Fibroid Size Research Articles

Hysteroscopic laser ablation of symptomatic uterine fibroids: insights from a prospective study

Objective This study aimed to evaluate the feasibility and efficacy of in-office hysteroscopic ablation of submucous uterine fibroids using a diode laser. Method A pilot study was conducted between January 2018 and January 2019 in a tertiary care university hospital. Patients with at least one symptomatic, class 0–2 FIGO classification, uterine fibroid ≤7 cm in size were eligible for inclusion. Evaluation of the changes in fibroid size and vascularity was performed using three-dimensional Doppler ultrasonography. Vaporization of the fibroid core was conducted using a 980–1470 nm wavelength diode laser inserted through the hysteroscope’s working channel. The primary outcome was evaluation of the fibroid volume before and at 2 months after the procedure. Results Twenty women were enrolled in the study. At 2-month follow-up, the volume of the fibroids was significantly reduced (51.6 ± 22.5 vs. 33.4 ± 17.1 mm3; p < 0.001). A major reduction of three-dimensional sonographic color Doppler vascularity (observed by the same operator and confirmed by four blind reviewers) was also achieved in 12/20 patients (60%; p = 0.03) while a reported symptom of heavy menstrual bleeding decreased from 18/20 (90%) to 2/18 (10%; p < 0.01). Conclusion Hysteroscopic laser ablation represents a feasible and effective alternative for treating women with symptomatic submucous fibroids in the office setting. Further studies with larger sample size and longer follow-up periods are needed to validate this promising technique. Key message This pilot study shows that in-office hysteroscopic laser ablation (HLA) could be a feasible alternative to treat symptomatic submucous uterine fibroids by coagulating their core, reducing their size and vascularization.

Comparative study of Ulipristal and Ormeloxifene in treatment of uterine fibroids

Aim: This study was conducted among reproductive age women between 30-50 yrs diagnosed with uterine fibroids to compare the efficacy and safety of Ormeloxifene and Ulipristal in treatment of uterine fibroids.Methodology: Prospective interventional study was conducted from May 2021 to September 2022 among 40 patients diagnosed with uterine fibroids who were randomly divided into two groups, 20 patients in each group, Group 1 were given Ormeloxifene and group 2 were given UlipristalResults: Mean fibroids size reduced in patients who took Ulipristal than in Ormeloxifene group which was statistically significant. Mean HB CONC increased in Ulipristal group than in Ormeloxifene group which was statistically insignificant.Conclusion: Ulipristal is better as compared to ormeloxifene in reduction of fibroid size. Ulipristal also reduced menstrual blood loss and improved hemoglobin levels when compared to Ormeloxifene.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Ayurvedic Intervention of Garbhashyagata Granthi (Uterine Fibroid) - A Case Report

Uterine fibroid is most common solid benign tumors in women of reproductive age. The symptoms of uterine fibroid adversely affect social and recreational activities, women's quality of life, and productivity at work. Uterine fibroid occur in 50–60% of women, rising to 70% by the age of 50 and in 30% of cases cause morbidity. A 40-year-old married woman consulted in the outpatient department (OPD) of P.G. department of Prasutitanta and Striroga with a complaint of heavy and prolong menstrual bleeding with painful menstruation since 5 years. It is associated with lower back pain, lower abdominal pain, frequent urination, mild constipation and pain in both lower extremities. Her Ultrasonography report shows bulky uterus and intramural uterine fibroid size of 19x17x25 mm. Patient was treated according to Ayurvedic management of Granthi. So the drug having properties Raktstambhak, Lekhana, Raktshodhak, Shothahara, etc. are used with advice of Pathya Aahar-Vihara.Treatment was continued for one years with a follow up once in 15days and a repeat scan revealed shrinking size of the fibroid and relief in all symptoms.

Hysteroscopic myomectomy with the IBS® Intrauterine Bigatti Shaver: A Retrospective Comparative Analysis of the impact of rotational speed and aspiration flow rate

Myoma removal remains a challenge hysteroscopically including for the "IBS®" Intrauterine Bigatti Shaver technique. To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology. This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size:<3 cm and 3-5 cm. Both Groups A and B were similar in terms of patient age, parity, symptoms, myoma type and size. Submucous myomas were classified according to the European Society for Gynaecological Endoscopy classification. All patients underwent a myomectomy with the IBS® under general anaesthesia. The conventional 22 Fr. Bipolar Resectoscope was used in cases requiring conversion to the resection technique. All surgeries were planned, performed and followed by the same surgeon in both institutions. Complete resection rates, total operation time, resection time and used fluid volume. Complete resection with the IBS® Shaver was seen in 93/107 (86.91%) in Group A versus 83/84 (98.8 %) in Group B (P=0.0021). Five patients (5.8%) in Subgroup A1 (<3 cm) and nine patients (42.9%) in Subgroup A2 (3cm~5cm) could not be finished with the IBS (P<0.001, RR=2.439), while in Group B only one case (8.3%) in Subgroup B2 (3cm~5cm) underwent a conversion to bipolar resectoscope (Group A: 14/107=13.08% vs. Group B: 1/84=1.19%, P=0.0024). For <3cm myomas (subgroup A1 versus B1) there was a statistically significant difference in terms of resection time (7.75±6.363 vs. 17.28±12.19, P<0.001), operation time (17.81 ± 8.18 vs. 28.19 ±17.614, P<0.001) and total amount of fluid used (3365.63 ± 2212.319 ml vs. 5800.00 ± 8422.878 ml, P<0.05) in favour of Subgroup B1. For larger myomas, a statistical difference was only observed for the total operative time (51.00±14.298 min vs. 30.50±12.122 min, P=0.003). For hysteroscopic myomectomy using the IBS®, 1,500rpm rotational speed and 500ml/min aspiration flow rate are recommended as these settings result in more complete resections compared to the conventional settings. In addition, these settings are associated with a reduction in total operating time. Reducing the rotational speed rate from 2500 rpm to 1500 rpm and increasing the aspiration flow rate from 250 ml/min to 500 ml/min improve complete resection rates and reduce operating times.

Differences in Fibroid Symptom Reporting among Asian and Caucasian Patients in a Multidisciplinary Fibroid Center

Introduction: Uterine fibroids are prevalent in reproductive-age Asian women and can have a severe impact on health due to heavy bleeding, pelvic pain, and psychosocial harm. Current treatment, ranging from expectant management to hysterectomy, is aimed at symptom alleviation. Therefore, it is crucial for providers to accurately gauge symptom impact to determine appropriate treatments. A recent study reported differential symptom scores between Asian and Caucasian women treated at the Stanford Fibroid Center (SFC).1 In this pilot study, we aim to explore potential etiologies contributing to this finding by comparing fibroid size and location, clinical factors, and surveying sociocultural factors. Methods: We utilized a mixed methods approach to uncover potential associations to differential Uterine Fibroid Symptom and Health-Related Quality of Life Symptom Severity Scores (UFS-QoL SSS) between Asian and Caucasian patients at SFC. We quantitatively analyzed fibroid imaging data and clinical risk factors from this cohort and qualitatively compared semi-structured interviews in a representative sub-sample. Results: We found no significant difference in fibroid size or location between groups. However, Asians had significantly lower body mass index (P &lt; 0.0001) and were more likely non-smokers (P = 0.0037) compared to Caucasians. After adjusting for these and other risk factors, pretreatment UFS-QoL SSS in Asian patients were still significantly lower (P &lt; 0.0001). Qualitative interviews with Asian and Caucasian interviewees demonstrated comparable symptom experiences and quality of life, but more Asian participants described a negative impact from family and friends, less access to and distrust of medical providers, and pursuit of alternative therapies for their fibroids. Conclusion: These findings suggest that the UFS-QoL questionnaire may be insufficient for capturing symptom burden in patients of different races. Further understanding on how the above factors modulate symptom reporting is warranted to help design appropriate fibroid treatment recommendations for diverse populations.

Utilization and cost of cell salvage in minimally invasive myomectomy

ObjectiveTo assess the utilization and cost of intraoperative cell salvage (ICS) in minimally invasive myomectomy. Study DesignRetrospective cohort study of patients who underwent minimally invasive myomectomy at a quaternary care academic hospital. Patients were classified into: ICS setup vs no ICS setup, ICS setup with reinfusion vs ICS setup without reinfusion. ResultsOf 382 patients who underwent minimally invasive myomectomy, 67 (17.5 %) had ICS setup, 30 (44.8 %) of those patients reinfused. Median volume of reinfusion per patient was 300 mL (range 125–1000 mL). Patients who ultimately underwent ICS reinfusion, compared to those with ICS setup only, had significantly larger mean maximum fibroid size (9.8 cm vs 8.0 cm, p = 0.02), higher median total specimen weight (367 vs 304 g, p = 0.03), higher median estimated blood loss (575 vs 300 mL, p < 0.0001), longer mean operative time (261 vs 215 min, p = 0.04). No perioperative complications were associated with ICS. Higher costs are associated with universal use or complete lack of ICS; lowest cost is associated with ICS setup only for those ultimately reinfused. ConclusionICS might reduce requirements for allogeneic blood transfusions in patients undergoing minimally invasive myomectomy, and may contribute to cost savings. Uterine and maximum fibroid sizes are possible preoperative indicators for patients who require cell salvage reinfusion.

Uterine Weight as a Modifier of Black/White Racial Disparities in Minimally Invasive Hysterectomy Among Veterans with Fibroids in the Veterans Health Administration.

Uterine fibroids are the most common indication for hysterectomy. Minimally invasive hysterectomy (MIH) confers lower risk of complications and shorter recovery than open surgical procedures; however, it is more challenging to perform with larger fibroids. There are racialized differences in fibroid size and MIH rates. We examined the role of uterine size in black-white differences in MIH among Veterans in the Department of Veterans Affairs (VA). Using VA clinical and administrative data, we conducted a cross-sectional study among black and white Veterans with fibroids who underwent hysterectomy between 2012 and 2014. We abstracted postoperative uterine weight from pathology reports as a proxy for uterine size. We used a generalized linear model to estimate the association between race and MIH and tested an interaction between race and postoperative uterine weight (≤250 g vs. >250 g). We estimated adjusted marginal effects for racial differences in MIH by postoperative uterine weight. The sample included 732 Veterans (60% black, 40% white). Postoperative uterine weight modified the association of race and MIH (p for interaction=0.05). Black Veterans with postoperative uterine weight ≤250 g had a nearly 12-percentage point decrease in MIH compared to white Veterans (95% CI -23.1 to -0.5), with no difference by race among those with postoperative uterine weight >250 g. The racial disparity among Veterans with small fibroids who should be candidates for MIH underscores the role of other determinants beyond uterine size. To eliminate disparities in MIH, research focused on experiences of black Veterans, including pathways to treatment and provider-patient interactions, is needed.

Impact of Vitamin D Supplementation among the Women with Uterine Fibroid in Different Age Groups

Background: Uterine fibroid (UF) is a common tumor of the female reproductive system. Though most of the women with fibroids are asymptomatic, approximately 30% of them can mention about some severe symptoms like abnormal uterine bleeding, pelvic pain, anemia, back pain, urinary frequency and even infertility etc. Generally, among the patients with uterine fibroids, prevalence of vitamin D deficiency is found. But, the impact of vitamin D on reduction of the sizes the uterine fibroids are still unknown. Aim of the study: The aim of this study was to assess the impact of vitamin D supplementation among the women with uterine fibroid in different age groups. Methods: This prospective observational study was conducted in the department of Radiology &amp; Imaging, BSMMU, Dhaka, Bangladesh during the period from January 2020 to December 2020. In total 75 women with uterine fibroid were enrolled in this study as study population. Before data collection proper written consents were taken from all the participants. Along with the data regarding fibroids and vitamin D status, all the demographic and clinical data were collected and analyzed. In data collection, a predesigned questioner was used. All data were processed, analyzed and disseminated by using MS Excel and SPSS version 23.0 program as per necessity. Results: In this study, in assessing the fibroid’s sizes of several age group patients, between baseline and follow-up we found that, at baseline, in 20-30, 31-45 and &gt;45 year’s age groups, the mean ±SD sizes of fibroids were 3.32±0.46, 3.91±0.50 and 4.05±0.51 cm respectively. On the other hand, at follow-up stage in those groups the mean ±SD sizes of fibroids were found as 2.64 ±0.40, 3.66±0.48 and 3.5±0.47 cm respectively. Finally, in evaluating the impact of vitamin D supplementation among our participants, comparing the fibroid sizes between baseline and follow-up stages, we observed that, in &gt;45 years’ age group the fibroid size change was non-significant (P&lt;0.05). ..

Development of relugolix combination therapy as a medical treatment option for women with uterine fibroids or endometriosis

Treatment of uterine fibroids (UF) and endometriosis (EM) has relied on the surgical skills of gynecologists to improve symptoms and potentially alter the course of these debilitating diseases. Medical management of symptoms for both diseases leverages combined hormonal contraceptives used off label as a first-line treatment, with nonsteroid anti-inflammatory drugs and opioids to manage pain as needed. Gonadotropin-releasing hormone (GnRH) receptor agonists (peptide analogs) have been used as short-term therapy to manage severe symptoms of UF or EM, treat anemia, and reduce fibroid size before surgery. The introduction of oral GnRH receptor antagonists opened the door for the development of new treatment options for UF, EM, and other estrogen-driven diseases. Relugolix is an orally active, nonpeptide, GnRH receptor antagonist that competitively binds to GnRH receptors, preventing the release of follicle-stimulating hormone and luteinizing hormone (LH) into the systemic circulation. In women, the reduction in follicle-stimulating hormone concentrations prevents natural follicular development, suppressing ovarian production of estrogen, and together with reductions in LH concentrations, prevent ovulation, corpus luteum formation, and, thereby, the production of progesterone (P). By reducing circulating concentrations of estradiol (E2) and P, relugolix improves heavy menstrual bleeding and other symptoms associated with UF and moderate to severe pain associated with EM, including dysmenorrhea, nonmenstrual pelvic pain (NMPP) and dyspareunia. However, as monotherapy, the use of relugolix is associated with signs and symptoms of a hypoestrogenic state, including bone mineral density loss and vasomotor symptoms. The clinical development of relugolix incorporated the addition of a 1 mg dose of E2 and a 0.5-mg dose of norethindrone acetate (NETA) to achieve systemic E2 concentrations that remain in a therapeutic range while mitigating the risk for bone mineral density loss and vasomotor symptoms, enabling the longer-term treatment and reducing the impact of symptoms on quality of life, and potentially delaying or preventing the need for surgery. Relugolix 40 mg in combination with estradiol (E2) 1 mg and NETA 0.5 mg as a single fixed-dose combination tablet (relugolix combination therapy [relugolix-CT]) approved in the United States as MYFEMBREE is the first and only once daily oral GnRH antagonist combination therapy indicated for the management of heavy menstrual bleeding associated with UF and moderate to severe pain associated with EM. In the European Union (EU) and the United Kingdom (UK), relugolix-CT is approved as RYEQO for the management of symptoms associated with UF. In Japan, relugolix 40 mg, as monotherapy, was the first GnRH receptor antagonist approved to improve symptoms associated with UF or pain associated with EM under the brand name RELUMINA. In men, relugolix suppresses testosterone production. Relugolix 120 mg (ORGOVYX) was developed by Myovant Sciences and is approved in the United States, EU, and UK as the first and only oral androgen-deprivation therapy for the treatment of advanced prostate cancer. This review is focused on the development of relugolix and relugolix-CT in women's health indications.

Comparison of the Clinical Outcomes and Efficiencies of HIFU (High-Intensity Focused Ultrasound), Da Vinci Robotic Surgery and Laparoscopic Surgery for Uterine Fibroids: A Systematic Review and Meta-Analysis

Background: To compare the clinical outcomes and treatment efficiencies of advanced surgical treatments including High-Intensity Focused Ultrasound (HIFU), robotic surgery and laparoscopic surgery in the uterine fibroid patients. Methods: A total of 512 studies from 1995 to 2021 were identified by screening from Science Direct, Cochrane library, Medscape, Willey Online Library, PubMed, and Taylor Francis. From these studies 29 articles were qualitatively included in our systematic review and 24 of them considered quantitively eligible were included in the meta-analysis. Study analyzed by pooling the weighed mean difference (WMD) with the 95% confidence interval (CI) were study provided as a mean + (SD) and pooled risk ratio (RR) was expressed for dichotomous variables. Pooled results were assessed with either a random-effect or fixed-effect model. Heterogeneity was evaluated using the I2 statistic. Results: Comparison of HIFU and robotic surgeries with operation times of 86.13 ± 36.37 minutes to 120.2 ± 63 minutes and 166 ± 48.5 minutes to 278 ± 67 minutes were higher significant differences (I2 = 97%, p &lt; 0.00001), (WMD –111.88 [–189.68, –34.08]) with statistically significant (p = 0.005). Comparison of HIFU and laparoscopic surgery in operation time of 86.13 ± 36.37 minutes to 120.2 ± 63 minutes and 79 ± 30 minutes to 106.4 ± 38.5 minutes were not statistically significant (p = 0.75) with higher significant differences heterogeneity (I2 = 96%, p &lt; 0.00001), (5.51 [–27.82, 38.83]). Comparison of between blood losses and fibroid sizes at 154 ± 75 mL to 278 ± 164.6 mL and 6.5±2.9 cm to 13.6 ± 3.1 cm respectively in laparoscopic surgery was higher significant differences (I2 = 91%, p &lt; 0.0007), (WMD 202.29 [87.77, 316.80]) with statistically significant (p = 0.0005). Between hospital stay and blood loss in laparoscopic surgery at 1.2 ± 0.9 days to 5.4 ± 0.2 days and 200 ± 107 mL to 278 ± 164.6 mL showed significant differences (I2 = 90%, p &lt; 0.0001), (WMD –269.71 [–361.33, –178.09]) with statistically significant (p &lt; 0.00001) while in robotic surgery was not significant. The follow up uterine fibroid symptom &amp; health-related quality of life questionnaire (UF-QOL) at 3 months 45.3 + 26.9 to 70.6 + 26.9 in fibroids group and 61.6 + 41.4 to 79.64 + 17.91 in adenomyosis group and both shows significantly different (I2 = 83%, p = 0.02), (WMD 14.08 [4.42, 23.75]) with statistically significant (p = 0.0004) and (I2 = 97%, p &lt; 0.00001), (WMD –15.95 [–28.06, –3.84]) with (p = 0.010). SSS follow up 3 months 27.2 + 15.7 to 36.6 + 7.9 in fibroids of HIFU, the heterogeneity test showed significant differences (I2 = 95%, p &lt; 0.00001), (WMD 16.22 [8.33, 24.11]) with statistically significant (p &lt; 0.0001). In terms of pregnancy outcome, delivery outcome in live birth between HIFU and laparoscopic surgery 4 (8) within 165 (219) and (7) 23 within 158 (224), the heterogeneity was not significant (I2 = 0%, p = 0.44), (RR 1.06 [0.97, 1.17]) neither with for risk of delivering was not significant (p = 0.20). Conclusions: HIFU treatment reveals more efficient clinical and treatment outcomes than robotic or laparoscopic surgery, including improved symptoms, absence of bleeding, shorter operative time, shorter recovery time, and good benefits in both short-term and long-term quality-of-life.

8571 Prevalence of Baseline Lower Urinary Tract Symptoms in Women Planning to Undergo Hysterectomy for Uterine Fibroids

Study Objective Compare the prevalence of baseline lower urinary tract symptoms (LUTS) in women planning to undergo hysterectomy for fibroids versus abnormal uterine bleeding (AUB) and examine their association with fibroid characteristics Design This is a retrospective cohort study of 202 women planning to undergo hysterectomy for fibroids vs. AUB. The aim was to compare LUTS in those with vs without fibroids. Baseline demographics, fibroid characteristics, and urinary symptoms were collected. Urinary symptoms included stress and urge incontinence, dysuria, frequent bladder infections, hematuria, nocturia, incomplete emptying, urgency, and frequency. Fibroid characteristics included dominant fibroid size, location, and total uterine volume. A priori power analysis determined 97 participants were needed per group (194 total) to assess for a 20% difference in LUTS, with alpha = 0.05 and power = 0.8. 202 participants were included to account for missing data upon chart review. Setting N/A. Patients or Participants Participants were identified from a surgical database. They were eligible for inclusion if they were planning to undergo hysterectomy for fibroids or AUB from 2014-2019. Interventions N/A. Measurements and Main Results When assessing baseline LUTS in women planning to undergo hysterectomy for fibroids vs. AUB, there were no differences in individual symptoms (all p>0.05) or in prevalence of ‘any urinary symptom’ as a single variable (42.6 vs 45.5%, p=0.67). Dominant fibroid size >6cm was correlated with greater prevalence of ‘any urinary symptom’ (64.9% vs 40.4%, p=0.02), as well as difficulty passing urine (p=0.02), nocturia (p=0.04), and urinary frequency (p=0.04). When controlling for age, BMI, parity, chronic pelvic pain, and diabetes, fibroids >6cm remained significantly associated with the presence of lower urinary tract symptoms (OR 3.1, 95% CI 1.2-8.3). Conclusion Lower urinary tract symptoms are prevalent in women planning to undergo hysterectomy for fibroids, particularly in those with fibroids >6 cm. Future studies should evaluate how urinary symptoms change following hysterectomy. Compare the prevalence of baseline lower urinary tract symptoms (LUTS) in women planning to undergo hysterectomy for fibroids versus abnormal uterine bleeding (AUB) and examine their association with fibroid characteristics This is a retrospective cohort study of 202 women planning to undergo hysterectomy for fibroids vs. AUB. The aim was to compare LUTS in those with vs without fibroids. Baseline demographics, fibroid characteristics, and urinary symptoms were collected. Urinary symptoms included stress and urge incontinence, dysuria, frequent bladder infections, hematuria, nocturia, incomplete emptying, urgency, and frequency. Fibroid characteristics included dominant fibroid size, location, and total uterine volume. A priori power analysis determined 97 participants were needed per group (194 total) to assess for a 20% difference in LUTS, with alpha = 0.05 and power = 0.8. 202 participants were included to account for missing data upon chart review. N/A. Participants were identified from a surgical database. They were eligible for inclusion if they were planning to undergo hysterectomy for fibroids or AUB from 2014-2019. N/A. When assessing baseline LUTS in women planning to undergo hysterectomy for fibroids vs. AUB, there were no differences in individual symptoms (all p>0.05) or in prevalence of ‘any urinary symptom’ as a single variable (42.6 vs 45.5%, p=0.67). Dominant fibroid size >6cm was correlated with greater prevalence of ‘any urinary symptom’ (64.9% vs 40.4%, p=0.02), as well as difficulty passing urine (p=0.02), nocturia (p=0.04), and urinary frequency (p=0.04). When controlling for age, BMI, parity, chronic pelvic pain, and diabetes, fibroids >6cm remained significantly associated with the presence of lower urinary tract symptoms (OR 3.1, 95% CI 1.2-8.3). Lower urinary tract symptoms are prevalent in women planning to undergo hysterectomy for fibroids, particularly in those with fibroids >6 cm. Future studies should evaluate how urinary symptoms change following hysterectomy.

Racial Disparities in Abdominal and Laparoscopic Myomectomies: A NSQIP Study

<h3>Study Objective</h3> Identify disparities in myomectomy approach and outcomes for black and non-black patients. <h3>Design</h3> Retrospective analysis of benign myomectomy procedures, categorized into "abdominal" and "laparoscopic" based on Current Procedural Terminology (CPT) codes. Patient race, comorbid conditions, and postoperative outcomes were compared using univariate and multivariate analyses. <h3>Setting</h3> Analysis of American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. <h3>Patients or Participants</h3> Patients undergoing abdominal or laparoscopic myomectomy from 2018 to 2020. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> A total of 12,370 cases were identified as abdominal or laparoscopic myomectomies. 56% were abdominal and the remaining 44% were laparoscopic. Black patients accounted for 40% of all myomectomies, while white patients accounted for 29%. Black patients had a 65% increased odds of an abdominal approach compared to white patients (OR 1.65, 95% CI 1.51-1.81), and a 27% increased odds compared to all non-black patients (OR 1.27, 95% CI 1.18-1.36). Black patients were more likely to have BMI ≥ 25 (p<0.001), 5 or more fibroids/size > 250g (p<0.001), hypertension requiring medications (p<0.001), need inpatient admission (p<0.001), have preoperative anemia (p<0.001), and receive a preoperative transfusion (p<0.001). After controlling for fibroid size and number, black patients were still 40% more likely to undergo an abdominal approach than non-black patients. Additionally, although overall rare, black patients were more likely to experience postoperative complications. They were more likely to require postoperative transfusion, even after adjusting for preoperative anemia, myomectomy route, and number/size of fibroids removed (OR 1.6, 95% CI 1.3-1.8). They were also more likely to have a pulmonary embolism (p=0.03) and hospital stays greater than 1 day (p=0.06) after an abdominal myomectomy, though these differences were not present for laparoscopy. <h3>Conclusion</h3> Black patients are more likely to undergo abdominal myomectomies and have postoperative complications than non-black patients. These disparities persist after controlling for preoperative risk factors and are not solely attributable to surgical route.

Long-term results of transcervical, intrauterine ultrasound-guided radiofrequency ablation of uterine fibroids with the Sonata System: a retrospective follow-up study

The Sonata System is a new minimally invasive, transcervical, uterine-sparing treatment option for fibroids with a mainly intramural location. The device combines intrauterine ultrasonography with radiofrequency ablation. Long-term follow-up data are still lacking. This study aimed to evaluate long-term outcomes of the Sonata System in terms of surgical reintervention and to identify factors predicting surgical reintervention. Moreover, patient satisfaction, fibroid size reduction, and complication rate were evaluated. We performed a retrospective single-center cohort study of 53 women who underwent Sonata treatment between December 2011 and April 2019. Medical chart review was conducted to collect data on surgical reintervention and patient, fibroid, and surgery characteristics. The follow-up period lasted from date of initial surgery until April 2020. In addition, women filled out a questionnaire at a single time point (April 2020) containing questions about surgical reintervention and patient satisfaction.Kaplan-Meier analysis was used to determine cumulative reintervention rates and median time without reintervention. Univariate Cox regression analyses were performed to identify factors predicting surgical reintervention. Median follow-up period was 36 months (interquartile range, 22-58). Twenty-four women (45.3%) underwent a surgical reintervention, of which most were hysteroscopic myomectomies (45.8%). Surgical reintervention rates as determined by Kaplan-Meier analysis at 1-year and 2-year follow-up were 24.5% and 39.8%, respectively.Eventually, 7 women (13.2%) underwent a hysterectomy after the Sonata treatment. Univariate Cox regression analyses were performed, but did not show a significant association between surgical reintervention and age, preoperative fibroid size, type of ablated fibroid, number of ablated fibroids, and presence of other fibroids that could not be ablated during the Sonata procedure. Median fibroid diameter was 41 mm (interquartile range, 29-50) before and 29 mm (interquartile range, 20-40) after treatment (Z=-5.01; P<.001; 95% confidence interval, -13.0 to 7.0). Thirty-four women (69.4%) were satisfied with the treatment effect, and 42 women (85.7%) would recommend the Sonata treatment to other women. No device-related complications occurred. The Sonata System is a safe and minimally invasive treatment option for women suffering from (partly) intramural fibroids. The findings of this long-term follow-up study support counseling women for treatment with the Sonata System. More prospective studies with long-term follow-up are needed to investigate for which type and size of uterine fibroid the Sonata System is of most value.

Immunohistochemical Expression of Vitamin D Receptor in Uterine Fibroids.

One of the many factors involved in the development of uterine fibroids is vitamin D deficiency. One aspect of this deficiency is decreased serum concentration of calcidiol-25(OH)D, a metabolite of D3 vitamin. The active form of vitamin D3, which arises after numerous enzymatic reactions, is calcitriol-1,25(OH)2D3; this compound is transported to various body tissues. Vitamin D possesses extra-genomic effects due to its influence on various signaling pathways, i.e., through activating tyrosine kinases and by genomic effects via binding to a specific nuclear receptor, vitamin D receptor (VDR). The vitamin D/VDR complex regulates the expression of genes and is involved in the pathogenesis of fibroids. Numerous studies have shown that vitamin D supplementation reduces fibroid size. It has also been shown that the expression of VDR in myoma tissue is significantly lower than in the uterine muscle tissue at the tumor periphery. However, the expression of VDR in non-myoma uterine muscle has not previously been investigated. Our VDR expression studies were performed immunohistochemically with tissue microarrays (TMA) in three tissue groups: 98 uterine myoma tissues, 98 uterine tissues (tumor margin), and 12 tissues of normal uterine muscle (i.e., without fibroids). A statistical analysis showed significantly lower VDR expression in uterine muscle at the periphery of the fibroid than in healthy uterine muscle. Lower expression of VDR at the periphery of the myoma compared to that in normal uterine muscle may indicate potential for new myomas. This observation and the described reduction in the size of fibroids after vitamin D supplementation supports the hypothesis of causal development of uterine fibroids and may be useful for the prevention of re-development in the event of their excision from the uterus.

Uterine artery embolization

Uterine fibroids (UF) is an extremely common benign tumor of the female reproductive system. This pathology is often associated with symptoms that significantly impair the quality of life of a woman and her working capacity, and can also affect the ability to conceive and gestation. Today, we have in the arsenal of operational, drug and minimally invasive methods of UF treatment. One of the most researched and at the same time rather controversial methods of UF treatment is uterine artery embolization (UAE).Literary sources were reviewed using the MEDLINE, PubMed and Web of Science databases for the period 2011–2021. The data related to the history of the technique development, its implementation, indications and contraindications for UAE, its effect on the UF symptoms and on fertility were systematized and presented in this review.UAE as an independent method for the treatment of benign uterine tumors has 20 years of experience in the world and in Ukraine. The indications for UAE are symptomatic UF: profuse and/or prolonged menstruation, dysmenorrhea, compression of the pelvic organs, dyspareunia, frequent urination or urinary retention. Absolute contraindications for UAE are genital tract infections, pregnancy, doubts about the diagnosis, as well as contraindications to the use of X-ray contrast agents.The effectiveness of UAE is assessed by the manifestations of UF symptoms and by the degree of fibroids size reduction. The average node reduction in the diameter is 2.2 cm. The clinical efficacy index is 81–96, 70–100 and 46–100% respectively in the treatment of abnormal uterine bleeding, pelvic pain and symptoms of compression of adjacent organs. There is a decrease in the node volume by 25–60% within 3–6 months.Conclusions. UAE today is an effective and safe minimally invasive operation, which is a worthy alternative to hysterectomy and expands the possibilities of organ-preserving technologies if there is UF.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

Quality care guidelines for uterine artery embolisation in women with symptomatic uterine fibroids in Australia and New Zealand: According to the AGREE-II checklist and endorsed by the Interventional Radiology Society of Australasia.

O-229 To remove or not to remove - debate continues

Abstract Fibroids and Fertility - To remove or not to remove debate continues Uterine fibroids (leiomyomas or myomas) are the most common benign pelvic tumors in reproductive age women. Fibroids are increasingly found in women seeking infertility treatment because of longer reproductive timeline &amp; current trend to postpone childbearing. Fibroids adversely affect the female fertility by distortion of uterine cavity, thinning of endometrium, reduced blood supply in endometrium &amp; myometrium, increased contractility of uterus and hormonal changes. Fibroids also exert global effect on endometrial receptivity through molecular signaling. Women with submucosal myomas experience significantly lower implantation, clinical pregnancy, ongoing pregnancy, and live birth rates, and higher miscarriage rates. The need and effect of myomectomy on submucous myoma is acknowledged in literature. Subserosal fibroids, do not affect fertility and removal is not advisable prior to IVF. There is heterogenicity in the studies reporting the effect of intramural fibroids on fertility. Some have reported an association between intramural fibroids and reduced chance of pregnancy and increased rates of early pregnancy loss. The effect of fibroids which are in close proximity to the endometrium &amp; are 100% intramural (FIGO type 3 and 4) on fertility has been investigated by many researchers. The endometrial cavity may not be distorted by these fibroids, yet they can affect fertility because of their proximity to the uterine cavity. Studies have shown that both size of the fibroid and distance of fibroid from endometrial cavity are important factors, which determine the effect of intramural fibroids on fertility. The production of transforming growth factor beta-3b (TGF- b3), is increased as size of the fibroid increases and impairs the endometrial receptivity. Fibroids causing menorrhagia are likely to affect endometrial receptivity. In women with infertility, an effort should be made to adequately evaluate and classify fibroids, particularly those impinging on the endometrial cavity, using transvaginal ultrasound, hysteroscopy, hysterosonography, or magnetic resonance imaging. (Evidence III-A) Submucosal fibroids are managed hysteroscopically. The fibroid size should be &amp;lt; 5 cm, although larger fibroids have been managed hysteroscopically, but repeat procedures are often necessary. ( III-B). In women with otherwise unexplained infertility, submucosal fibroids should be removed in order to improve conception and pregnancy rates. ( II-2A). Removal of subserosal fibroids is not recommended. (III-D). Whether to surgically remove intramural fibroids not distorting the endometrial lining (FIGO types 3–4) for improving fertility in asymptomatic infertile patients has been a subject of debate since long. The studies favoring myomectomy indicate that It is better to perform myomectomy prior to ART cycle women with reduced ovarian reserve, advanced maternal age, recurrent pregnancy loss or previous failed IVF cycles. Decision for a particular approach for myomectomy - via a laparotomy, laparoscopy or hysteroscopy should be based on the size and location of fibroid and experience of surgeon. There is fair evidence to recommend against myomectomy in women with intramural fibroids more than 3–4 cm before ART cycle (hysteroscopically confirmed intact endometrium) and otherwise unexplained infertility, regardless of their size (II-2D). Surgery in patients with intramural fibroids presenting with infertility, should be considered to be a risky procedure, not only because of the limited evidence of the efficacy of myomectomy on reproductive outcomes but also because of the potential for several surgery-related complications. We need to investigate other modalities such as uterine artery embolization and magnetic resonance-guided focused ultrasound. The observed lack of consensus regarding recommendations for myomectomy in case of infertile patients with intramural fibroid is mainly because of heterogenicity of the studies. The decision to perform myomectomy on intramural fibroids should be individualized (III-C)

Evidence-Based Management of Uterine Fibroids With Botanical Drugs-A Review.

Uterine fibroids (UFs) are a common benign gynecological tumor that affect the majority of women over their lifetime. Several pharmacological agents are available to reduce the size of fibroids and ameliorate the symptoms of UF. However, these drugs are expensive and are usually associated with profound side effects. Thus, botanical drugs are gaining attention in this era due to their cost effectiveness with a comparable and more potent therapeutic efficacy while demonstrating lesser adverse effects. The objective of this review is to summarize the available information on the mechanism of various botanical drugs and polyherbal formulations with anti-uterine fibroid activity. A systematic search was performed on botanical drugs with anti-uterine fibroid activity using several search engines, which include PubMed, Google Scholar, and Science Direct. Based on the literatures identified, a total of five botanical drugs and three polyherbal formulations were included and discussed in this review, which yields useful information regarding the mechanism of different botanical drugs and polyherbal formulations in exerting anti-uterine fibroid activity for its potential use as an alternative treatment choice for uterine fibroids.

The effect of myomectomy on reproductive outcomes in patients with uterine fibroids: A retrospective cohort study

Research questionWhat is the effect of myomectomy in women with uterine fibroids on time to live birth and other reproductive outcomes? DesignThis was a monocentric retrospective cohort study of 311 women with fibroids, of whom 165 eventually received myomectomy and 146 remained on expectant management. To assess the primary outcome time to live birth, a Cox proportional hazards model with a time-varying covariate for myomectomy was used. In the sensitivity analyses, this was combined with an approach to account for confounders via a cloning/censoring/weighting that aimed to emulate a randomized controlled trial. ResultsNotable differences in baseline characteristics between the myomectomy and expectant management group were fibroid size (fibroid >7 cm: myomectomy 48%; expectant management 15%) and whether the patient had fibroid-related complaints (myomectomy 85%, expectant management 67%). The adjusted hazard ratio for the effect of myomectomy compared with expectant management on live birth was 1.26 (95% CI 0.87–1.81). Sensitivity analyses yielded similar results, but secondary outcomes showed that women remaining on expectant management had more often received assisted reproductive technology (63%) compared with those who eventually received myomectomy (38%). ConclusionsThe study did not find a significant difference in time to live birth after myomectomy compared with expectant management in women with fibroids and a wish to conceive, despite more, larger and more symptomatic fibroids in the myomectomy group. The results after myomectomy encourage the execution of a randomized controlled trial in women with large (symptomatic) fibroids not or minimally distorting the intrauterine cavity, and infertility or a desire to conceive.