Location Of Uterine Fibroids Research Articles

Application of transabdominal ultrasound- and laparoscopy-guided percutaneous microwave ablation for treating uterine fibroids: 24-month follow-up outcomes.

To determine the ablation efficacy of transabdominal ultrasound- and laparoscopy-guided percutaneous microwave ablation (PMWA), to investigate whether the risk of damage to adjacent organs and endometrium due to this technique can be reduced or even avoided. We also evaluated the clinical efficacy of this technique in the treatment of uterine fibroids of different sizes and at different locations over a 24-month follow-up period. This study included 50 patients with uterine fibroids who underwent transabdominal ultrasound- and laparoscopy-guided PMWA from August 2018 to July 2020. Lesions were confirmed by pathology. The technical efficacy and complications of PMWA were assessed. The lesion diameter, lesion volume, lesion location, and contrast-enhanced ultrasound (CEUS) features before PMWA and within 24h after PMWA were recorded. Magnetic resonance imaging (MRI) was used for follow-up at 3 and 6months after PMWA. Transvaginal ultrasound was used for follow-up at 24months after PMWA. A total of 50 patients with uterine fibroids received treatment. The median ablation rate of uterine fibroids was 97.21%. The mean lesion volume reduction rates were 32.63%, 57.26%, and 92.64% at 3, 6, and 24months after treatment, respectively. The size and location of uterine fibroids did not significantly affect the ablation rate and the rate of lesion volume reduction. No major complication was found during and after the procedure. Transabdominal ultrasound- and laparoscopy-guided PMWA can be utilized to safely enhance the ablation rate while minimizing ablation time and avoiding harm to adjacent organs and the endometrium. This technique is applicable for treating uterine fibroids of different sizes and at varying locations. ChiCTR-IPR-17011910, and date of trial registration: 08/07/2017.

Occurrence of adverse events after magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) therapy in symptomatic uterine fibroids—a retrospective case-control study

Objectives Our study aims at the comprehensive analysis of adverse events (AEs) in patients with symptomatic uterine fibroids (UFs) who underwent magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) in the last 6 years in one of the major Polish centers performing this type of therapy. Methods The presented retrospective case-control study was conducted in the Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszów in cooperation with the Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw. The study enrolled 372 women with symptomatic UFs who underwent MR-HIFU and reported AEs during or after the procedure. The occurrence of particular AEs was analyzed. Statistical comparison of two cohorts (patients with and without AEs) was conducted based on epidemiological factors, UF characteristics, fat layer thickness, the presence of abdominal scars and technical parameters of the procedure. Results The overall mean occurrence rate of AEs was 8.9% (n = 33). No major AEs were reported. The only statistically significant risk factor of AEs was the treatment of type II UFs according to Funaki (OR 2.12, CI 95%, p = 0.043). Other investigated factors did not have a statistically significant influence on AE occurrence. Abdominal pain was the most common AE. Conclusion Our data showed that MR-HIFU seemed to be a safe procedure. The AE rate after the treatment is relatively low. According to the obtained data it seems that the occurrence of AEs does not depend on the technical parameters of the procedure and the volume, position and location of UFs. Further prospective, randomized studies and with long follow-up are necessary to confirm the final conclusions.

Association between serum vitamin D level and uterine fibroid in premenopausal women in Indian population.

We aim to evaluate the association between serum 25-hydroxyvitamin D3 levels and total number, volume and location of uterine fibroids (UFs) in premenopausal women in North Indian population. This case control study was undertaken in 310 women between 18 years and 45 years of age. Cases comprised of 102 women with fibroid lesion and the control group included 208 women with normal uterine morphology on ultrasonography. Blood samples were taken for measuring 25-hydroxyvitamin D3 levels. The mean serum 25-hydroxyvitamin D3 level in the study and control group was 14.52 ± 7.89 ng/mL and 26.6 ± 14.36 ng/mL respectively (p < 0.05). There was significant inverse correlation between serum 25-hydroxyvitamin D3 levels and total volume of fibroids (p = 0.000) while none between 25-hydroxyvitamin D3 levels with location, number of fibroids. 25-hydroxyvitamin D3 deficiency was more common in the study group (54.90%) compared to healthy controls (6.7%) while sufficiency was more common among controls (67.8% vs. 27.45) (p < 0.05). Women with deficient 25-hydroxyvitamin D3 levels have an odds of 18.36 for developing uterine fibroid. Women with low parity, those belonging to higher socioeconomic status and having less than 1-hour sun exposure per day were independently found to have high risk for development of UFs. Vitamin D may have a role in growth of UFs. Women not able to get adequate sun exposure due to indoor working conditions may need evaluation and supplementation as prophylaxis for development of fibroid.

Anatomical location of uterine fibroids among women attending a tertiary health facility in a southern Nigerian population

Uterine fibroids are benign monoclonal tumours of the smooth muscle cells of the uterus and usually occur during reproductive age. Studies have revealed that it is more prone to women of African descent and the major factors responsible for this occurrence is yet to be accurately discovered. The study determined prevalence, sonographic location, and type of uterine fibroid among women undergoing ultrasound scan in Radiology Department of the University of Port Harcourt Teaching Hospital. The research was a retrospective study conducted from August to October 2019. Study population was 271 and included all consenting females within ages 18-55 years undergoing ultrasound scan at the study centre. Primary data was collected by direct interview using data collection sheet, parameters retrieved included age, marital status, parity and history of previous surgery, while secondary data collected from the Unit register and We extracted information about, presence, number and location of the fibroids from participant’ medical records. This was done for only women with confirmed cases of uterine fibroids. Analysis of data was done using SPSS version 22 and presented in diagrams, tables, figures and charts where appropriate. Point Prevalence was found to be 33.9%, respondents within ages 31 to 35 years (26.4%) presented with the highest prevalence of fibroid. Multiple fibroids with two or more nodules were found to be the most common from ultrasound scan (64.8%). In terms of types, intramural had the highest occurrence at 61.9%. Tumours are most frequently located in the anterior wall of the uterus (14.4%). Type and location of fibroid was seen to be mostly intramural and on the anterior wall of the uterus, respectively. This study found prevalence of uterine fibroid to be 33.9%, also nulliparous women were found to have the highest incidence of uterine fibroids. The point prevalence value for the study population is high, therefore, we suggest that awareness campaign be increased in the region

Ultrasound-guided high-intensity focused ultrasound in the treatment of uterine fibroids.

The aim of the present study was to investigate factors affecting ablation effect and safety of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids (UFs).A retrospective analysis of 346 patients with symptomatic UFs who were treated with USgHIFU was performed. All UFs was grouped based on magnetic resonance imaging (MRI) characteristics before HIFU; all adverse events and treatment data were recorded during and after HIFU. One-way analysis of variance and multiple linear regression analysis were used to evaluate the effect of USgHIFU treatment and affecting factors.The results showed that the mean age of patients was 38.3 ± 6.1 years, with the mean nonperfusion volume rate of 74.4 ± 14.7% and the mean energy efficiency factor (EEF) of 7.2 ± 4.8 J/mm3. Except for the size group, the ablation rate was significantly different (P < .001); and the anterior, intramural, hypointense (T2WI), and mild enhancement (T1WI contrast enhancement) UFs had the highest ablation rate. The EEF of the anterior, intramural, hypointense (T2WI), mild enhancement (T1WI contrast enhancement), and >5 cm UFs had minimum value, with a statistically significant difference (P < .01). According to multiple linear regression model, the distance from the UFs ventral side to the skin, enhancement type on T1WI, size of UFs, signal intensity on T2WI, location of UFs, type and volume of fibroids all had a line relationship with EEF, and the enhancement type on T1WI was the greatest factor affecting the ablation effect. Some patients (37.6%) had thermal injury of the sacrum on MRI, but no serious adverse events were observed.Our results suggest that USgHIFU can be safely used and have a promising prospect for treating UFs, even though its effect may be affected by anatomical features, tissue characteristics, and blood supply.

Expanding upon the Human Myometrial Stem Cell Hypothesis and the Role of Race, Hormones, Age, and Parity in a Profibroid Environment

Uterine fibroids (UFs) are clonal, hormonally regulated, benign smooth-muscle myometrial tumors that severely affect female reproductive health, although their unknown etiology limits effective care. UFs occur fourfold more commonly in African American women than in Caucasian women, and African American women generally have earlier disease onset and greater UF tumor burden, although the mechanism of this ethnic disparity has not been identified. Recent findings have linked cancer (ie,tumor) risk to increased tissue-specific stem cell division and self-renewal and suggest that somatic mutations in myometrial stem cells (MyoSCs) convert them into tumor-initiating cells, leading to UF. Specifically, preliminary results in paraffin-embedded myometrial tissues have shown increased STRO-1+/CD44+ MyoSCs in African American versus Caucasian women. Using specific methods of flow cytometry and automated quantitative pathology imaging, a large cohort of myometrial samples were investigated to determine how the STRO-1+/CD44+ MyoSCs change with regard to a patient's race, age, parity, fibroid and hormone statuses, and the location of UFs within the uterus. We confirmed that the STRO-1+/CD44+ MyoSC population is expanded in African American women, is correlated with parity and fibroid number, and fluctuates with cyclic menstrual cycle hormone changes and age. Our data suggest that an expanded MyoSC population increases the formation of tumor-initiating cells, ultimately contributing to increased UF prevalence and burden in African American women.

Burden of symptomatic uterine fibroids in Canadian women: a cohort study

Objective:Due to variability in size, number, and location of uterine fibroids (UFs), symptoms can range widely among women. We sought to characterize burden of illness and quality of life (QoL) among women with symptomatic UFs.Research design and methods:An online survey queried the gynecologic health and menstrual cycle of Canadian women aged 20 to 49. Respondents reporting current UFs were assigned an Overall Severity Score based on a validated health-related QoL questionnaire (the UFS-QOL) and were dichotomized as having mild or moderate/severe UF. Subjects with moderate/severe UFs were matched 1:3 to non-UF subjects on age, race, and parity.Results:Of 9413 women with complete data, 384 (4.1%) reported physician-diagnosed UFs; of these, 50.6% met criteria for moderate/severe symptoms. Compared with matched non-UF respondents, moderate/severe UF respondents reported significantly greater mean menstrual duration (6.2 vs 5.0 days), more healthcare visits (emergency department, walk-in, family doctor, and specialist; total 10.5 vs 4.9 visits/6 months), and greater use of prescription analgesics (47.7% vs 26.7%) and iron supplements (29.7% vs 12.2%) (P < 0.05 for all). They spent more on feminine hygiene products ($32.0 vs $21.6/month) and reported losing nearly a full day of work/month (mean 7.6 hours) due to UFs. Women with moderate/severe UFs also scored lower on all QoL domains, compared to those with mild UF symptoms. Survey responses consistent with moderate/severe UFs were also identified in women who made no report of physician-diagnosed UFs, some of whom may be experiencing substantial burden due to undiagnosed UFs or other gynecologic conditions with related symptoms.Limitations:All outcomes recorded in this online survey were based on self-report. Therefore, respondents’ claims of medical diagnoses, including medical history, UF status and the presence or absence of potentially confounding comorbidities, could not be confirmed clinically.Conclusions:Women experienced significant healthcare utilization, medication use, and financial and QoL burdens as a result of moderate/severe UF symptoms. Prevalence of moderate/severe UFs may be conservatively estimated at 2%, based on this cohort of reproductive-age Canadian women. The extent of UF underdiagnosis in the general population remains to be elucidated.

Factors influencing the dosimetry for high-intensity focused ultrasound ablation of uterine fibroids: a retrospective study.

The aim of this article is to analyze factors affecting sonication dose and build a dosimetry model of high-intensity focused ultrasound (HIFU) ablation for uterine fibroids.Four hundred and three patients with symptomatic uterine fibroids who underwent HIFU were retrospectively analyzed. The energy efficiency factor (EEF) was set as dependent variable, and the factors possibly affecting sonication dose included age, body mass index, size of uterine fibroid, abdominal wall thickness, the distance from uterine fibroid dorsal side to sacrum, the distance from uterine fibroid ventral side to skin, location of uterus, location of uterine fibroids, type of uterine fibroids, abdominal wall scar, signal intensity on T2-weighted imaging (T2WI), and enhancement type on T1-weighted imaging (T1WI) were set as predictors to build a multiple regression model.The size of uterine fibroid, distance from fibroid ventral side to skin, location of uterus, location of uterine fibroids, type of uterine fibroids, signal intensity on T2WI, and enhancement type on T1WI had a linear correlation with EEF. The distance from fibroid ventral side to skin, enhancement type on T1WI, size of uterine fibroid, and signal intensity on T2WI were eventually incorporated into the dosimetry model.The distance from fibroid ventral side to skin, enhancement type on T1WI, size of uterine fibroid, and signal intensity on T2WI can be used as dosimetric predictors for HIFU for uterine fibroids.

The management of uterine fibroids in women with otherwise unexplained infertility.

Abstract Objective To provide recommendations regarding the best management of fibroids in couples who present with infertility. Usual and novel treatment options for fibroids will be reviewed with emphasis on their applicability in women who wish to conceive. Options Management of fibroids in women wishing to conceive first involves documentation of the presence of the fibroid and determination of likelihood of the fibroid impacting on the ability to conceive. Treatment of fibroids in this instance is primarily surgical, but must be weighed against the evidence of surgical management improving clinical outcomes, and risks specific to surgical management and approach. Outcomes The outcomes of primary concern are the improvement in pregnancy rates and outcomes with management of fibroids in women with infertility. Evidence Published literature was retrieved through searches of PubMed, MEDLINE, the Cochrane Library in November 2013 using appropriate controlled vocabulary (e.g., leiomyoma, infertility, uterine artery embolization, fertilization in vitro) and key words (e.g., fibroid, myomectomy). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English and French. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to November 2013. Grey (unpublished literature) was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The quality of evidence in this document was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table). Benefits, harms, and costs These recommendations are expected to allow adequate management of women with fibroids and infertility, maximizing their chances of pregnancy by minimizing risks introduced by unnecessary myomectomies. Reducing complications and eliminating unnecessary interventions are also expected to decrease costs to the health care system.

Abdominal Myomectomy Increases Fertility Outcome

Objective: The aim of this study was to assess fertility outcome after abdominal myomectomy and to examine the influence of the number, size, and location of uterine fibroids pertaining to fertility outcome after the surgery. Study design: Retrospective clinical study. Patients and methods: Fertility outcome from 178 women who had abdominal myomectomy during 2000-2004 were analyzed. Data from women with unexplained infertility were collected from medical records and from survey interviews of all women participants. Main outcome measures: Conception rate, pregnancy loss, and live birth rate after myomectomy were measured. The relationship of size and location of fibroids to fertility outcome was also evaluated. Results: Conception rate was determined after myomectomy. The percentage of total pregnancies after myomectomy was 58% and spontaneous abortion rate was 45%. Age, number of fibroids removed, and indication for surgery predicted post-myomectomy fertility. Conclusions: Our study suggests that abdominal myomectomy might improve reproductive outcome in patients with myomas. The reproductive performance was particularly good when the patients were younger and had previous pregnancies prior to the surgery. Myomectomy is associated with less miscarriage rate after pregnancy, compared to those prior to the surgery.

Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study

Can uterine scar healing after laparoscopic intracapsular myomectomy (LIM) be adequately monitored by traditional two-dimensional (2D) ultrasound (US) and Doppler velocimetry? The myometrial area of the scar after LIM can be followed by 2D US and Doppler velocimetry. Apart from post-surgical adhesions, the main concern linked to laparoscopic myomectomy is the quality of healing of the myometrial incision: it has been suggested that US could be useful for assessing uterine scars after myomectomy. However, no diagnostic method has yet been widely accepted to assess the healing process. A cohort prospective study (level of evidence II-2), run in University-affiliated hospitals: 149 women with symptomatic uterine fibroids (UFs) underwent LIM, between January 2007 and October 2011. During follow up 13 patients withdrew from the study. After LIM, all patients were followed by traditional 2D US scanning and Doppler velocimetry on Days: 0, 1, 7, 30 and 45. Authors evaluated: number, size and location of UFs, scar diameter and Doppler velocimetry and resistance index (RI) of the uterine arteries, at their ascending branch. The uterine examination showed a significant (P < 0.05) progressive reduction of uterine scar area from 78% of the previous UF location on the first day, to 19% on 30th day, and <4% on the 45th day. There was no correlation with the size of the fibroid or the relative reduction in the size of the scar, on both Days 1 and 45. There was a significant (P < 0.05) increase in the RI of the ipsilateral uterine arteries from 0.65 on the first post-operative day to 0.83 after 7 days followed by a decrease to 0.71 on the 30th and 0.61 on the 45th post-operative day. This is a cohort investigation on a limited number of patients and it does not surgically compare LIM and 'classic' myomectomy in the scar US follow up. LIM avoided intraoperative bleeding and excessive tissue damage, as post-operative US follow up showed, with just two intra-myometrial hematomas (1.5%). The 2D US and Doppler velocimetry, a non-invasive safe method to check the myometrium after LIM, can detect post-operative hematoma and disechogenic, heterogeneous or ill-defined scar area, all unfavorable signs for myometrial scarring. Moreover, Doppler transvaginal monitoring, evaluating the pulsatility index (PI) and RI of the uterine arteries at their ascending branch, could identify patients with altered PI and RI parameters, possible markers of impaired wound healing.

Magnetic Resonance Imaging (MRI) Analysis of Fibroid Location in Women Achieving Pregnancy After Uterine Artery Embolization

The purpose of this study was to evaluate the fibroid morphology in a cohort of women achieving pregnancy following treatment with uterine artery embolization (UAE) for symptomatic uterine fibroids. A retrospective review of magnetic resonance imaging (MRI) of the uterus was performed to assess pre-embolization fibroid morphology. Data were collected on fibroid size, type, and number and included analysis of follow-up imaging to assess response. There have been 67 pregnancies in 51 women, with 40 live births. Intramural fibroids were seen in 62.7% of the women (32/48). Of these the fibroids were multiple in 16. A further 12 women had submucosal fibroids, with equal numbers of types 1 and 2. Two of these women had coexistent intramural fibroids. In six women the fibroids could not be individually delineated and formed a complex mass. All subtypes of fibroid were represented in those subgroups of women achieving a live birth versus those who did not. These results demonstrate that the location of uterine fibroids did not adversely affect subsequent pregnancy in the patient population investigated. Although this is only a small qualitative study, it does suggest that all types of fibroids treated with UAE have the potential for future fertility.

Effects of the position of fibroids on fertility

This prospective, controlled study was performed in order to evaluate whether the location of uterine fibroids may influence reproductive function in women and whether removal of the fibroid prior to conception may improve pregnancy rate and pregnancy maintenance. We examined 181 women affected by uterine fibroids who had been trying to conceive for at least 1 year without success. The main outcome measures were the pregnancy rate and the miscarriage rate. Among the patients who underwent myomectomy, the pregnancy rates obtained were 43.3% in cases of submucosal, 56.5% in cases of intramural, 40.0% in cases of submucosal–intramural and 35.5% in cases of intramural–subserosal uterine fibroids, respectively. Among the patients who did not undergo surgical treatment, the pregnancy rates obtained were 27.2% in women with submucosal, 41.0% in women with intramural, 15.0% in women with submucosal–intramural and 21.43% in women with intramural–subserosal uterine fibroids, respectively. Although the results were not statistically significant in the group of women with intramural and intramural–subserosal fibroids, this study confirms the important role of the position of the uterine fibroid in infertility as well as the importance of fibroids removal before the achievement of a pregnancy, to improve both the chances of fertilization and pregnancy maintenance.