leiomyomas, various aspects involved in the treatment of the condition are extremely important. Many treatment methods are already long established, but there are important new findings that are of relevance for everyday practice - particularly with regard to myoma embolization, various hysterectomy procedures, and the issue of myoma enucleation in patients wishing to have children. Prospective and randomized studies have shown that 1 year after hysterectomy, patients have fewer symptoms compared to women who undergo myoma embolization, and that after 2 years there are no differences between the two methods. Two years after embolization, 20 - 25 % of the women having received this form of treatment had also undergone a hysterectomy. After myoma embolization, fertility was found to be reduced compared to a control group undergoing organ-preserving surgery, and the rate of miscarriages was markedly increased. It has been shown in randomized studies that supracervical hysterectomy offers no advantages over total hysterectomy with regard to sexuality, incontinence, or bowel function. Laparoscopic hysterectomy techniques are associated with an increased risk of injury to the urinary tract, but reduce the postoperative morbidity for patients.