Large Myomatous Uterus Research Articles

Thrombosis of the pelvic veins associated with a large myomatous uterus

Background: Deep vein thrombosis is a rare indication for hysterectomy. Case: A 45-year-old woman presented with a myomatous uterus of 20 gestational weeks’ size that was compressing the pelvic veins directly and causing thrombosis. After preparation of the patient with anticoagulants and installation of an umbrella device in the inferior vena cava, we performed an uneventful abdominal hysterectomy. Conclusion: Pelvic deep vein thrombosis is a rarely reported complication of myomatous uterus. It can be managed successfully by anticoagulants, placement of an umbrella device in the inferior vena cava, and hysterectomy, as in our case.

Supracervical Versus Total Hysterectomy

Manchester, England was the site of the world's first hysterectomy, performed by Charles Clay in November 1843.1 Under-taken to remove a large myomatous uterus, the operation was successful (the uterus was removed), but the patient died on the 15th postoperative day. Approximately 10 years later

Medically induced abortion in a woman with a large myomatous uterus

For women with abnormal uterine anatomy that would make operative abortion technically difficult or impossible, a medically induced abortion may be the only option for pregnancy termination. Methotrexate and misoprostol were used to effect an early abortion in a woman with a markedly enlarged leiomyomatous uterus. (Am J Obstet Gynecol 1996;175:1379-80.)

Laparoscopic-assisted vaginal hysterectomy of large myomatous uteri with supracervical amputation followed by trachelectomy

Since most abdominal hysterectomies are performed for treatment of large uterine fibroids, an effective laparoscopic approach must be discovered for the endoscopic treatment of large uterine fibroids. We performed a retrospective analysis of all laparoscopic-assisted vaginal hysterectomies (LAVHs) we performed on uteri that were both greater than 12 weeks' size on preoperative examination and heavier than 450 g on pathologic evaluation. Twenty cases fulfilled the selection criteria, with mean uterine weight of 709 g and operating time of 178 minutes. Two surgical approaches were compared. Group 1 (5 women) consisted of LAVH without supracervical amputation with mean operating time of 216 minutes. Group 2 (15 women) consisted of laparoscopic supracervical amputation followed by vaginal trachelectomy with mean operating time of 165 minutes. Our results suggest that laparoscopic supracervical amputation can enhance the laparoscopic management of large uterine fibroids.

Cherney versus midline vertical incision for myomectomy or hysterectomy of a significantly enlarged uterus

OBJECTIVE: Our purpose was to determine whether a different in clinical outcome could be demonstrated with the choice of Cherney versus vertical incision in patients undergoing surgical treatment of large benign uterine myomas. STUDY DESIGN: Twenty consecutive patients underwent hysterectomy or myomectomy for a large (five or more times normal size) myomatous uterus through a Cherney incision. A pathologist blinded for clinical outcome matched the specimens removed from the Cherney group with 20 others removed through vertical incisions during the corresponding period on the basis of specimen weight alone. A chart review was undertaken to determine significant demographic and outcome variables, with particular attention to clinical course and operative complications. RESULTS: The groups were similar in age, race, parity, body mass index, preoperative hematocrit, associated illnesses, type of anesthesia and anesthetic agents, associated surgical fiindings, and associated surgical procedures. No significant differences were detected in the duration of anesthesia, surgical procedure or hospital stay, volume of perioperative blood loss, narcotic analgesic usage, or the number of minor or major complications. Trends toward greater blood loss, transfusion, and complications in the vertical group may have been related to exposure, whereas longer duration of surgery and greater postoperative analgesic use were seen with Cherney incisions. CONCLUSION: No clinical difference could be demonstrated with incision choice in a group of 40 patients having surgical treatment of large uterine myomas.

The effect of chronic gonadotropin-releasing hormone analog (D-Trp-6) treatment on elevated and normal serum prolactin levels

A long-acting GnRHa (D-Trp-6 microcapsules) proved capable of lowering serum PRL levels in a young hyperprolactinemic patient treated for a large myomatous uterus. No similar inhibitory effect was found in normoprolactinemia. Chronic GnRHa therapy may constitute an alternative to the existing forms of treatment for hyperprolactinemia and pituitary adenomas.

Uterine myomas: clinical and pathologic aspects.

A small, asymptomatic myomatous uterus usually may be left alone but should be periodically observed. A large myomatous uterus that is subject to bleeding or produces pressure on the bowel, bladder or ureters requires surgery—usually total hysterectomy, with retention of normal ovaries if the patient is young. When a myoma in an older woman shows accelerated growth, malignant degeneration should be suspected.

Barium enema examination in the evaluation of large pelvic masses.

The findings on barium enema examination were evaluated in a series of commonly monly seen large pelvic masses—the myomatous uterus, the distended bladder and the ovarian mass. The masses studied showed significant extension into the abdominal cavity. The study emphasizes the utility of the lateral roentgenogram in evaluating the mobility or fixation of the masses and the probable pelvic organ from which they originate. A sign suggestive of the large myomatous uterus—flattening of the superior contour of the distal sigmoid in the frontal projection—is discussed and its probable mechanism postulated.

A study of five hundred eighteen consecutive hysterectomies

Five hundred eighteen consecutive hysterectomies are presented, of which 93 per cent are abdominal and 7 per cent vaginal. Ninety-nine per cent of the abdominal hysterectomies were total uterine extirpations.Two patients died postoperatively, both after abdominal hysterectomy; one from concealed hemorrhage from the appendiceal artery, and the other from pulmonary embolism.The most serious operative complication was transection of a ureter during removal of a large myomatous uterus. This could have been prevented by a preceding myomectomy or morcellation.Parametritis with or without abscess formation occurring at the vaginal vault was the commonest serious postoperative complication. We have recently been testing various methods of vaginal preparation and vault drainage in an attempt to eliminate this complication: we are not yet ready to state any conclusions. We can say, incidentally, that leaving one end of the vaginal cuff drain in the peritoneal cavity does not cause adhesions, as proved by subsequent laparotomy. The remaining postoperative complications should be preventable by proper preparation of the patient, exact surgical technique, early ambulation, and attentive postoperative care.The morbidity rate was 54 per cent after vaginal hysterectomy, and 36 per cent after abdominal hysterectomy. These rates are high, and we are at present engaged in discovering methods of reducing them.Chronic cervicitis has been noted to greater or lesser degree in every cervix in this series, except in the presence of acute cervicitis, which usually followed radium application.Patients remained in the hospital an average of 15 days after vaginal hysterectomy and 12 days after the abdominal. Ordinarily, with uncomplicated recovery, we now discharge patients seven days after the abdominal and ten days after the vaginal operation.The late results in this series have been satisfactory, except as listed. The most frequently observed pathological lesion was granulation tissue in the vaginal vault, occurring after 27 per cent of abdominal hysterectomies and 10 per cent of the vaginal. Ovarian cysts have occasionally been observed following hysterectomy. These may be due to embarrassment of the ovarian blood supply by the operative technique, as suggested by Freed and Kimbrough,9 or they may occur spontaneously.As regards climacteric symptoms, we have not been impressed by an incidence of troublesome symptoms following bilateral oophorectomy in women over age 45. If nervousness, hot flashes, and psychic instability occurred, which they usually did not, control has been generally satisfactory with oral estrogens.Finally, regarding the abdominal or vaginal route, each has its advantages. Factors in favor of the vaginal approach are: 1.1. Vaginal plastic procedures can also be done from the single approach.2.2. There is less likelihood of intestinal trauma.3.3. This approach is on the whole probably less shocking systemically.4.4. Evisceration and incisional hernia do not occur.5.5. The immediate postoperative intestinal disturbance is less.6.6. Postoperative adhesions and bowel obstruction are less likely.7.7. There is no residual abdominal sear.Factors in favor of the abdominal approach are: 1.1. Morbidity, and thus patient jeopardy, is less likely.2.2. Exploration of the abdomen is possible.3.3. There is easier access to the adnexa.4.4. The appendix can be removed.5.5. There is no shortening of the vagina.106.6. There is less likelihood of fistula formation.7.7. There is less likelihood of vault prolapse.8.8. A more exact surgical technique is possible for most operators.9.9. Larger tumors are more easily removable by most operators.10.10. Better exposure is possible except in the very obese patient.11.11. Better hemostasis is usually possible.12.12. The postoperative hospital convalescence is shorter.13.13. There is less likelihood of urologic complications.14.14. The disease process can be better visualized and more accurate evaluation can be made.15.15. Peritoneal adhesions to the pelvic organs can be more accurately severed.16.16. Prolapse of a portion of the oviduct, or some portion of the bowel does not occur.11The choice of the abdominal or vaginal approach among gynecologists practicing in Schenectady usually depends on the presence or absence of uterine prolapse. We rarely perform vaginal hysterectomy in patients in whom the cervix cannot be pulled down at least to the vestibule without anesthesia.

Autotransfusion with blood from large myomatous uteri

1.1. Autotransfusion is a standard procedure in the Gynecological Service of the Albany Hospital.2.2. In selected cases blood may be obtained from a myomatous uterus during the operation or after the uterus is removed and returned to the patient intravenously as soon as the operator is sure that malignancy is not present in the uterus.3.3. A simple technic for this purpose is described.