Fibroid Type Research Articles

Impact of ultrasound-guided high-intensity focused ultrasound for the treatment of uterine fibroids on ovarian reserve and quality of life: a single-center prospective cohort study

BackgroundWe aimed to evaluate changes in ovarian reserve and quality of life in women treated with ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids.MethodsIn this single-center prospective study, a total of 69 patients with uterine fibroids treated with USgHIFU from October 2018 to November 2021 were enrolled. Fibroid volume, anti-Müllerian hormone (AMH) levels, uterine fibroid symptom scores, and uterine fibroid symptoms and quality of life (UFS-QOL) questionnaire scores before and 1, 3, and 6 months after USgHIFU treatment were analyzed. Correlations between AMH levels and age, fibroid type, and fibroid location were assessed.ResultsData from 54 of the 69 patients included in the present study were analyzed. The UFS-QOL scores at baseline and at 1 month and 6 months after USgHIFU treatment were 70 (50.75–87.50), 57 (44.75–80.00), and 52 (40.75–69.00) points, respectively (p < 0.001). The rate of fibroid volume reduction increased significantly at the 3-month follow-up compared with the 1-month follow-up (p < 0.001), and no significant change was observed between the 3-month and 6-month follow-ups (p > 0.99). The median AMH levels before and at 1, 3 and 6 months after treatment were 1.22 (0.16–3.28) ng/ml, 1.12 (0.18–2.52) ng/ml, 1.15 (0.19–2.08) ng/ml and 1.18 (0.36–2.43) ng/ml, respectively (p = 0.2). Multivariate linear regression analyses revealed that age was independently associated with AMH levels.ConclusionsUSgHIFU treatment for uterine fibroids can significantly improve quality of life with minimal adverse effects on ovarian function.

P-301 Real life experience with myolysis by radiofrequency in infertile patients with type 2 and 3 fibroids

Abstract Study question Can transvaginal radiofrequency myolysis (TVRF) be a safe alternative to reduce the fibroid volume without interfering with subsequent RA treatment? Summary answer RFTV myolysis is a safe and effective alternative for the treatment of type 2-3 uterine fibroids &amp;lt; 4cm that compromise the endometrial cavity. What is known already The most common benign tumors among women who are in their reproductive years are uterine fibroids. Although most of them are not symptomatic, when they compromise the endometrial cavity, they can lead to reproductive problems. Type 2 and 3 fibroids that are smaller than 4 cm in diameter can cause compromise to the endometrial cavity and are difficult to remove through laparoscopy/hysteroscopy. Study design, size, duration The fibroid volume and % of reduction after 3 months were primary variables. All fibroids were examined with 2D/3D transvaginal ultrasonography to record nº of myomas, volume (the volume of an ellipsoid in cm3 = 4/3 (distance1xdistance2xdistance3), type of fibroid according to the FIGO. The secondary variables were mean procedure time, complications, and reproductive outcome after ART (pregnancy rate (PG), miscarriage Rate (MR), Live born rate (LBR) and obstetrics complications, and type of delivery way. Participants/materials, setting, methods We evaluated thirty-four patients between 2019-2023 with type 2-3 fibroids under 4 cm evaluated by 2D/3D ultrasound, confirming that they compromised the uterine cavity and with a complex surgical approach. Myolysis was carried out by TVRF Main results and the role of chance The average age of our patients was 42 years (range 37-50). In our patients, 52% had fibroids of type 3, and 48% had fibroids of type 2. According to FIGO classification. The average TVRF time for the patients was 4.17 minutes. The average volume was initially 21 cm3, but it decreased to 10 cm3 after one month, and finally dropped to 4.6 cm3 after three months. The volume reduction was &amp;gt;75% when evaluated three months after the TVRF. No complications were reported during the procedure except for mild pain that was controlled with oral analgesia in 21% of patients, and minimal bleeding. In eight patients, the fibroid was extruded towards the endometrial cavity and removed by hysteroscopy. Twenty four out of 34 patients (71%) underwent ART, at least 4 months after TVRF. The reproductive outcome was comparable to what was expected, with a 63% pregnancy rate, 17% miscarriage rate, and 50% ongoing pregnancy rate. Live birth rate was 46%, with 83% reaching term pregnancy, and 16% premature births at 36 and 34 weeks. The rate of cesarean section was 66%. Among the obstetric complications, only one case or IUGR was described Limitations, reasons for caution The main limitation of these data is retrospective analysis of the date and the small sample size, as this is the earliest date on the impact of TVRF on infertile patients. Wider implications of the findings TVRF myolysis is a safe and effective alternative for the infertile women with type 2-3 uterine fibroids &amp;lt; 4 cm that compromise the endometrial cavity that have a complex surgical approach by hysteroscopy/laparoscopy. It appears that TVRF has no impact on reproductive outcomes. Trial registration number not applicable

Treatment Goals and Symptoms of Patients Presenting to a Center for Fibroid Care [ID 2683523

INTRODUCTION: Multidisciplinary fibroid centers represent a new model of fibroid care. We evaluated the goals and symptoms of patients presenting to our center. METHODS: This is a retrospective cohort study of patients presenting between June 2022 and June 2023. Patients were sent the Uterine Fibroid Symptom Quality of Life (UFS-QOL) survey and a goals questionnaire prior to first appointment. Patients who completed both were included. We obtained age, race, most recent hemoglobin level (Hgb), largest fibroid type on most recent imaging, composite symptom severity score (SS), and health-related QOL score (HRQL). This study met IRB exemption criteria. RESULTS: Of 581 patients, 326 (56%) completed both surveys. Mean age was 43.0 years (SD 8.0). Patients identified as Black (35.3%), White (24.8%), Asian (8.9%), and other/multiple race (7.7%). Most patients' largest fibroid was subserosal (37%), followed by intramural (28.7%), submucosal (5.9%), and combined type (28.3%). There was no difference in SS (P=.307) or HRQL (P=.504) between these groups. Most patients (60.7%) selected a top goal of symptom elimination, followed by treating anemia (21.2%) and becoming pregnant (18.1%). Almost a quarter (26.4%) reported difficulty conceiving, and they had higher SS (mean difference [MD] −6.1; 95% CI, −12.1, −0.6) and lower HRQL (MD 7.2; 95% CI, 0.4, 14.0). Patients with Hgb below 12 had higher SS (MD −8.6; 95% CI, −14.6, −2.7) and lower HRQL (MD 8.0; 95% CI, 1.1, 15.0). CONCLUSION: Most patients reported a primary goal of symptom elimination. Difficulty conceiving and low Hgb were associated with worse symptoms, yielding insight into treatment opportunities affecting QOL.

Prevalence of uterine fibroids among women resident in Ogoni, Rivers State, Nigeria.

Background: Uterine fibroids are benign tumor cells of the uterus composed of smooth muscle cells and fibroblasts rich in extracellular matrix. Due to the increased likelihood of women developing leiomyomas within their lifetime, there is a noticeable impact on quality and other aspects of life, such as financial burden and medical expenses Objective: To determine the Prevalence, age distribution, most occurring types and clinical characteristics of patients with uterine fibroid. Methods: This study is a six-year retrospective analysis on the Prevalence and age distributions of uterine fibroid among women resident in Ogoni, Rivers State, Nigeria, from January 2017 to December 2022. Medical records from Hospitals in the area were used for this study. Results: result revealed that 821 out of 5800 case files were positive for uterine fibroid giving a prevalence of 14.2. The year 2022 recorded the highest incidence of uterine fibroid (22.6), followed by the year 2021 (14.9.), 2019 (13.9), 2018 (11.9), 2020 (9.6), and 2017(8.3) respectively. Women within 26 – 35 years were significantly affected in all the years under review, with a prevalence rate of 62.6%, while older women (&gt;35) and those younger (&lt;26), presented an incident rate of 29.4% and 7.9% respectively. Conclusion: The study revealed that the most prevalent type of uterine fibroid in Ogoni is intramural while the least prevalent is submucosal. It also showed that women of age 26-35 years had the highest prevalence of uterine fibroid while those of age 16- 25 years had least prevalence.

Surgical Outcomes and Complications of Myomectomy: A Prospective Cohort Study

Study objectiveTo investigate postoperative surgical and non-surgical complications that occur within 30 days following myomectomy procedures, whether laparoscopic or via open surgery. DesignProspective cohort study SettingDel Ponte Women's and Children's Hospital, Varese, Italy PatientsWomen undergoing myomectomy either with laparoscopic or open surgery from July 2020 to June 2023 InterventionsData of consecutive patients who underwent abdominal myomectomy procedures, either via laparoscopy or open abdominal surgery were collected. The study examined patient characteristics, size and location of fibroids, surgical data, and complications. Univariate and multivariable analyses were employed to identify factors contributing to postoperative Clavien-Dindo grade ≥ II complications. Measurements and main resultsOverall 383 patients were included in the study. The univariate analysis showed intramural fibroid type (p = 0.0009), large fibroid size (p = 0.03), and extended operative times (p = 0.05) were associated with postoperative complications. Open surgical approach (p<0.001) and uterine cavity opening (p = 0.02) also contributed to complications. Postoperative anemia emerged as the most prevalent complication. In the multivariable analysis, the open surgical approach emerged as the only independent factor associated with an increased risk of grade ≥ II complications (odds ratio 7.37; p < 0.0001). ConclusionIn this study we found an increased likelihood of complications in case of open myomectomy. While the presence of potential selection bias may have impacted this finding, it could provide valuable insights for clinicians and surgical teams in the strategic planning of myomectomy procedures.

Sonographic features of uterine fibroids that predict the ablation rate and efficacy of high-intensity focused ultrasound.

This study aimed to identify the sonographic indicators that predict the ablation rate and efficiency of uterine fibroids during high-intensity focused ultrasound (HIFU) treatment. In this retrospective study, we analyzed the clinical data of patients with uterine fibroids who underwent HIFU treatment at Fujian Provincial Hospital between April 2019 and April 2022. Routine abdominal ultrasound examinations were performed to observe potential indicators before the HIFU treatment. After the treatment, enhanced magnetic resonance imaging (MRI) examination was performed within 2 weeks. The fibroid and non-perfused volumes (NPV) were determined, and the ablation rate and energy efficiency factor (EEF) were calculated. A total of 75 patients (124 uterine fibroids) were included in this study. Uterine fibroids with a larger volume, high echogenicity, elliptical/diffuse leaf shape, and a posterior attenuation band had a higher HIFU ablation rate (p<0.05). Uterine fibroids with a larger volume and high echogenicity and without necrotic areas had a lower EEF (p<0.05). Multiple comparisons between fibroid types revealed statistically significant differences in EEF between subserosal and submucosal fibroids (p < 0.05) and between subserosal and mixed-type fibroids (p < 0.05). However, no statistically significant difference was observed between mixed-type and submucosal fibroids. The HIFU ablation rate and EEF showed no significant differences based on location within the wall and blood flow within the fibroids. Sonographic features of uterine fibroids can predict the rate and efficiency of HIFU ablation, providing useful guidance in selecting appropriate treatment for patients.

The challenge of FIGO type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties.

Uterine leiomyomas (ULs) are non-cancerous tumors composed of smooth muscle cells that develop within the myometrium and represent the most prevalent pathological condition affecting the female genital tract. Despite the volume of available research, many aspects of ULs remain unresolved, making it a "paradoxical disease" where the increase in available scientific literature has not been matched by an increase in solid evidence for clinical management. Fertility stands at the top of the list of clinical issues where the role of ULs is still unclear. The leiomyoma subclassification system, released by the International Federaion of Gynecology and Obstetrics (FIGO) in 2008, introduced a new and more effective way of categorizing uterine fibroids. The aim was to go beyond the traditional classification "subserosal, intramural and submucosal", facilitating a detailed examination of individual ULs impact on the female reproductive system. The "type 3 UL" is a special type of myoma, characterized by its complete myometrial development while encroaching the endometrium. It is a unique "hybrid" between a submucous and an intramural UL, that may exert a detrimental "double hit" mechanism, which is of particular interest in patients wishing pregnancy. To date, no robust evidence is available regarding the management of type 3 ULs. The aim of this narrative review is to provide a comprehensive overview of the physiopathological mechanisms that type 3 UL may exert on fertility, and to present new perspectives that may help us to better understand both the need for and the methods of treating this unique type of fibroid.

Post treatment and 3 month contrast enhanced MRI findings following HIFU of submucosal fibroids: a retrospective study

Purpose This study used contrast-enhanced MRI (CE-MRI) examination to assess the efficacy of high-intensity focused ultrasound (HIFU) for submucosal fibroids. Methods A total of 81 submucosal fibroids, including 33 cases of type 1, 29 cases of type 2, and 19 cases of type 2–5, treated by HIFU were retrospectively reviewed. CE-MRI was performed in all cases immediately after HIFU, the non-perfused volume ratio (NPVR) and the degree of endometrial impairment were recorded. Thereafter, CE-MRI was repeated in all cases after three months, and the change of fibroid volume shrinkage rate (FVSR), NPVR and the degree of endometrial impairment were recorded. Results The immediate NPVR was 86.4 ± 19.3% in type 1, 90.0 ± 13.3% in type 2 and 90.3 ± 7.2% in type 2–5. Among 81 fibroids, grades 0, 1, 2 and 3 endometrial impairments were observed in 38.3%, 16.1%, 14.8% and 30.9%, respectively. Three months later, NPVR was 68.0 ± 36.4% in type 1, 74.3 ± 27.7% in type 2 and 85.0 ± 16.1% in type 2–5. Grades 0, 1, 2 and 3 endometrial impairments were observed in 64.2%, 23.5%, 9.9% and 2.4%.FVSR was 49.0 ± 1.3% in type 1, 39.6 ± 1.7% in type 2 and 37.2 ± 2.1% in type 2–5. The FVSR in submucosal fibroid type 1 was superior to type 2 and type 2–5 (p < 0.05). The NPVR of submucosal fibroids in type 2–5 were higher than type 1 (p < 0.05) .There was no difference among different types of submucosal fibroids in endometrial impairment (p > 0.05) three months after HIFU. Conclusions At three months after HIFU, FVSR was better for submucosal fibroid type 1 than for type 2 and type 2–5. And there was no difference in endometrial impairment among the different types of submucosal fibroid groups.

Incidence and Risk Factors of Postoperative Febrile Morbidity among Patients Undergoing Myomectomy.

Background and Objectives: To identify the incidence, causes, and independent predictors of postoperative febrile morbidity among patients undergoing myomectomy. Material and methods: Medical records of patients who had undergone myomectomy at Chiang Mai University Hospital between January 2017 and June 2022 were comprehensively reviewed. The clinical variables, including age, body mass index, previous surgery, leiomyoma size and number, the International Federation of Gynecology and Obstetrics (FIGO) fibroid type, preoperative and postoperative anemia, type of surgery, operative time, estimated blood loss, and intraoperative antiadhesive use, were analyzed as a predictive factor of postoperative febrile morbidity. Results: During the study period, 249 consecutive women were reviewed. The mean age was 35.6 years. The majority of women had FIGO fibroid type 3-5 (58.2%) and type 6-8 (34.2%). Febrile morbidity was noted in 88 women (35.34%). Of them, 17.39% had a urinary tract infection and 4.34% had a surgical site infection, whereas the causes in the majority of cases (78.26%) could not be identified. The significant independent risk factors for febrile morbidity were abdominal myomectomy (adjusted odds ratio: aOR, 6.34; 95% CI, 2.07-19.48), overweight women (aOR, 2.25; 95% CI, 1.18-4.28), operation time of more than 180 min (aOR, 3.37; 95% CI, 1.64-6.92), and postoperative anemia (aOR, 2.71; 95% CI, 1.30-5.63). Conclusions: Approximately one-third of women undergoing myomectomy experienced febrile morbidity. The cause could not be identified in most cases. The independent risk factors included abdominal myomectomy, overweight, prolonged operation time, and postoperative anemia. Of them, abdominal myomectomy was the most significant risk factor.

Therapeutic dose and long-term efficacy of high-intensity focused ultrasound ablation for different types of uterine fibroids based on signal intensity on T2-weighted MR images

Objective To investigate the therapeutic dose and long-term efficacy of high-intensity focused ultrasound (HIFU) ablation for different types of uterine fibroids based on signal intensity on T2-weighted MR images (T2WI). Materials and methods Four hundred and one patients with a solitary uterine fibroid treated with HIFU were classified into four groups consisting of extremely hypointense, hypointense, isointense and hyperintense fibroids. Each group was further classified into two subtypes: homogeneous and heterogeneous, based on signal homogeneity of fibroids. The therapeutic dose and long-term follow-up results were compared. Results There were significant differences in treatment time, sonication time, treatment intensity, total treatment dosage, treatment efficiency, energy-efficiency factor (EEF) and non-perfused volume (NPV) ratio among the four groups (p<.05). The average NPV ratio achieved in patients with extremely hypointense, hypointense, isointense and hyperintense fibroids was 75.2 ± 14.6%, 71.1 ± 15.6%, 68.2 ± 17.3% and 67.8 ± 16.6%, respectively; the re-intervention rates at 36 months after HIFU were 8.4%, 10.3%, 12.5% and 6.1%, respectively. Sonication time, treatment intensity and total energy for heterogeneous fibroids were greater than that for homogeneous fibroids in patients with extremely hypointense fibroids (p<.05). The treatment time for heterogeneous fibroids was significantly longer than that for homogeneous fibroids in patients with isointense fibroids (p<.05). Multivariate ordered logistic regression analysis showed that the ablation volume of fibroids and treatment time were related to NPV ratio (p<.05). Conclusion Every group of patients obtained satisfactory long-term results. Hyperintense fibroids are difficult to treat by HIFU. Heterogeneous fibroids are more difficult to treat with HIFU than homogeneity fibroids.

Large parasitic leiomyoma mistaken for an ovarian mass: A case report

Introduction: Uterine leiomyomas, commonly known as fibroids, are benign tumors composed of uterine myometrial tissue which are the most prevalent pelvic masses during female reproductive age. Abnormal uterine bleeding is the most common symptom. When a fibroid undergoes separation from the uterus and grows extensively it can cause difficulty in making an accurate diagnosis and limit potential treatment options. Case Report: This case report discusses a large pelvic mass found in a 40-year-old female. Because of the size of the mass and inadequate diagnostic imaging, a proper diagnosis was difficult to establish, so the patient underwent surgical management. A total abdominal hysterectomy with bilateral salpingectomy and right oophorectomy was performed with additional unexpected intraoperative findings. Conclusion: Parasitic leiomyomas can cause atypical patient presentations. They can grow to occupy a great amount of space in the abdominopelvic cavity which can create obstacles during diagnostic workup. This report demonstrates how a relatively rare type of fibroid can be easily misdiagnosed and lead to limited treatment options.

Pregnancy With Uterine Fibroids: Obstetric Outcome at a Tertiary Care Hospital of Central India.

Uterine fibroids are the most frequent benign tumorof the female reproductive system, with a significantly lower frequency in pregnancy. This could be due to the fact that uterine fibroids are linked to infertility and low implantation rates following in vitro fertilization (IVF). The goal of this study was to look at the obstetrics outcomes of uterine fibroids and their consequences in a tertiary hospital. The current study was a observational cohort study that evaluated the cases of pregnancy with fibroid. Study was undertaken at the Department ofObstetrics and Gynecology (OBGY) at a medicalcollege in central India and it was conducted over a period of nine months from 1st November 2021 to 31st July 2022. All pregnant women who had an ultrasonography (USG)-documented uterine fibroid diagnosed prenatally or antenatally were enrolled. All demographic information, laboratory and USG results were noted and their mode of delivery, obstetric complications, if any, and neonatal outcomes were evaluated. A total of 110 cases were enrolled as per inclusion and exclusion criteria. The majority of patients (42.73%) were in the 26- to 30-year-old age group. In this study, the majority of cases were carried to term (80.9%). The most prevalent mode of delivery was caesarean section (61.82%). Major complications during pregnancy were threatened preterm labor (21.82%), and blood transfusion (20.00%), whereas postpartum hemorrhage (PPH) occurred in 9.09% cases, and 47 patients (42.72%) were asymptomatic throughout pregnancy.Major neonatal outcomes in our study wereneonatal intensive care unit (NICU) hospitalization (20%), required neonatal resuscitation (14.55%), and neonatal mortality occurring in 1.82% cases.Gestational age at termination of pregnancy, when compared with different characteristics of fibroid, like type (p value 0.663), location (p value 0.552) and number of fibroid (p value 0.112), did not show any significant association. Similarly, maternal complications also did not show significant association (p value >0.05) with different characters of fibroid. Conclusion: Pregnancies with fibroid are high-risk pregnancies that are linked to difficulties throughout the antepartum, intrapartum, and postpartum periods, as well as increased chances of cesarean delivery and PPH.

Миомэктомия при абдоминальном родоразрешении: клинические особенности и исходы

Objective. To study the clinical features and outcomes of myomectomy during cesarean delivery, including in the effect of progestogens. Patients and methods. The study enrolled 61 patients who gave birth by cesarean section. Among them there were 41 women with multiple uterine fibroids and/or a node diameter &gt;50 mm. The patients were divided into three groups: group 1 included 22 women who took progestogens in the first and second trimesters of pregnancy; group 2 consisted of 19 women who did not receive hormone therapy; the control group included 20 women without uterine fibroids. Results. The duration of operation did not differ cumulatively between three patient groups, including the control group. A strong positive correlation between operation duration and blood loss was found in patients with uterine fibroids. The length of stay was determined both by myomectomy performed during cesarean section and by progestogen intake during the current pregnancy. The location of myomatous nodes had an impact on discharge day when comparing patients with fibroid types 4 and 5 according to FIGO. The length of stay was statistically significantly longer in fibroid type 4 (intramural). Conclusion. Progestogen administration did not directly affect the size of myomatous nodes removed during delivery and the duration of postoperative hospital stay in patients who underwent myomectomy, while intraoperative blood loss was 100 mL greater than in the control group without myomectomy. Key words: discharge day, operation duration, cesarean section, blood loss, myomectomy during delivery, progestogens

Management of Uterine Fibroids and Its Complications During Pregnancy: A Review of Literature.

The word "uterine fibroids" itself indicates these are leiomyomas (a group of smooth muscle tumors that are benign), generally growing in the wall of the uterus. Nowadays, this is one of the most common diseases in women in the premenopausal age group. According to the studies, uterine fibroids are more commonly observed in women of African ancestry than white women. This article aims to educate readers on some fundamental concepts regarding uterine fibroids, such as the different types of fibroids according to various classification schemes, as well as their etiology, epidemiology, pathogenesis, management, and treatment, all of which must be understood by anyone studying medicine or working in the medical field. Along with reviewing current management options for uterine fibroids, it also identifies areas needing additional study to identify novel therapeutic targets and improve treatment individualization.

Relugolix Combination Therapy Improves Uterine Fibroid Symptoms Independent of Fibroid Location over 24 Weeks

<h3>Study Objective</h3> To evaluate the impact of fibroid location (submucosal, intramural, or subserosal) on treatment outcomes with relugolix combination therapy (Relugolix-CT) in women with uterine fibroid (UF)-associated heavy menstrual bleeding (HMB) in the LIBERTY 1 (L1) and LIBERTY 2 (L2) studies. <h3>Design</h3> L1 and L2 were replicate, Phase 3, double-blind, 24-week trials. <h3>Setting</h3> 80 (L1) and 99 (L2) research centers globally. <h3>Patients or Participants</h3> Premenopausal women (age 18–50 years) with diagnosed UF (confirmed on ultrasonography) and HMB (assessed by the alkaline hematin method). <h3>Interventions</h3> Participants were randomized to once-daily Relugolix-CT (relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) or placebo for 24 weeks. <h3>Measurements and Main Results</h3> Fibroid location was investigator-defined using ultrasound; FIGO type 0/1 fibroids were excluded. Menstrual blood loss (MBL) volume was measured by alkaline hematin method (responders: MBL volume <80mL and ≥50% reduction from baseline over last 35 days of treatment). Pain and other UF-associated symptoms were evaluated using the Numerical Rating Scale and Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire (Symptom Severity scale) in this <i>post-hoc</i> analysis<i>.</i> Pooled L1 and L2 data were used. In the Relugolix-CT (N=253) and placebo (N=256) groups, fibroid location was categorized as subserous (N=50 and N=58), intramural (N=115 and N=130), submucosal (N=46 and N=43) or "other/unknown" (N=119 and N=106). Overall, 136 women had >1 type of fibroid and were therefore included in >1 subgroup. Baseline characteristics, including MBL volume, pain and quality of life scores, were similar between subgroups. For each fibroid subgroup, respectively, women randomized to Relugolix-CT had comparable responder rates: 76.0%, 79.1%, 80.4%, and 65.6% at Week 24, which were higher than with placebo: 24.1%, 16.2%, 14.0%, and 16.0% (all nominal p<0.0001). Across all subgroups, Relugolix-CT resulted in significant reductions in MBL volume, UF-associated pain and Symptom Severity versus placebo. <h3>Conclusion</h3> Relugolix-CT improved HMB and other UF-associated symptoms through 24 weeks independent of fibroid location.

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.

Study of Women Presenting with Leiomyoma in Terms of Symptoms, Age of Presentation and Location

Abstract Aim and objective: To Categories women presenting with leiomyoma with respect to: • Age • Most common symptom • Location of leiomyoma Settings and Design: This was an observational study carried out in a tertiary health center for a period of 1 year from September 2019 to September 2020. Materials and Methods: A retrospective observational study was conducted in 35 women having pain in abdomen, abnormal uterine bleeding, who were presented to the department of obstetric and gynecology, Bharati Vidyapeeth deemed university, Pune between sept 2019 and sept 2020. All the patient presented with above mentioned symptoms were studied after obtaining consent from participant. Ultrasound was done and location of leiomyoma was studied. Fibroid were studied in terms of its, location and most common presenting symptoms and age of occurrence of symptoms. Results: In our study, themost common age group of presentation was 36-40 years (reproductive age group.) Most common type of fibroid was intramural (62.8 %) Most common symptoms was menorrhagia (57.1%). Most commonly associated with nulligravida (49.5%). Keywords: Ultrasound; Clinical symptoms; Abnormal uterine bleeding.

Analysis of Pregnancy Outcomes after Laparoscopic Myomectomy: A Retrospective Cohort Study.

Objective This study aimed to investigate the factors related to pregnancy outcomes after laparoscopic myomectomy. Methods A retrospective review was conducted on 156 patients aged 18 to 45 years who underwent laparoscopic myomectomy in Ningbo Women and Children's Hospital from January 2010 to December 2016. Follow-up medical records and information were collected on demographic variables, clinical variables, and postoperative pregnancy rate. The logistic regression model was used to assess the association between related factors and postoperative pregnancy rate or pregnancy outcome. The outcome indicators included abortion = 0, premature birth = 1, and full term = 2. The chi-squared test or Fisher's exact test was used to compare the differences in pregnancy outcomes, postpartum hemorrhage, and placenta adhesion between the cohorts. Results The size of fibroids correlated with the postoperative pregnancy rate. The larger the fibroids, the lower the postoperative pregnancy rate, and the difference was statistically significant. The number of fibroids and placental adhesions was positively associated with postoperative pregnancy; the higher the number of fibroids, the higher the incidence of placental adhesions. However, the postoperative interval of pregnancy, fibroid size, and number and type of fibroids are not correlated with the pregnancy outcomes of postoperative patients. Conclusions The size of myoma may influence the pregnancy rate of patients after laparoscopic myomectomy. The number of fibroids can affect the incidence of placental adhesions during postoperative pregnancy.

Fibroid vascularisation assessed with 3D Power Doppler as predictor for fibroid related symptoms and quality of life; a pilot study.

Uterine fibroids present differently, from well vascularised up to calcified, with some causing heavy menstrual bleeding (HMB). To investigate the association between fibroid vascularisation and HMB, other fibroid related symptoms and quality of life (QOL). A single centre pilot study was carried out in the Netherlands. Women with a maximum of two fibroids who chose expectant management were included. 3D sonography including power doppler was performed at baseline and at 3, 6 and 12 months follow up. Women were asked to complete the Pictorial Blood Assessment Chart (PBAC) and Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaires at every visit. Main outcome measure: The association between fibroid vascularisation and HMB. 53 women were included in the study. Baseline fibroid vascularisation, measured as vascular index (VI) is associated with PBAC score; a 1% higher VI at baseline leads to an 11 point increase in PBAC score over time (RC 10.99, p=0.05, 95% CI -0.15 - 22.12). After correction for the baseline variables ethnicity and fibroid type the association becomes stronger (P<0.05). Fibroid volume at baseline and HMB are also associated: a 1 cm3 larger fibroid leads to 0.6 points increase in PBAC score over time (RC 0.56, p=0.03, 95% CI 0.05 - 1.07). Conclusions: This study highlights that both fibroid vascularisation and fibroid volume may be associated with an increase in menstrual blood loss, other fibroid related symptoms and QOL over time. What is new? We used 3D power doppler to predict symptomatic fibroids.

The True Fibroid Map: Correlating Preoperative MRI and Intraoperative Findings

Study Objective To evaluate and compare the accuracy of Magnetic Resonance Imaging (MRI) in myoma diagnosis and mapping and its correlation with intraoperative findings. Design All patients with symptomatic leiomyoma attending the centre of study (Centre for minimally invasive Gynaecology, Obstetrics and ART, Paras Hospital, India) from August 2018-June 2020 underwent MRI and were subsequently operated at the same centre were considered for inclusion. The MRI was reviewed for number of fibroids, size, location, type and FIGO class of the largest fibroid and the same was correlated with intraoperative findings. Setting N/A. Patients or Participants 42 women with a diagnosis of symptomatic leiomyoma and meeting the inclusion criteria were enrolled. Interventions Laparoscopic myomectomy, Hysteroscopic myomectomy, Total laparoscopic hysterectomy, Abdominal myomectomy. Measurements and Main Results Of 42 patients enrolled, the number of fibroids predicted by MRI corroborated with intraoperative findings in 26 patients, 15 patients had greater number of fibroids during surgery and 1 had less than that predicted (median fibroid on MRI=2.0, median number in surgery=2.0, p=0.001). Location of largest fibroid predicted by MRI correlated with intraoperative findings in 77.8% anterior wall, 90% posterior wall, 83.3% left lateral wall and in 81.8% of fundal fibroids (k=0.757, p<0.001). MRI could accurately predict the type of fibroid in 80% submucosal, 87.5% intramural and 66.7% subserosal variants (k=0.642, p<0.001). FIGO class of largest fibroid denoted by MRI showed good correlation with intraoperative findings (k=0.670, p<0.001). Size of largest fibroid predicted by MRI (median=58.5cm2) correlated well with size measured during surgery (median= 60cm2, k=0.819). Conclusion MRI is an efficient tool for mapping of fibroid location, type and FIGO class but falls short in identifying the exact number of fibroids that can be encountered during surgery particulary in patients with larger uteri (> 12-week size) or multiple myomas (>5 in number). To evaluate and compare the accuracy of Magnetic Resonance Imaging (MRI) in myoma diagnosis and mapping and its correlation with intraoperative findings. All patients with symptomatic leiomyoma attending the centre of study (Centre for minimally invasive Gynaecology, Obstetrics and ART, Paras Hospital, India) from August 2018-June 2020 underwent MRI and were subsequently operated at the same centre were considered for inclusion. The MRI was reviewed for number of fibroids, size, location, type and FIGO class of the largest fibroid and the same was correlated with intraoperative findings. N/A. 42 women with a diagnosis of symptomatic leiomyoma and meeting the inclusion criteria were enrolled. Laparoscopic myomectomy, Hysteroscopic myomectomy, Total laparoscopic hysterectomy, Abdominal myomectomy. Of 42 patients enrolled, the number of fibroids predicted by MRI corroborated with intraoperative findings in 26 patients, 15 patients had greater number of fibroids during surgery and 1 had less than that predicted (median fibroid on MRI=2.0, median number in surgery=2.0, p=0.001). Location of largest fibroid predicted by MRI correlated with intraoperative findings in 77.8% anterior wall, 90% posterior wall, 83.3% left lateral wall and in 81.8% of fundal fibroids (k=0.757, p<0.001). MRI could accurately predict the type of fibroid in 80% submucosal, 87.5% intramural and 66.7% subserosal variants (k=0.642, p<0.001). FIGO class of largest fibroid denoted by MRI showed good correlation with intraoperative findings (k=0.670, p<0.001). Size of largest fibroid predicted by MRI (median=58.5cm2) correlated well with size measured during surgery (median= 60cm2, k=0.819). MRI is an efficient tool for mapping of fibroid location, type and FIGO class but falls short in identifying the exact number of fibroids that can be encountered during surgery particulary in patients with larger uteri (> 12-week size) or multiple myomas (>5 in number).