Myoma Recurrence Research Articles

Predicting recurrence of uterine myoma after carrying out a selective uterine arteries embolization

Aim. To establish clinic and anamnestic predictors for recurrence of uterine myomas growth after carrying out a selective uterine arteries embolization (s-UAE).
 Materials and methods. The one-center longitudinal retrospective cohort study including 366 women with symptomatic uterine myoma, after carrying out s-UAE at 20132017. The Control group 315 patients after s-UAE with absolute reduction of blood-circulation and strong remission for 3 years. The main group 51 cases of restoration of clinical symptoms and blood-groove after ultrasonography registered absolute reduction and knocking over of clinical symptoms more than two years period. The median of age of control group patients has made 40 years (95% confidence interval 95% CI 39.041.1), the main 42 years (95% CI 39.043.0). In group of comparison it is carried out the analysis of 103 potential risk factors for uterine myomas relapse after s-EMA. For the correlation between uterine myomas relapse and subset quantitative and qualitative signs the model of the logistic regressions was used with a step-by-step elimination of a sign.
 Results. Statistically significant risk factors for recurrence of uterine myomas after s-EMA are established: body mass index (BMI) 22,3 (odds ratio OR 4.03); previous plentiful menstrual bleedings (OR 3.56); the previous hormonal therapy (OR 3.06); hypertension (OR 2.58); chronic cystitis (OR 2.18); dyspareunia (OR 2.22); the conglomerate including 23 uterine myomas (OR 1.79); an edge localization of uterine myomas (OR 2.24). Use a logit-models, with inclusion of these specific signs allows to predict uterine myomas growth recurrence after s-EMA in 78.8% cases (95% Cl 0.760.83; р0.0001).
 Conclusion. At preoperative consultation stage to patients with symptomatic uterine myoma establishment a combination of criteria "body mass index" (BMI)22.3, previous plentiful menstrual bleedings and previous hormonal therapy, assumes to refuse carrying out s-EMA in advantage alternative method of treatment.

The prevention of recurrence of uterine fibroids after conservative myomectomy

The objective: to conduct a comparative analysis of the efficacy and tolerability of antigestagens (mifepristone) and gonadotropin-releasing hormone agonists (aGnRH) as part of adjuvant therapy for the prevention of the recurrence of uterine fibroids after conservative myomectomy in women of reproductive age.Materials and methods. The study included 99 patients of reproductive age (19–42 years old) with uterine myoma. The women were divided into three groups (n=33 each), which were balanced by age and the number of myomatous nodes. From the 8th day after surgical treatment, the patients of the 1st group were prescribed the antigestagen mifepristone at a dose of 50 mg daily for 4 months, the 2nd group – aGnRH (triptorelin) 3.75 mg intramuscularly once every 28 days for 6 months. The third, control group included women who had contraindications to adjuvant therapy or refused to take hormonal drugs. The effect of treatment on the uterus size was studied by ultrasound examination on the 8th day and in 1 and 4 months after surgery, the control of the recurrence was performed every 3 months for 3 years after surgery. The fact of myoma recurrence was established when at least one myomatous node more than 1 cm in diameter appeared.Results. From the second month of the therapy, 78.8% of patients in the 2d group had estrogen-deficient symptoms. In patients in the 1st group, minor side effects were registered only in 15.1%, in the 3rd group – 3–6% (p<0.05). After the completion of the therapy, the menstrual cycle restored in 3.3±1.5 weeks in the 1st and 6.2±1 weeks in the 2nd group of patients. All women in the control group had regular menstruations every month. In 1 month after surgical treatment, compared with the 8th day after operation, the volume of the uterus decreased by 14±2% in women in all three groups, in 4 months a further decrease was observed only in the 1st and 2nd groups, in the control group the indicators remained at the same level as in the first month after surgery. There was no recurrence of myoma during the first year after conservative myomectomy in patients of the 1st and 2nd groups, the further the cumulative risk was almost the same and after 24 months it was 12.5±5.2% and 13.7±8%, respectively. The cumulative recurrence rate in the 3d group was 9.1±5.6% after 6 months, 33±8.1% after 12 months, and 41.6±9.2% – 24 months. The pregnancy occurred mostly in the interval from 1 to 1.5 years after the operation, the average interval between the operation and fertilization was 13.7±5 months.Conclusions. Adjuvant therapy with mifepristone or aGnRH after conservative myomectomy leads to an equal reduction in the risk of myoma recurrence – in 4.25 times. The cumulative incidence of fibroid recurrence in 3 years after surgery is the lowest in the group of women taking mifepristone, and is the highest one in patients without adjuvant therapy. With a similar efficacy to GnRH agonists, the antiprogestins have less side effects and good tolerance, faster recovery of the menstrual function, reverse of hormonal parameters and a decrease in uterine volume. Therefore, in order to restore reproductive function and prevent early recurrence of uterine fibroids, women after conservative myomectomy can be recommended to take the adjuvant therapy with antiprogestins or GnRH agonists, the choice of which should be differentiated and individual.

Risk factors for recurrence of uterine fibroids

The objective: a study of the risk factors and the frequency of recurrence of uterine fibroids (UF) after conservative myomectomy. Materials and methods. A clinical and statistical retrospective analysis of the long-term outcomes of surgical treatment of 40 patients in reproductive age (from 19 to 42 years) with UF was carried out based on the data of case histories, outpatient cards and data from a questionnaire/telephone survey. All women had a complicated gynecological and reproductive history. In the postoperative period, the patients received hormonal therapy with progestogens (in cyclic regime) and oral contraceptives for 6–12 months. For the diagnosis of UF recurrence, clinical examination, bimanual examination, transvaginal echography were performed every 3 months during the first 3 years, then every six months. The fact of UF recurrence was ascertained of the appearance at least of one myomatous node more than 1 cm in diameter. Results. The long-term results were studied in 36 out of 40 patients after conservative myomectomy. At the time of assessment, the average age of patients after surgery was 39.7±6.17 years, 4 (11 %) women of them were in active reproductive age, 11 (33.3 %) – late reproductive age, and 10 (27.7 %) – premenopausal period. The mean period of observations was 6.22±1.71 years. Recurrence of UF was diagnosed in 22 (55 %) patients, 3 (7.5 %) of them required repeated surgery (2 women after supravaginal amputation of the uterus, 1 – transcervical resection of the submucous node).The cumulative (accumulated) percentage of UF recurrence within 7 years after surgery was 67.4±8 % with the maximum increase of recurrence frequency in the 2nd and 3rd years after surgery (up to 31.7 6 % and 51.2±7 %, respectively). After conservative myomectomy, pregnancy occurred in 11 (27.5 %) women, including 2 out of 5 persons with infertility before surgery, and 4 out of 9 patients who had miscarriage in anamnesis. The maximum number of pregnancies (5) occurred in the interval from 1 to 1.5 years after surgery. Pregnancy ended in timely delivery in 7 patients, spontaneous abortion – 3 (7.5 %), induced abortion – 1 (2.5 %). All 7 pregnant women were delivered by caesarean section.Conclusions. A retrospective analysis of long-term outcomes of organ-preserving surgical treatment of patients of reproductive age with uterine fibroids determined a high frequency of myoma recurrence after conservative myomectomy, reaching 67.4±8 % in7 years after the operation. The greatest increase in recurrence was observed in the 2nd and 3rd years after surgery. The statistically significant risk factors for the development of recurrence of the disease were the number of myomatous nodes and the patient’s age (30–40 years). The use of hormonal therapy (norethisterone or oral contraceptives) after surgery did not lead to a decrease in the rate of recurrence of uterine fibroids. And although conservative myomectomy made it possible to increase the frequency of pregnancy in operated patients, the level of reproductive losses after surgery remained high (36.3 %).

Comparison of Laparoscopic Myomectomy with and without Uterine Artery Occlusion in Treatment of Symptomatic Multiple Myomas

ObjectiveUterine artery occlusion (UAO) is a minimally invasive approach often used to treat symptomatic uterine myomas. This study aimed to compare the clinical effects of laparoscopic UAO (LUAO) in combination with laparoscopic myomectomy (LM) with LM alone to treat symptomatic multiple uterine myomas.MethodsThis was a prospective observational study. In total, 122 patients with symptomatic multiple uterine myomas underwent LUAO + LM or LM alone between April 2015 and October 2017. The surgical procedure time, blood loss, highest postoperative temperature, hospital length of stay, number of removed myomas, surgical complications, and recurrence rate of the two groups were compared.ResultsMean blood loss was significantly lower in the LUAO + LM group compared with the LM group (177.97 ± 104.09 mL vs 258.10 ± 119.55 mL, p < 0.05). No significant difference in surgical procedure time, hospital length of stay, highest postoperative temperature, and surgical complications was found between the LUAO + LM group and LM group. The number of removed myomas was considerably higher in the LUAO + LM group than in the LM group (4[4–7] vs 3[3–5], p < 0.05). The recurrence rate in the LUAO + LM group was considerably lower than that in the LM group (6.2% vs 25.9%).ConclusionLUAO in combination with LM was associated with higher surgical quality and lower recurrence of myomas compared with LM alone. LUAO in combination with LM is recommended for women with symptomatic multiple uterine myomas who wish to retain their uteruses.

Evaluation of Biomarkers in Myoma Patients: A Prospective Study Investigating the Role of LDH, CA 125, and IGF-1 after Uterus-Preserving Surgical Therapy

Objective: Myomas are one of the most common tumors of the lower abdomen in women. At present, sonography and clinical examination are the prevalent diagnostic standards for these tumors, and no biomarkers have been established yet. The primary aim of this study was to determine if the surgical removal of myomas leads to a drop of lactate dehydrogenase (LDH), CA 125, and/or insulin-like growth factor (IGF-1) and therefore if these parameters are suitable as potential biomarkers for the presence or recurrence of a myoma. Study Design: The blood levels of LDH, CA 125, and IGF-1 were determined in 83 patients (age 18–50) with a verified diagnosis of myomas and surgical therapy at 3 different timepoints: preoperative (T0), 2 days postoperative (T1), and 6 months postoperative (T2). Vaginal sonography was performed preoperatively and once again at 6 months postoperatively. Results: The median (Q1–Q3) LDH values dropped significantly postoperatively: 239 (217–266) U/L at T0 versus 217 (190–255) U/L at T1, p < 0.001. The median (Q1–Q3) IGF-1 values also dropped: 140.4 (118.6–179.0) ng/mL versus 112.4 (99.5–143.0), p < 0.001. By contrast, the CA 125 values rose slightly but not significantly. At 6 months (n = 34), the LDH values were not significantly different from either the preoperative or the immediate postoperative values. This was observed both in patients with and without a recurrence of myoma. In contrast, the median (Q1–Q3) IGF-1 level at T2 was significantly elevated both in patients with sonographic evidence of new myomas (129.0 [116.0–163.1] ng/mL, p = 0.023) and in patients with sonographic proof of no new myomas (161.0 [130.2–198.5] ng/mL, p < 0.001). Conclusion: Both LDH and IGF-1 dropped significantly in the immediate postoperative days in women with myomas after uterus-preserving surgeries were performed. The postoperative concentration of IGF-1 was correlated with the evidence of new myomas and can be potentially used for further monitoring. Future studies should be able to confirm these results. This study concludes that myomas do influence LDH and IGF-1 and could possibly be suitable as biomarkers.

Mass Spectrometry in Prediction of the Myomas Recurrence

Study Objective The mass spectrometric study of changes in the lipid profile of various tissues in patients with recurrent fibroids and the use of mass spectrometric data in the prediction of myoma recurrence. Design Level II-1, Canadian Task Force. Setting National Medical Research Center, Moscow, Russia. Patients or Participants Lipid analysis of the myometrium, fibroids, and plasma was conducted in 66 patients: 35 patients with newly diagnosed uterine fibroids (UF) and 31 patients with recurrent myoma (RUF). Plasma only was studied in the control group of 15 patients who underwent intrauterine septum resection. A semi-quantitative assessment of tissue lipid levels was performed using direct mass spectrometry. A semi-quantitative assessment of blood plasma lipidome was conducted. The suitability of biomarkers for diagnostics was assessed. Interventions Laparoscopic myomectomy, followed by lipid analysis of obtained samples of myometrium, fibroids, and plasma. Measurements and Main Results Significant differences were found in the levels of lipids involved in the metabolism of glycerophospholipids, sphingolipids, triglycerides, fatty acids when studying uterine fibroids. Studying of the myometrium identified the difference in the levels of lipids involved in the metabolism of glycerophospholipids, lipids with an ether bond, and sphingolipids. In patients with recurrent disease, linoleic acid metabolism was altered in the tissues of the fibroids and not in the myometrium. Significant differences were found in the levels of cholesterol esters, triacylglycerols, (lyso) phosphatidylcholines, and sphingomyelins when comparing the plasma of the control group with the plasma of the UF and RUF groups. When comparing plasma of groups UF and RUF, lipids belonging to the classes of cholesterol esters, phosphotidylcholines, sphingomyelins, triacylglycerols were identified as significant. Conclusion A broad, diagnostically significant panel of potential serologic biomarkers for the diagnosis of recurrent myoma was identified in this study.

Ulipristal Acetate Before Hysteroscopic Myomectomy: A Systematic Review.

Uterine leiomyomas, also referred to as myomas or fibroids, are the most common benign tumors of the reproductive tract. Ulipristal acetate (UPA) is an active selective progesterone receptor modulator used as preoperative treatment for uterine myomas. The aim of this review is to provide an overview of the literature about the effects of UPA administration before hysteroscopic myomectomy. The clinical question in "PICO" format was in patients affected by uterine myomas undergoing operative hysteroscopic management, "Does UPA impact the surgical outcomes?" We performed a systematic literature search in PubMed/MEDLINE and Embase for original studies written in English (registered in PROSPERO CRD42018092201), using the terms "hysteroscopy" AND "ulipristal acetate" published up to March 2019. Original articles about UPA treatment before hysteroscopic myomectomy (randomized, observational, retrospective studies) were considered eligible. Our literature search produced 32 records. After exclusions, 4 studies were considered eligible for analysis. Results show that UPA does not worsen the overall technical difficulty of hysteroscopic myomectomy. Moreover, it may increase the chance of complete primary myomectomy in complex hysteroscopic procedures. Despite the positive results presented in this systematic review, low-quality evidence exists yet on the impact of UPA treatment before hysteroscopic myomectomy. High-quality prospective randomized controlled trials are required to establish the impact of UPA on surgical outcomes of patients treated for uterine myomas by hysteroscopy. Moreover, long-term outcomes of myomectomies after UPA treatment (such as frequency of myoma recurrence, recovery time, and quality of life) should be determined.

Clinical recurrence of submucosal myoma after a mechanical hysteroscopic myomectomy: Review after 5 years follow up

ObjectiveEvaluation of five years follow up of the clinical recurrence after hysteroscopic myomectomies with MyoSure® morcellator in our district. Study designPremenopausal patients from April 2013 to October 2018, with symptoms of abnormal uterine bleeding, and/or infertility, and sonographic suspicion of submucosal myoma, confirmed by diagnostic hysteroscopy prior to myomectomy were included in the prospective, not randomized cohort study (N = 320). All patients had a follow up visit between three to six months post procedure. Further follow up was established by chart review. The information was extracted from the medical records.Patient characteristics were expressed as mean ± SD or median (interquartile range) for continuous data (assumption of normality assessed using the Kolmogorov-Smirnov test). Dependence relationship between presence of corporal myomas and the performance of a major long-term surgery, and between the amount of submucosal myomas and clinical recurrence throughout the 5 years of follow-up were studied were studied by χ2. ResultsAfter one year follow up, no recurrence or symptoms were noted. 53 (16.6%) re-morcellations were performed due to incomplete resection. At the second year, three women who were discharged previously were classified as recurrence (0.9%). There were 99 women remaining to be evaluated (30.90%) in the second year. A percentage estimation of 5–6 recurrences with the 100% of women evaluated. In the third year, only one woman was classified as recurrence (0.3%), with 176 (55%) women not evaluated. At the fourth and fifth year of follow-up, 75% are still awaiting complete of the study five years.No relationship was observed in the presence of corporal myomas and recurrence throughout the 5 years of follow-up (χ2 = 0.000, p = 0.994). Dependence relationship was observed between the presence of corporal myomas and the performance of a major long-term surgery (χ2 = 11.757, p = .001, OR = 3.528). ConclusionIn office hysteroscopic mechanical myomectomy with MyoSure® morcellator of submucosal fibromas was a highly effective therapy for women, at three years of follow-up. It appears to give satisfactory long-term results with a low recurrence rate and without significant complications.

COMPLICATIONS IN LAPAROSCOPIC MYOMECTOMY ( LITERATURE REVIEW )

Conservative myomectomy aims to preserve fertility, treat abnormal uterinebleeding, and alleviate pain. It should cause minimal damage to the endometrium,reduce the incidence of myoma recurrence and complications including bleeding,hematoma, adhesions, and uterus perforation.The aim of the work is to analyze the complications that arise after laparoscopicmyomectomy in women of reproductive age.Conclusions. Laparoscopic myomectomy, when performed by an experienced surgeon,can be considered a safe technique with good results in terms of pregnancy outcome.

Application of DDI in prediction of fertility outcome after laparoscopic myomectomy

Objective: To analyze the application of difficulty degree index (DDI) in predicting patients's fertility outcome after laparoscopic myomectomy. Methods: A retrospective study was carried out on 118 patients with subserous myoma or intramural myoma undergoing laparoscopic myomectomy from January 2005 to December 2014. The rate of post-operative pregnancy, delivery outcome and disease recurrence were investigated. Logistic regression analysis was used to analyze the impact of DDI, the age of patients undergoing surgery, presence of infertility history etc, on the patients' reproductive outcome following the surgery. Results: Follow-up for 1 to 10 years,118 cases were included in the study, the rate of post-operative pregnancy, live birth, vaginal delivery were 72.9% (86/118) , 52.5% (62/118) and 24.2% (15/62) respectively. No cases of uterine rupture and obstetric complications occurred. Univariate analysis showed that the independent variables of post-operative pregnancy rate were DDI, patient's age at the time of surgery, presence of infertility history and myoma recurrence (all P<0.05) . In multivariate analysis, the factors of post-operative pregnancy rate were DDI (OR=3.131, 95%CI:1.012-8.894) , patient's age at the time of surgery (OR=2.722, 95%CI:1.048-7.067) and presence of infertility history (OR=8.509, 95%CI: 2.102-34.445) . Conclusions: DDI could be applied to predict post-operative pregnancy rate, with the increasing of DDI the post-operative pregnancy rate decreasing. The patients with high DDI scores, age>35 years old or presence of infertility history should get ready for pregnancy positively.

A case-control study to compare the outcome of women treated by two minimally invasive procedures-ultraminilaparotomy myomectomy and laparoscopic myomectomy

ObjectiveUltraminilaparotomy myomectomy (UMLT-M with less 4 cm transverse skin incision) and conventional 3-port wound laparoscopic myomectomy (LM) approaches were proposed as alternative minimally invasive procedures in the management of women with symptomatic uterine myomas but few studies have compared the outcomes of both procedures. Materials and methodsBetween January 2002 and December 2003, 71 patients undergoing UMLT-M were compared with those 71 women undergoing LM. The last data collection for all patients was done on 31 December 2016. The parameters for comparison included the characteristics of the uterine myomas, surgical parameters, morbidities, and outcomes. Surgical parameters included the operative time (minutes), estimated blood loss (milliliters), time for removal of drainage, percentage of blood transfusion and co-morbidities. ResultsMean operative time in the LM group was significantly longer than that in the UMLT-M group (208.7 ± 65.9 vs. 98.0 ± 28.2 min, p < 0.001). Intra-operative blood loss was significantly higher in the LM group than that in the UMLT-M group (210.9 ± 184.5 vs. 111.7 ± 108.4 ml, p < 0.001). However, more patients had postoperative fever in the UMLT-M group (39.4% vs. 8.5%, p < 0.001). The recurrence rate of myoma at 5-year follow-up was significantly different between two groups (35.2% of UMLT-M vs. 57.7% of LM, p = 0.007), but there was no difference when follow-up time was over ten years. The location of the myoma recurrence was different between two groups with higher recurrence rates in the fundal and lateral sides of uterus in the UMLT-M group and in the anterior wall of uterus in the LM group. However, the overall symptom control, the need of repeated myoma-related surgery and subsequent pregnancy outcome of both groups seemed to be similar in both groups. ConclusionsMore operative time and more blood loss reflected that LM demanded skills, experience and equipment. Therefore, UMLT-M might be a feasible alternative choice in the management of uterine myomas, since it is an easy-to-perform and familiar technique, especially in the absence of suitable equipment or skilled operator. A large and randomized study is needed to confirm the above findings.

Prevention and Management of Complications in Laparoscopic Myomectomy.

Myomectomy aims to preserve fertility, treat abnormal uterine bleeding, and alleviate pain. It should cause minimal damage to the endometrium, while being tolerable and durable, and reduce the incidence of myoma recurrence and complications including bleeding, hematoma, adhesions, and gravid uterus perforation. Training and experience are crucial to reduce complications. The surgical strategy depends on imaging information on the myomas. The position of the optical and secondary ports will determine the degree of ergonomic surgery performance, time and difficulty of myoma enucleation, and the suturing quality. Appropriate hysterotomy length relative to myoma size can decrease bleeding, coagulation, and suturing times. Bipolar coagulation of large vessels, while avoiding carbonization and myometrium gaps after suturing, may decrease the risk of myometrial hematoma. Quality surgery and the use of antiadhesive barriers may reduce the risk of postoperative adhesions. Slow rotation of the beveled morcellator and good control of the bag could reduce de novo myoma and endometriosis. Low intra-abdominal CO2 pressure may reduce the risk of benign and malignant cell dissemination. The benefits a patient gains from laparoscopic myomectomy are greater than the complication risks of laparoscopic morcellation. Recent publications on laparoscopic myomectomies demonstrate reduced hospitalization stays, postoperative pain, blood loss, and recovery compared to open surgery.

ДЕЯКІ АСПЕКТИ ВПЛИВУ ДИСФУНКЦІЇ ЩИТОПОДІБНОЇ ЗАЛОЗИ НА ВИНИКНЕННЯ ЛЕЙОМІОМИ МАТКИ

У статті наведені дані щодо сучасних поглядів на розвиток найчастішої гінекологічної патології – лейоміоми матки. Проведено аналіз даних щодо зв’язку виникнення даного захворювання із змінами гормонального, імунного балансу організму та ролі генетичних чинників у цьому процесі. Проаналізовано значення порушення тиреоїдної функції в розвитку гіперпластичних процесів органів репродуктивної системи. Вказано на необхідність вибору методів лікування, які дозволяють зберегти репродуктивну функцію жінки та покращити якість життя в післяопераційному періоді. Враховуючи те, що лейоміома матки – це захворювання не одного органа, а всього організму, відмічено, що лікування та профілактика рецидиву міоматозних вузлів потребують сукупності заходів, спрямованих на регуляцію зв’язків гіпоталамо-гіпофізарно-яєчникової cистеми і порушеного метаболічного та імунного гомеостазу, відновлення периферичної гемодинаміки, усунення запалення. Проаналізовано результати досліджень із використанням лікарських засобів різних груп. Представлено досвід використання антипрогестеронових засобів та речовин, які модулюють активність прогестеронових рецепторів та можуть бути використані у лікуванні лейоміоми матки.

Laparoscopic Myomectomy with Temporary Bilateral Uterine Artery Occlusion Compared with Traditional Surgery for Uterine Myomas: Blood Loss and Recurrence

Study ObjectiveTo compare the surgical technique of temporary bilateral uterine artery blockage with titanium clips in laparoscopic myomectomy with traditional surgery for uterine myomas to determine efficacy, ability to control bleeding, and recurrence. DesignRandomized, controlled, prospective study (Canadian Task Force classification I). SettingObstetrics and gynecology department in Jinhua Municipal Central Hospital. PatientsWomen with symptomatic uterine myoma. InterventionsSixty-four patients with symptomatic uterine myomas were randomly divided into trial (group A, n = 33) and control groups (group B, n = 31). Temporary bilateral uterine artery occlusion and myomectomy were used in group A and laparoscopic myomectomy only in group B. Operative time, perioperative bleeding, follow-up relief of menorrhagia, and recurrence of myomas were evaluated. Measurements and Main ResultsAll patients in this study underwent successful laparoscopic operation without intraoperative complications. Operative time between groups was not significantly different (p = .255 in single-myoma group and p = .811 in multiple-myoma group), blood loss in group A was notably lower than the conventional surgery group (p < .001). At final follow-up (2 years), recurrence rate and menorrhagia symptom relief were not statistically significant (p = .828 and p > .999, respectively). The fertility index of antimüllerian hormone showed no statistical difference between groups preoperatively or at 2 days, 3 months, 6 months, and 1 year postoperatively (p = .086, p = .247, p = .670, p = .753, and p = .857, respectively). ConclusionTemporary bilateral uterine artery occlusion during laparoscopic myomectomy does not increase mean operative time, offers a possible option to reduce blood loss effectively, improves menorrhagia, and does not impact recurrence rate compared with conventional surgery.

Uterine artery embolization: is it reliable for myoma treatment?

Objective. We aimed to share the long-term technical and clinical success results, complications and radiologic follow-up findings in our myoma cases treated with uterine artery embolization (UAE) ) and to make a contribution to the literature data on this subject. Method. The study was retrospective and the results of 70 patients who underwent UAE for myoma treatment at our institute between January 2012 and January 2015 were analyzed. Results. The age range was 22 to 46 years and the mean age 34 years. The postprocedural follow-up duration was 6 to 24 months and the mean follow-up duration was 14 months. The technical success rate was 100% and the clinical success rate was 84.7%. On postprocedural follow-up, fibroid passage was seen in 2 patients (2.85%), severe hypermenorrhea in 4 (5.7%) and postembolization syndrome in 6 (8.5%). Our myoma recurrence rate was 11.36% (n=5). The UAE procedure did not need to be repeated in any of the patients. Conclusions. UAE is a reliable alternative to hysterectomy and myomectomy. We believe that UAE should be preferred in patients who are recommended hysterectomy or are predicted to potentially need hysterectomy during myomectomy.

Can we consider cesarean myomectomy as a safe procedure without long-term outcome?

Aim: To investigate short- and long-term outcomes in women undergoing cesarean myomectomy (CM).Methods: This was a retrospective study that explored short-term outcomes of women, who underwent cesarean operations with or without myomectomies (CM controls) in a single tertiary center throughout a 6-year-period. For long-term outcomes, the mean duration of follow-up was 6.3 ± 1.0 years.Results: There were no differences among the CM (n= 91) and control groups (n = 60) considering mean change in hemoglobin and hematocrit levels, hemorrhage, as well as requirement for blood transfusions with a slightly increased operative time. Multiple myomas, and cervical and cornual localization were associated with an increased drop of hemoglobin and hematocrit (p < 0.05). Subsequent pregnancy and recurrence rates were 35% (32/91) and 5.5% (5/91), respectively. Preterm delivery (n = 1, 3.1%), uterine dehiscence (n = 1, 3.1%), placenta previa (n = 1, 3.1%) and mild-to-severe post-CM adhesions (n = 8, 25%) were observed in subsequent pregnancies. Recurrence was identified in five of the nonpregnant (5.5%) women, and three of these (4.1%) underwent an additional major surgery. There was no recurrence in subsequent pregnancies.Conclusion: The recurrence of myoma was relatively low following CM. Subsequent pregnancy is protective for recurrence of myoma without increased adhesion formation and obstetric complications.

Multicentre study to evaluate the clinical effects of laparoscopic uterine artery occlusion in combination with myomectomy to treat symptomatic uterine leiomyomas

ObjectiveUterine artery occlusion is often used to treat symptomatic uterine myomas, as this is a minimally invasive approach. However, alternative methods for uterus-sparing therapy are in development. This study aimed to compare the clinical effects of laparoscopic uterine artery occlusion (LUAO) in combination with laparoscopic myomectomy (LM) with LM alone for the management of symptomatic uterine leiomyomas. Study designThis multicentre study was a retrospective controlled investigation. In total, 618 patients with symptomatic uterine myomas from six hospitals in Eastern China underwent LUAO+LM or LM alone between June 2011 and December 2012. Operative time, blood loss, transfusion, highest temperature, postoperative hospital stay, complications and follow-up results were compared between the two groups. ResultsComplete clinical data were available for 504 patients. Among these, 324 patients underwent LUAO+LM and 180 patients underwent LM alone. Mean±standard deviation blood loss, transfusion, highest peri-operative temperature and duration of hospital stay were significantly lower in the LUAO+LM group compared with the LM group (83.61±53.70ml vs 109±58.43ml, 1.85% vs 6.11%, 37.6±0.40°C vs 37.9±0.45°C and 5.11±0.62 days vs 6.10±0.83 days, respectively). The mean duration of follow-up was 38.97±5.82 months in the LUAO+LM group and 37.30±2.25 months in the LM group (p>0.05). The relief of abnormal uterine bleeding, reduction of uterine volume and recurrence of myomas were more remarkable in the LUAO+LM group than the LM group (97.22% vs 83.75%, 62.42% vs 51.83% and 3.47% vs 10.63%, respectively). ConclusionsLUAO in combination with LM was associated with higher surgical quality, greater relief of abnormal symptoms and less recurrence of myomas compared with LM alone. LUAO in combination with LM is recommended for women with symptomatic uterine myomas who wish to preserve their uterus.

POSSIBILITIES OF MIFEPRISTONE USE AFTER SURGICAL THERAPY OF UTERINE MYOMA

The effectiveness of mifepristone (Gynestril) use in patients after surgical therapy of uterine myoma (laparoscopic myomectomy, embolization of uterine arteries, hysteroresectoscopy) was studied. It was shown that use of mifepristone at a dosage 50 mg per day in an intermittent regime for 3 months after surgical therapy main myoma of a uterus led to statistically significant reduction of the uterine volume in 96% of women (p &lt; 0.05) and reduction of recurrence of uterine myoma for a year after the drug withdrawal.

Risk of Recurrence of Myomas Following Robotic-Assisted Laparoscopic Myomectomy.

Risk of Recurrence of Myomas Following Robotic-Assisted Laparoscopic Myomectomy.

Intraoperative transvaginal sonography: a novel approach for localization of deeper myomas during laparoscopic myomectomy

The aim of this study is to assess the use of intraoperative transvaginal ultrasonography (TVS) to locate deep myomas that were not identified on laparoscopic view. The design of this study is a prospective observational study. This study was conducted in private Advanced Endoscopy and Infertility Treatment Centre, Kerala, India. The study comprised of 84 patients who underwent laparoscopic myomectomy from January 2011 to December 2013 in whom intraoperative TVS was used as an intervention. The number of additional deeper myomas removed was calculated, and recurrence at 1 year was calculated. The total number of myomas enucleated was 390, and the additional myomas enucleated after intraoperative TVS were 94. The recurrence of myomas at 1-year follow-up was 7.1 %. Intraoperative TVS was helpful to the surgeon for identifying deeper myomas making the surgery more effective.