Myoma Volume Research Articles

Effectiveness of Cabergoline in Comparison with Control in Women with Fibroids Uterus: A Randomized Clinical trial

Background: Uterine fibroids are one of the most common benign tumors that cause abnormal bleeding and pain in women of reproductive age. One of the objectives of this study is to evaluate the effect of cabergoline drug on the size and volume of uterine bleeding as well as menopausal symptoms in women with uterine myomas. Methods: This double-blind clinical trial was conducted among 80 women with fibroid myomas and Abnormal Uterine Bleeding (AUB). The participants were allocated to two groups after random allocation. Group I received Cabergoline, 1 tablet (0.5 mg/w) orally once a week for 3 months. Group II obtained a placebo tablet (0.5 mg/w), taken at the same time. Results: 80 patients were included in the study (40 patients in the control group and 40 patients in the cabergoline treatment group). No statistically significant difference was observed between the two groups in terms of age, number of pregnancies, number of births, body mass index, uterine myoma characteristics, myoma type, myoma volume, and myoma number. A 37% decrease in myoma size was observed in the cabergoline recipients, as well as a 25% decrease in the placebo group, which is not statistically significant (p-value >0.05). Conclusion: Cabergoline drug reduces the volume of bleeding and the number of uterine myomas, but this reduction is not statistically significant and requires more studies in this field.

Thinking in context: Fibroids-to-uterine volume ratio in pre-surgical fertility evaluation for intramural fibroids

ObjectiveTo explore the utility of the total fibroids-to-uterine volume (FTUV) ratio as a simple, preoperative tool to assist in counseling patients seeking pregnancy who are undergoing myomectomy for intramural (IM) fibroids. Study designThis is an historical cohort study on reproductive-aged patients seeking pregnancy who underwent laparotomic myomectomy for intramural fibroids from January 2017 to December 2021. Only G3 to G5 fibroids, according to the 2011 International Federation of Gynecology and Obstetrics (FIGO) classification, were included. Pre-operative transvaginal ultrasound (TVUS) was performed to measure the volume of intramural myomas (diameter1*diameter2*diameter3*0.52) and to calculate their total volume. The total fibroids-to-uterine volume (FTUV) ratio was calculated as the proportion of the uterine volume occupied by the sum of IM fibroids volumes. ResultsA total of 166 women with pre-surgical TVUS evaluation of IM fibroids were included, with a mean age of 36.22 ± 5.15 years. The FTUV ratio was identified as a positive predictor of clinical pregnancy after surgery (adjOR, 1.04; 95 % CI, 1.02–1.06; p = 0.0001), whereas age showed a negative association (adjOR, 0.90; 95 % CI, 0.83–0.98; p = 0.012). Endometrial cavity distortion prior to surgery was also positively associated with pregnancy post-surgery (adjOR, 3.50; 95 % CI, 1.51–8.08; p = 0.003). Consistent results were found for live births, with the FTUV ratio being a significant positive predictor of live birth after surgery (adjOR, 1.03; 95 % CI, 1.01–1.05; p = 0.001) and age showing a negative association (adjOR, 0.88; 95 % CI, 0.80–0.96; p = 0.004). Parity prior to surgery also positively impacted live birth post-surgery (adjOR, 2.65; 95 % CI, 1.30–5.40; p = 0.007). An FTUV ratio threshold of 53.39 % accurately predicted clinical pregnancy in 68.46 % of cases (sensitivity of 71.70 % and specificity of 66.67 %). For live births, a higher FTUV ratio threshold of 59.21 % predicted outcomes accurately in 69.13 % of cases (sensitivity of 65.85 % and specificity of 70.37 %). ConclusionThe use of the FTUV ratio in pre-operative ultrasound evaluation of IM fibroids may improve counseling for patients desiring to conceive after myomectomy. By providing a personalized assessment of the amount of myometrial volume occupied by fibroids, the FTUV ratio can help predict fertility outcomes after surgery, enabling better-informed decisions and treatment planning.

Accuracy of the Measurement of Uterine Leiomyoma by Transabdominal Ultrasonography.

Introduction Uterine leiomyoma is a benign smooth muscle tumor. It does not necessarily require curative treatment, but if conservative management is chosen, it is important to rule out uterine leiomyosarcoma. When a size increase is observed, one must consider malignancy, and thus objective and cost-effective measurement of uterine size is important, especially for early detection of malignant change. Although MRI imaging is thought to be the gold standard for the diagnosis of uterine leiomyosarcoma, frequent MRI is impractical because of the incidence of uterine leiomyoma and the economic burden in real-world clinical practice. On the other hand, ultrasonography (US) is considered the most useful device in the observation of size changes. So this study aimed to examine the accuracy of the measurement of transabdominal US compared to MRI imaging. Materials and methods This retrospective study included 92 patients withuterine myoma ≥ 50 mm who undertook an MRI within 30 days after the transabdominal US. The longest diameter of the largest myoma (a), the longest diameter perpendicular to a in the sagittal image (b), and the longest diameter perpendicular to a and b in the axial image (c) were measured by US and MRI, and these were used to calculate the volume. Results were analyzed by intraclass correlation coefficient (ICC) 3.1. Results The ICC for the volume and major axis of the largest myoma by US and MRI were 0.87 and 0.90, respectively. The 95% confidence intervals (CI) were 0.82-0.91 and 0.87-0.93, respectively. Both reliability levels ranged from good to excellent. ICC was 0.54 (95%CI 0.15-0.78) in myomas with a volume of >500 cm3, and the concordant rate between US and MRI was poor to good. On the other hand, ICC was 0.82 (95%CI 0.57-0.93) even though all myomas with major axes greater than 120 mm had a volume >500 cm3, and the concordant rate between US and MRI measurements was moderate to excellent. In the evaluation by major axis, ICC was 0.60 (95%CI -0.41-0.95) for myomas larger than 160 mm, indicating a lower concordant rate. Conclusion Transabdominal US is an appropriate modality as well as MRI for follow-up of uterine myoma size if the nodules are 160 mm or smaller. Measurement of the major axis is easier and more useful than volume.

Transvaginal radiofrequency ablation of a myoma in 10 key steps

To describe transvaginal radiofrequency ablation of myomas (TRAM) in 10 key steps. Video article. University hospital. A 38-year-old woman presented with menometrorrhagia and consequent chronic anemia (hemoglobin 8.5 g/dL) caused by a cervical myoma measuring 51 cm3. Initially, a cervicovaginal embolization was performed, but without any improvement in symptoms. Given the complex position of the myoma (close proximity to the uterine arteries), as well as the patient's desire for future pregnancies, a TRAM was proposed. Not applicable. Volume of myoma and menometrorrhagia 6 months after treatment. Not applicable. Transvaginal radiofrequency ablation of myomas is a quick, simple, minimally invasive, and easily reproducible technique. It could be an interesting alternative to the conventional laparoscopic and open-surgical treatments of myomas. There is a lack of high-quality data establishing TRAM safety in infertility and pregnancy. The only available radiofrequency ablation device in the United States has specific language stating that this procedure is not recommended for women considering future pregnancy.

Uterine artery embolization versus hysterectomy for uterine myoma: a meta-analysis of postoperative ovarian function.

Uterine artery embolization (UAE) and hysterectomy are often used to treat uterine myoma. Nevertheless, the impact of these two treatments on postoperative ovarian function remains uncertain. To compare the postoperative ovarian function in individuals with uterine myoma who had UAE against hysterectomy. Searches were conducted in the Wanfang, Web of Science, and PubMed databases to find qualifying studies. The data were combined and analyzed. Seven publications were included in this meta-analysis. Uterus and uterine myoma volume were dramatically decreased by UAE (p < 0.00001 for both). The combined preoperative levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were similar in both groups. Three months postoperatively, the combined FSH (p = 0.28) and LH (p = 0.64) levels were similar in both groups, while the combined E2 level was notably higher in the UAE group compared to the hysterectomy group (p < 0.00001). Six months postoperatively, the combined postoperative FSH and LH levels were considerably lower in the UAE group compared to the hysterectomy group (p = 0.002 for both). However, the combined E2 levels were similar between the two groups (p = 0.07). Also, 12 months after surgery, the combined postoperative FSH and LH levels were remarkably lower in the UAE group compared to the hysterectomy group (p = 0.02 and p < 0.00001, respectively). However, the combined E2 levels were similar in both groups (p = 0.15). UAE may provide superior preservation of postoperative ovarian function compared to hysterectomy in individuals with uterine myoma.

Combined transabdominal and transvaginal ultrasound-guided percutaneous microwave ablation of uterine myomas: an effective monitoring technique

Objective This study compared the feasibility and efficacy of transabdominal ultrasound (TAU) and combined transabdominal and transvaginal ultrasound (TA/TV US)-guided percutaneous microwave ablation (PMWA) for uterine myoma (UM). Method This study enrolled 73 patients with UM who underwent PMWA via the transabdominal ultrasound-guided (TA group) or the combined transabdominal and transvaginal ultrasound-guided (TA/TV group) approaches. The intraoperative supplementary ablation rates, postoperative immediate ablation rates, lesion reduction rates and other indicators three months postoperatively were compared between the groups. The display of the needle tip, endometrium, uterine serosa, rectum and myoma feeding vessels under the guidance of TAU, transvaginal ultrasound (TVU) and TA/TV US were evaluated in the TA/TV group. Results In the TA/TV group, the real-time position of the needle tip and the endometrium complete display rate of the same lesions with TVU guidance were significantly higher than those using TAU. TA/TV US guidance significantly improved the complete display rate of each indicator. The intraoperative supplementary ablation rate in the TA/TV group was lower than that in the TA group. Similarly, the postoperative immediate ablation and volume reduction rates of the lesions three months postoperatively were higher than those in the TA group, especially for lesions with a maximum diameter ≥6 cm. Conclusion TA/TV US is an effective monitoring method that can be used to improve imaging display. Its use is recommended in patients with obesity, poor transabdominal ultrasound image quality and large myoma volumes.

Serum sestrin 2 levels in patients with uterine leiomyomas

Our aim was to evaluate SESN2 levels in patients with uterine leiomyomas by comparing serum SESN2 levels in myoma patients with the levels in healthy women to deepen our understanding of the pathophysiology of uterine leiomyomas. Patients 18–50 years of age who applied to the University of Health Sciences Turkey, Istanbul Kanuni Sultan Suleyman Training and Research Hospital between January and March 2021 and who were diagnosed with uterine leiomyoma were defined as the ‘myoma group’. The control group included patients without any sign of leiomyomas in routine ultrasonography. The patients’ demographic features, gynecological symptoms, myoma volume and classification were recorded. Serum SESN2 concentrations in venous blood samples were measured using a sandwich enzyme-linked immunosorbent assay (ELISA) kit. The study included 31 patients in the myoma group and 30 in the control group. The mean age/gravid/parity or BMI values did not differ significantly between the groups. The only gynecological symptom that showed a significant difference was menorrhagia. Serum SESN2 levels were significantly higher in the myoma group then the control groups (11.7 ± 2.5) (p < 0.001). In conclusion, although uterine leiomyoma is the most common benign tumour in women of reproductive age, there are no known markers for predicting the development of leiomyomas. Based on the results of the current study, SESN2 could be such a marker. IMPACT STATEMENT What is already known on this subject? Uterine leiomyoma is the most common type of benign tumour in women of reproductive age as well as the most common indication for a hysterectomy. Symptoms associated with uterine leiomyoma include abnormal bleeding, chronic pelvic pain, menorrhagia, dysmenorrhoea, dyspareunia and anaemia, which adversely affect the patient’s quality of life. Sestrins are a family of metabolic regulator proteins that play a potential role in carcinogenesis. What the results of this study add? This is the first study evaluating the role of sestrin in the development of uterine leiomyomas. Significantly higher levels of sestrin 2 (SESN2) were detected in patients with leiomyomas. What are the implications of these findings for clinical practice and/or further research? Although uterine leiomyoma is the most common type of benign tumour in women of reproductive age, there are still many unknowns regarding its pathophysiology. Further, there are still no known markers for predicting the development of leiomyomas. Hence, primary prevention is not possible. Based on the results of the current study SESN2, could be such a marker. Further studies are needed to confirm the results of this study.

Prediction using T2-weighted magnetic resonance imaging-based radiomics of residual uterine myoma regrowth after high-intensity focused ultrasound ablation.

To develop and evaluate magnetic resonance imaging (MRI)-based radiomics models for predicting residual myoma regrowth within 1 year after high-intensity focused ultrasound (HIFU) ablation of uterine myomas. A retrospective analysis of residual myoma regrowth within 1 year was performed on 428 myomas in 339 patients who were diagnosed with uterine myoma and treated with HIFU ablation in two hospital centers. In total, 851 radiomics features were extracted from T2-weighted images (T2WI) obtained 1 day after HIFU ablation, and the least absolute shrinkage and selection operator in the training cohort (n = 243) was employed to select radiomics features. Support vector machines were adopted to develop radiomics, clinicoradiological and combined radiomics-clinical models to predict residual myoma regrowth, defined as an increase in residual myoma volume of > 10% between that at day 1 post HIFU and that at follow-up MRI within 1 year. These models were validated in both internal (n = 81) and external (n = 104) test cohorts. The predictive performance and clinical application of these models were assessed using receiver-operating-characteristics-curve analysis, the area under the curve (AUC) and decision-curve analysis. The AUCs of the T2WI-based radiomics prediction model in the internal and external test cohorts were 0.834 (95% CI, 0.747-0.920) and 0.801 (95% CI, 0.712-0.889), respectively, and those of the clinicoradiological model were 0.888 (95% CI, 0.816-0.960) and 0.912 (95% CI, 0.851-0.973), respectively. The combined model had better predictive performance than either the radiomics or the clinicoradiological model, with AUC values of 0.922 (95% CI, 0.857-0.987) and 0.930 (95% CI, 0.880-0.980) in the internal and external test cohorts, respectively. Decision-curve analysis also indicated that application of the combined model has clinical value, this model achieving more net benefits than the other two models. T2WI-based radiomics features can predict effectively the occurrence of residual myoma regrowth within 1 year after HIFU ablation of uterine myomas, which serves as an accurate and convenient reference for clinical decision-making. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Prospective Study Investigating Change in Carboxyhemoglobin Blood Level During Operative Hysteroscopy

To evaluate whether the use of radiofrequency energy during resectoscopy leads to increases in patient blood levels of carboxyhemoglobin (COHb) and investigate procedural variables associated with these elevations. A prospective cross-sectional study of 40 subjects undergoing a hysteroscopic procedure using bipolar radiofrequency energy. The study was conducted at an ambulatory surgery center. Procedures for uterine leiomyoma, septa, products of conception, or a combination of these pathologies were included. We measured blood COHb levels before and immediately after the surgery. Abnormal postoperative COHb level was defined as an increase of plasma COHb ≥3.0%. All patients with abnormal postoperative levels were contacted and screened for carbon monoxide toxicity symptoms. Summary statistics included frequency for categorical variables and averages for continuous variables. p values were reported without modification. A total of 17.5% of subjects met the criteria for abnormal postoperative COHb levels. None of these subjects reported symptoms of carbon monoxide toxicity. One subject with an elevated postoperative COHb level had intraoperative hemodynamic changes possibly related to COHb elevation. An abnormal postoperative COHb level was associated with a higher fluid deficit (p=.024) and greater myoma volume (p=.04). This study demonstrates that systemic absorption of carbon monoxide is a reproducible phenomenon in hysteroscopic resections using bipolar diathermy. Greater absorption is associated with a higher fluid deficit and greater myoma volume. Although none of the subjects with an abnormal increase screened positive for symptoms in the postoperative setting and only 1 experienced hemodynamic changes intraoperatively, our study looked at a healthy and young patient population. More research is needed on the safety of this COHb exposure in patients with medical comorbidities. Special consideration should be given to the possibility of carbon monoxide absorption and the uncertain long-term effects when planning extensive hysteroscopic resections.

Efficacy, Complications, and Factors Predictive of Response to Treatment with Transvaginal Radiofrequency Ablation for Symptomatic Uterine Myomas

Transvaginal radiofrequency ablation is a minimally invasive treatment for myomas in women who wish to preserve their uterus. This study aimed to evaluate the efficacy and safety of transvaginal radiofrequency to treat myomas and to identify factors predictive of the response to treatment. Prospective case series. Virgen de las Nieves University Hospital, a tertiary center in Granada, Spain. The participants were 59 patients with myomas. Transvaginal radiofrequency ablation. The variables recorded were personal (age and type of myoma), procedure dependent (pain, need for analgesia, duration of sick leave, procedure duration, and complications), clinical (total days of menstrual bleeding and days of heavy menstrual bleeding), and score on the symptom severity scale of the Uterine Fibroid Symptom and Quality of Life Questionnaire. Myoma volume was determined by ultrasonography. Changes in clinical variables and myoma volume were analyzed 2, 6, and 12 months after the procedure. Moreover, the influence of age, initial myoma size, type of myoma, and duration of the procedure on the outcomes of treatment were analyzed. Statistically significant improvements in symptoms were seen in all variables analyzed for bleeding at 0, 2, 6, and 12 months, and a significant improvement was seen in the symptom severity scale score 12 months after the procedure. Mean myoma volume (in milliliters) was significantly lower 2, 6, and 12 months after treatment (p <.05). At 12 months, the mean reduction in myoma volume was more than 80%. Patient age and initial myoma size were identified as factors predictive of the outcomes. Transvaginal radiofrequency ablation was an effective and safe technique for the treatment of myomas. The patient's age and initial size of the myoma influenced the outcome of treatment.

Transcervical microwave ablation in type 2 uterine fibroids via a hysteroscopic approach: analysis of ablation profiles

Type 2 uterine fibroids are challenging to resect surgically as ≥ 50% volume of myoma lies within the myometrium. A hysteroscopic approach for ablating fibroids is minimally-invasive, but places a considerable burden on the operator to accurately place the ablation applicator within the target. We investigated the sensitivity of transcervical microwave ablation outcome with respect to position of the ablation applicator within 1 – 3 cm type 2 fibroids. Methods: A finite element computer model was developed to simulate 5.8 GHz microwave ablation of fibroids and validated with experiments in ex vivo tissue. The ablation outcome was evaluated with respect to applicator insertion angles (30°, 45°, 60°) , depth and offset from the fibroid center (±2 mm for 3 cm fibroid and ±1 mm for 1 cm fibroid) with 35 W and 15 W applied power for 3 cm and 1 cm fibroids, respectively. Power deposition was stopped when thermal dose of 40 cumulative equivalent minutes at 43 °C (CEM43) was accrued in adjacent myometrium. Results: Within the range of all evaluated insertion angles, depths and offsets, the ablation coverage was less sensitive to variation in angle as compared to depth and offset, and ranged from 34.9 – 83.6% for 3 cm fibroid in 140 – 400 s and 34.1 – 67.9% for 1 cm fibroid in 30 – 50 s of heating duration. Maximum achievable ablation coverage in both fibroid cases reach ∼ 90% if thermal dose is allowed to exceed 40 CEM43 in myometrium. Conclusion: The study demonstrates the technical feasibility of transcervical microwave ablation for fibroid treatment and the relationship between applicator position within the fibroid and fraction of fibroid that can be ablated while limiting thermal dose in adjacent myometrium.

Clinical investigation of fertility after uterine artery embolization

Uterine artery embolization is an effective and safe technique for the treatment of uterine fibroids, but its use remains controversial for women who wish to procreate. This study aimed to study the clinical, anatomic, and obstetrical results of uterine artery embolization in patients of childbearing age not eligible for myomectomy. This was a retrospective cohort study of 398 female patients under the age of 43 years who were treated by uterine artery embolization between 2003 and 2017 for symptomatic fibroids and/or adenomyosis. Uterine artery embolization was performed according to a standardized procedure (fertility-sparing uterine artery embolization technique), with ovarian protection in the event of dangerous utero-ovarian anastomosis. Magnetic resonance imaging and pelvic ultrasounds were performed before and after uterine artery embolization. The overall clinical success rate (ie, resolution of preembolization symptoms such as heavy menstrual bleeding, iron-deficiency anemia, pelvic pressure) was 91.2%, and there were no major complications. One year after uterine artery embolization, we observed a mean 73% reduction in myoma volume. A total of 108 patients (49.3%) presented with dangerous utero-ovarian anastomosis and 33 (14.5%) benefited from ovarian protection. In our group, there were 148 pregnancies and 109 live births; 74 children were born at term; 23 were born preterm, on average at 35.12±2.78 weeks. Including preterm births, the mean birthweight and birth length of the children were within normal limits. Restoration of uterine anatomy and ovarian protection were identified as the main predictive factors for obstetrical success. Restoration was also a major predictive factor for clinical success and was associated with a lower rate of miscarriage. This study provided detailed clinical and obstetrical outcomes for 398 female patients who underwent uterine artery embolization for fibroid treatment; it contributes to the identification of anatomic and technical factors that could have an impact on fertility after uterine artery embolization. Further controlled clinical trials are needed to confirm our findings and reevaluate this procedure's indications and limitations for women with a desire to procreate.

Laparoscopic Uterine Artery Occlusion Combined with Uterine-sparing Pelvic Plexus Block and Partial Adenomyomectomy for Adenomyosis: A Video Case Report

OBJECTIVE Adenomyosis usually causes dysmenorrhea and anemia. Clinically, it is difficult to be solved by medicine and traditional surgery, and hysterectomy is always performed for radical treatment. In this article, we introduce a new method which could control the dysmenorrhea and anemia through laparoscopic uterine artery occlusion (LUAO) combined with uterine-sparing pelvic plexus block, and partial adenomyomectomy for uterus perservation.

Uterine fibroids treatment: do we have new valid alternative? Experiencing the combination of vitamin D plus epigallocatechin gallate in childbearing age affected women.

Uterine myomas are the most common benign tumors in females, and at least 25% of affected patients experience symptoms severe enough to need treatment, like heavy hemorrhage, pelvic pain, and infertility. Currently, a non-invasive approach is preferred in women of childbearing age who desire pregnancy. The aim of our study was to determine the effect of oral supplementation with a combination of vitamin D plus epigallocatechin gallate (EGCG) and vitamin B6 in women with myomas. Between April and December 2020, we enrolled 95 women of childbearing age, afferent to our hospital, displaying at least one myoma with a diameter <4 cm. Patients were divided in two groups: 41 women were treated daily with two tablets of 25 μg vitamin D + 150 mg EGCG + 5 mg vitamin B6 for 4 months; 54 women, representing the control group, received no treatment. Total volume and vascularization of myomas were analyzed ultrasonographically. Bleeding and pelvic pain was also evaluated, as well as patients' quality of life and health through questionnaire Short Form Health Survey (SF-36) and Patient Global Impression of improvement (PGI-I). After treatment myomas' total volume and peripherical vascularization significantly decreased respectively by 37.9% (p<0.001) and 7.7%. On the other hand, we observed an increase in myomas' volume by 5.5 % and of peripherical vascularization by 5% in the control group. The treated group reported an improvement in SF-36 (p<0.001) and PGI-I (85.4%) questionnaire scores. We demonstrated, in young women who want to preserve fertility, that the combined supplementation of vitamin D, EGCG, and vitamin B6 reduced myomas' volume and improved patients' quality of life, without side effects.

Grossesse après les premières procédures d’embolisation des fibromes utérins en Afrique subsaharienne en Côte d’Ivoire

ObjectiveTo report the obstetrical outcome of patients wishing to conceive after embolization of uterine fibroids in Côte d’Ivoire. Materials and methodOver a 72-month period from February 2012 to February 2018, a prospective observational and descriptive longitudinal study focused on 181 non menopausal patients who had symptomatic uterine fibroids for which they had benefited from embolization of the uterine arteries. Among them, some were selected taking into account the inclusion criteria and were regularly monitored by their obstetrician-gynecologist. ResultsThe mean age of the 65 patients was 40.7 years and 16.3% of them had a history of myomectomy. The mean uterine volume and size of dominant myomas before and six months after embolization were 849.5cm3, respectively; 67.7cm and 584cm3; 45.4cm (all these measurements are in centimeters), i.e. a reduction rate of 33% and 43%. Of the 65 patients, eleven of them with an average age of 36.7 years were able to conceive, a rate of 16.9%. Among these 11 patients, 8 had had one pregnancy and three had had two each, for a total number of 14 pregnancies. The mean time from uterine fibroid embolization to pregnancy was 34 months with extremes ranging from 06 to 60 months. Among the obstetric complications, there was one case of placenta accreta which required hysterectomy and two cases of placenta previa which had progressed well after cesarean delivery. ConclusionThe onset of pregnancy is possible after embolization of uterine fibroids. This less invasive procedure than myomectomy can also be offered to patients with a desire for motherhood. However, there is little agreement on fertility status after UFE and fertility rates after UFE have not yet been effectively quantified. Also, the decision to favor EFU over myomectomy in women wishing to maintain their fertility remains limited by the small size of our sample. We should analyze more patients who are trying to conceive after UFE and use longer follow-up.

Assisted Reproductive Techniques and submucous myoma

Submucous myomas have negative effects on fertility. To maintain fertility, conservative treatment should be suggested to women who wish to become pregnant, especially young patients. The patient was a 33-year-old woman, who had had secondary infertility for 3 years. Upon vaginal ultrasound, we noticed a submucous myoma measuring 26 mm x 31 mm with a compressive effect on the anterior surface of the endometrium. Ovarian reserve was low. The gold standard of myoma treatment is surgical intervention. But, for the following reasons: the adverse effects of surgery on the endometrium (intrauterine adhesion), the patient's refusal to undergo a myomectomy and her request for pregnancy, our strategy for treating was to reduce volume of submucous myoma and start the assisted reproductive techniques (ART) cycle, simultaneously. We administered three courses of Gonadotropin-releasing hormone analogues (GnRHa) and then induced controlled ovarian hyperstimulation. Ovum pick up was done. Finally, we transferred two embryos (4 and 6 cells). In subsequent patient visits, βhCG was positive after 14 days. At the last patient visit, the heart of the embryo was formed. From this finding, it may be concluded that combined GnRHa and ART is the treatment of choice for infertile women with uterine submucous myoma, considering the reduced ovarian reserve and response.

INTERDISCIPLINARY INTERACTION IN MAINTAINING THE REPRODUCTIVE HEALTH IN WOMEN WITH UTERINE LEYOMYOMA

The aim: Optimizing the interdisciplinary approaches in the diagnosis and monitoring the dynamics of uterine leiomyoma treatment by high-intensity focused ultrasound ablation. Materials and methods: In the course of scientific research we conducted a survey 72 women of reproductive age were diagnosed with leiomyoma. All patients underwent bimanual gynecological examination, ultrasound and MRI to determine the condition of the pelvic organs, assess the structure, location, number of myomas, as well as assess the possible acoustic pathway of high-intensity focused ultrasound. During monitoring, dynamic contrasting was used to determine the zone of node necrosis. Methods of control in the postoperative period: ultrasound, MRI of the pelvic organs using paramagnetic, were performed after 1, 3, 6 months. Ultrasound ablation of uterine fibroids was performed using the JC extracorporeal treatment system (Chongqing HAIFU (HIFU) Technology Co. Ltd., China) with a built-in ultrasound system (Italy). Controlling the direct result was based on gray scale changes during real-time ultrasound examination on the monitor of the JC device. Since HIFU is a non-invasive method of treatment, in the future, the diagnosis was limited to using the ultrasound and MRI paramagnetic. Indicators such as: uterine body size were considered as indicators that characterize the effectiveness of treatment; specific volume of myoma; regression of uterine body size; regression of the myoma; regression of the node, calculated on its specific volume, because one patient could have several nodes. Results: Analyzing the obtained results, it should be noted that for a month the average volume of leiomatous hives that were exposed to HIFU, almost did not change and was 122 cm³, while three months after treatment it was - 98 cm. The nodes underwent a significant reduction 6 months after the treatment, their volume averaged 61 cm³. The dynamics analysis results of uterine body volume reduction, which is no less important expected result, showed the following: in the first month after the intervention the uterine volume almost did not change and, compared to the average size before treatment 342cm³, was 300cm³. In three months after treatment, the body volume of the uterus decreased to 264 cm³, and in six months - to 200 cm³. When assessing the node 6 months after the procedure, it was found that during this period there was a significant reduction in the volume of leiomyoma, which was positively correlated with the clinical manifestations of the disease. Conclusions: An interdisciplinary approach with the widespread introduction of modern organ-preserving techniques is an important direction in maintaining the reproductive health of women with uterine leiomyoma. Positive dynamics of leiomatous node volume regression depends on its location, volume and MR type. The terms 1 and 3 months after ultrasound ablation are insufficient for objective radiological evaluation of the treatment outcome, but are important for the choice of further tactics in observing and treating the uterine leiomyoma.

Imaging features and clinical analysis of diffuse uterine leiomyomatosis cases

Objective: To discuss the imaging, clinical features and management of diffuse uterine leiomyomatosis (DUL). Methods: Six cases of DUL confirmed in Peking Union Medical College Hospital from August 2009 to September 2019 were reviewed on their image and clinical data. Retrospective analysis was conducted on their perioperative and postoperative follow-up data. Results: The average age of the first diagnosis of DUL was (27±3) years old. All of the patients complained menorrhagia and three patients suffered moderate to severe anemia. Three patients were diagnosed infertility. Pelvic ultrasound and MRI showed symmetrical enlarged uterus with complete replacement of the myometrium by innumerable, confluent leiomyomas.Four patients were treated with GnRH-a before operation to reduce the volume of myoma and correct anemia. Among the six patients, five had undergone myomectomy because of DUL before visiting Peking Union Medical College Hospital. Three patients underwent open myomectomy. The number of resected myoma was 188-300 and the bleeding volume was 1 200-2 500 ml. Two of them suffered recurrence at 51 and 40 months after operation. One received sirolimus for 20 months without recurrence until now. Other three patients underwent hysterectomy. One patient underwent partial small bowel resection and partial omentum resection because of severe pelvic adhesion during hysterectomy, and the blood loss was 2 000 ml. Conclusions: Pelvic imaging especially MRI is helpful for early recognition and preoperative evaluation for DUL. Fertility preservation is a great challenge for DUL patients. The risk of recurrence after myomectomy is high. Hysterectomy is the last choice to completely cure DUL at present.

Application of the prone position in myomectomy by transvaginal natural orifice transluminal endoscopic surgery.

IntroductionNatural orifice transluminal endoscopic surgery (NOTES) is a new concept of minimally invasive surgery. It could prevent complications related to the trocar in laparoscopic surgery, and help achieve ideal cosmetic outcomes.AimTo describe the safety and feasibility of the prone position in transvaginal NOTES (V-NOTES) resection of posterior uterine myoma.Material and methodsSeventeen patients were included in the study from February to December 2019. All the patients were diagnosed with solitary posterior uterine myoma and underwent V-NOTES myomectomy in the prone position. We measured the characteristics and the surgical outcomes of these patients, to evaluate the safety and feasibility of the prone position in V-NOTES myomectomy.ResultsThe mean age of the patients was 38.71 ±7.68 years and the mean body mass index was 22 ±2.02 kg/m2. Five patients had a cesarean section once, and 1 patient had a history of two operations (cesarean section and laparoscopic cholecystectomy). The remaining patients had no history of surgery. The mean myoma volume in the ultrasound report was 121.99 ±125.24 cm3. The mean operation time was 107.48 ±34.16 min. The mean hemoglobin decrease 48 h after the operation was 1.37 ±0.66 g/dl. The mean weight of the myoma was 183.88 ±144.29 g. The mean VAS score 12 h and 24 h after surgery was 2 ±0.87 and 1.18 ±0.73, respectively. The mean postoperative hospital stay was 3.18 ±0.39 days. One patient was converted to TU-LESS. No other complications such as massive hemorrhage, infection or injury occurred.ConclusionsThe prone position in V-NOTES myomectomy is safe and feasible. It expands the operative space and reduces the difficulty of surgery. Perhaps it can be used as a standard position for posterior uterine myomectomy by V-NOTES.

Intraoperative tranexamic acid to decrease blood loss during myomectomy: a randomized, double-blind, placebo-controlled trial

Myomectomy is associated with a significant risk of hemorrhage. Tranexamic acid is a synthetic lysine derivative with antifibrinolytic activity used in other surgical disciplines to reduce blood loss during surgery. However, its utility in gynecologic surgery is not well understood. This study aimed to determine the effect of early administration of intravenous tranexamic acid on perioperative bleeding and blood transfusion requirements in women undergoing myomectomy. This study was a double-blinded, randomized, placebo-controlled trial conducted in an academic teaching hospital. Women with symptomatic fibroids thought to be at risk for large intraoperative blood loss who met the following criteria were included in the study: (1) at least 1 fibroid ≥10 cm, (2) any intramural or broad ligament fibroid ≥6 cm, and/or (3) at least 5 total fibroids based on preoperative imaging. Patients were randomized to receive a single intravenous bolus injection of tranexamic acid 15 mg/kg (intervention group) versus an intravenous bolus injection of saline of equivalent volume (placebo group) 20 minutes before the initial surgical incision. Perioperative bleeding was defined by measuring intraoperative estimated blood loss, change between pre- and postoperative hemoglobin, and frequency of blood transfusions. Estimated blood loss was calculated by combining the blood volume collected within the suction canister and the weight of used sponges. The 2 groups were compared for age; body mass index; perioperative hemoglobin and hematocrit; perioperative blood loss; duration of surgery; blood transfusion requirements; and the number, total weight, and volume of myomas removed. A total of 60 patients (30 per arm) were enrolled into the study between March 1, 2015, and January 29, 2018. Age, body mass index, baseline hemoglobin and/or hematocrit, number and total weight of myomas removed, and size of myomas did not differ between arms. Of 60 patients, 32 (53%) had laparoscopic myomectomy, 24 (40%) had robotic myomectomy, and 4 (7%) had laparotomy. Median estimated blood loss was 200 mL for the tranexamic acid group and 240 mL for the placebo group (P=.88). There was no difference in median duration of surgery (165 vs 164 minutes; P=.64) or change in perioperative hemoglobin (1.00 vs 1.1 g/dL; P=.64). Patients in the tranexamic acid group did not require blood transfusions; however, 4 patients (13.3%) in the placebo group (P=.11) required blood transfusions. Intravenous administration of tranexamic acid in patients undergoing laparoscopic or robotic myomectomies was not associated with decreased blood loss.