Myomas In Women Research Articles

Management of Symptomatic Myomas in Women with Incomplete Fertility

Management of Symptomatic Myomas in Women with Incomplete Fertility

Optimization of surgical treatment of uterine myoma in women with obesity and the metabolic syndrome

Objectives: to evaluate the benefits of delayed conservative myomectomy with the aim of reducing body weight and correcting hematological and metabolic parameters against the background of the use of gonadotropin-releasing hormone (GnRH) agonists and a combination of myo-inositol and D-chiro-inositol (Inofolic combi) in obese patients with metabolic syndrome by comparing this technique with immediate surgery.Materials and methods. The study included 72 patients with uterine fibroids and obesity who required conservative myomectomy. Patients were offered to postpone surgical intervention in order to correct body weight, metabolic and hematological indicators. As a preoperative preparation, patients were recommended to use GnRH agonists (goserelin), inositols, and iron preparations for anemia. Patients were divided into 2 groups: the first group (n = 31) followed all these recommendations, the second group (n = 41) refused to follow the recommendations and postponed surgical treatment. Group 1 underwent surgical treatment 3 months after the start of treatment, group 2 – after the initial consultation.Results. Patients of the first group lost an average of 7.3 ± 1.4 kg of body weight during preoperative preparation, their hemoglobin level increased by an average of 21.78%, and the volume of the largest myomatous node decreased by an average of 21.82%. The duration of the operation was significantly shorter in group 1 (75 ± 3.84 min) than in group 2 (118 ± 5.33 min). Laparotomy in the first group was not performed in any patient, in the second group it was performed in 9 patients (21.95%) (p < 0.05). There was a decrease in the severity of postoperative pain in group 1, (3.4 В± 1.25 points on the visual analog scale), which was significantly lower than in group 2 (5.1 В± 3.4 points).Conclusions. Body weight reduction against the background of the use of GnRH agonists (goserelin) and inositols (Inofolic combi) due to the improvement of the technical conditions of the operation, metabolic and hematological indicators allow to reduce the duration of surgical intervention and the frequency of laparotomies in patients with uterine fibroids against the background of obesity and metabolic syndrome.

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.

Effect of Two Different Doses of Vitamin D Supplementation on Uterine Myoma on South East Iranian Population; A Clinical Trial

Objective: Uterine myoma is the most common benign tumor however with significant distress and reduced quality of life in affected women. Besides, vitamin D deficiency may be a risk factor for uterine myoma. This study aimed to evaluate the effect of vitamin D supplements on the size of myoma in women with vitamin D insufficiency or deficiency. Materials and methods: This clinical trial was conducted in a teaching hospital from 2019 to 2020. According to baseline vitamin D level, participants were assigned into two interventional equal groups (vitamin D deficiency or insufficiency) to receive either 1000 IU daily or 50000 IU weekly vitamin D for 12 weeks. The size and location of the uterine myoma were compared before and after the intervention. Results: Totally, 137 women with uterine myoma were enrolled. Based on baseline vitamin D level, 52 cases had vitamin D insufficiency and 85 cases had vitamin D deficiency. No significant difference was observed in age and BMI in both groups. The location of the subserosal and intramural myoma did not differ, otherwise, the percent of the submucosal myomas were increased significantly (p=0.020) after the intervention. In both groups decreased myoma size otherwise not significant was seen after the intervention (p=0.148 and p=0.664 respectively). Conclusion: Vitamin D supplementation may not be effective in women with vitamin D insufficiency or deficiency in the short term to reduce myoma size.

The Study of Polymorphisms Rs3020434, Rs11742635, Rs124577644, Rs12637801, Rs2861221, and Rs17677069 in Women with Familial Uterine Myoma

Study Objective To find genetic markers of family forms of myomas for the optimization of diagnostics, management of patients, and prediction of the risk of recurrence. Design Canadian Task Force: Level II-2. Setting Department of Operative Gynecology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation. Patients or Participants 106 patients with uterine myoma scheduled for hysterectomy or myomectomy were organized into 3 groups: group 1 with family history of myoma; group 2 without such history; group 3 - patients who did not have information about their anamnesis. 24 women represented the control group. Interventions Patients underwent hysterectomy or myomectomy for symptomatic uterine myoma. Individual fibroids and blood of all patients were collected during the surgery. DNA extraction and genotyping of six loci (rs3020434, rs11742635, rs124577644, rs12637801, rs2861221, rs17677069) of the ESR1, FBN2, CELF4, KCWMB2 genes was undertaken. Measurements and Main Results 130 patients were included in the study (51, 36, and 19 women in the first, second, and third groups respectively and 24 patients in the control group). While rare alleles of polymorphisms rs3020434 (TT), rs11742635 (TT), rs2861221 (GG) and rs17677069 (GG) were not found in patients with familial myoma; common forms of these polymorphisms were found in this group and included: CC allele of rs3020434 polymorphism in 73 % (p=0.003), GG variant of rs11742635 in 82 % (p=0.008), and CC allele of rs2861221 and AA allele of rs17677069 in 82 % of these women (p=0.02 and p=0.001, respectively). Conclusion Rare alleles of rs3020434, rs11742635, rs2861221, and rs17677069 polymorphisms can potentially be protective variants in the development of family forms of uterine myoma. Common alleles identified could increase the risk of development of familial myoma. It may be possible to use these alleles as genetic markers for predicting the development of myoma in women with a family history of this disease.

The Effect of Non-Cavity-Distorting Myomas on the Outcomes of Stimulated Intrauterine Insemination in Unexplained Infertility

Objective: To investigate the relationship between reproductive outcomes and noncavity-distorting uterine myomas in women with unexplained infertility and undergoing ovulation induction and intrauterine insemination (OI-IUI). Material and Methods: Women between 18-40 years of age with regular ovulatory cycles and bilateral tubal patency as detected on hysterosalpingography (HSG) and with spouses having total progressive motile sperm (TPMSS) counts >5 million on spermiogram analysis, were included in this study. The number of women with noncavity-distorting myomas, as detected using ultrasonography, were recorded. The frequencies of pregnancies after OI-IUI, ectopic pregnancies, abortions, clinical pregnancies, and live births were compared between women with non-cavity-distorting myomas and those without myomas. Results: A total of 857 cycles of OI-IUI were administered to 436 patients, resulting in 110 pregnancies. Non-cavity-distorting myomas were recorded in 27 subjects. Using multivariate logistic regression analysis, the presence of non-cavity-distorting myoma significantly affected pregnancy (p<0.05). Conception (p=0.008), clinical pregnancy (p=0.034), and live birth rates (p=0.037) were significantly higher in patients without fibroids than those with fibroids. Conclusion: Conception, clinical pregnancy, and live birth rates were significantly higher in patients without uterine fibroids than those with fibroids. These findings suggest that myomas might have negative effects on fertility outcomes.

Clinical-anamnestic features and quality of life in women with endometrial pathology on the background of uterine myoma.

A total of 325 women 35-55 years old suffering from various forms of endometrial pathology were examined. It was found that 110 (33.8%) patients had combination of endometrial pathology and uterine myoma. They made up the main group (group MM), the reference group consisted of 215 women without uterine myoma (group K). It was established that group with uterine myoma is characterized by increased extragenital morbidity: cardiomyopathy (p&lt;0.009), hypertension (p&lt;0.03), obesity stage III-IV (p&lt;0.006), iron-deficiency anemia (p&lt;0,02), vegetative-vascular dystonia (p&lt;0,03) and nervous system diseases (p&lt;0,01) were significantly more common. The presence of uterine myoma is associated with increased risk of recurrence of endometrial hyperplasia and polyps. These data suggest that in the pathophysiology of uterine myoma in women of late reproductive and premenopausal age with endometrial pathology somatic and somatoform disorders play a more significant role than concomitant or previous genital pathology. In late reproductive age and menopause period endometrial lesions are combined with uterine myoma in every third patient. Somatic factors have a greater impact on the development of uterine myoma than reproductive. The presence of uterine myoma is an additional criterion of reduceof quality of life and burdens the prognosis of treatment of endometrial pathology in late reproductive age and premenopausal period.

Estimation of candidate genes in the development of a combination of endometrial hyperplasia and uterine fi broids

Objective: the study of bioinformatics by six genetic polymorphisms (rs1782507, rs555621, rs7753051, rs887912, rs6732220, rs4986938) in the formation of a combination of endometrial hyperplasia with uterine myoma in women in the Central region of Russia. Materials and methods: the study group consisted of 1151 employees, including 170 patients with a combination of uterine fi broids with endometrial hyperplastic processes and 981 women in the control group without proliferative diseases of the pelvic organs. Material for the study were DNA samples isolated from venous blood by phenol-chloroform extraction. Analysis of the investigated polymorphisms was carried out by the detection ATK-man probes using real-time PCR. Results: risk factors for the development of a combination of endometrial hyperplasia and uterine fi broids combination of molecular genetic markers with rs673220, and rs4986938 and G rs887912 (ОR = 1.70), with rs6732220 and rs555621, g rs887912 (ОR = 1.53) and C rs1782507 T rs7753051 and rs887912 G (ОR = 1.40). Conclusion: the obtained data testify to the signifi cant contribution of combinations of polymorphic variants rs1782507, rs555621, rs7753051, rs887912, rs6732220 and rs4986938 to the formation of a combination of endometrial hyperplasia and uterine fi broids among women in the Central region of Russia.

Comparing the effect of aromatase inhibitor (letrozole) + cabergoline (Dostinex) and letrozole alone on uterine myoma regression,a randomized clinical trial

ObjectiveTo evaluate the effect of letrozole in combination with cabergoline and letrozole alone on regression of symptomatic uterine myomas in women of reproductive age. DesignRandomized controlled clinical trial. SettingUniversity hospital. PatientsNinety-one women of reproductive age were enrolled in the study and 88 women were eligible. Eight participants were excluded from the study. InterventionsEighty women of reproductive age with symptomatic myomas >4cm were evaluated in two groups. Participants in Group 1 received 2.5mg letrozole once daily and cabergoline 0.5mg/week from the first day of the menstrual cycle for 12 weeks, and participants in Group 2 received letrozole alone. Main outcome measuresChanges in uterine size and volume; myoma size, volume and number; and side effects of treatment. ResultsOverall, 76 patients completed the study. Compared with baseline values, mean uterine volume was reduced significantly in both groups (p=0.01), and there was no significant difference between groups (p=0.99). The mean number of dominant myomas was reduced significantly in both groups (p=0.03), with no significant difference between groups (p=0.6). The mean volume of myomas was reduced significantly in both groups (p=0.01), with no significant difference between groups (p=0.45). Although a significant decrease in number and volume of myomas was documented in each group (p<0.05), the intergroup analyses did not reveal significant differences between the two groups in terms of the change in number (p=0.28) and volume (p=0.96) of myomas. Headache was significantly more common in the letrozole+cabergoline group (nine vs two cases, p=0.02), but the two groups were comparable for the remaining minor side effects. ConclusionThis study showed that 12 weeks of treatment with letrozole with and without cabergoline improved the size and volume of the uterus and myomas, led to symptom improvement, and could be used for short-term treatment prior to surgery or fertility programmes. CondensationCondensation letrozole in combination with cabergoline in the management of uterine fibroids.

Three Coagulation Related Mutations and Increased Risk of Myoma in Women of Fars Province

Background: Myoma is one of the most common benign tumor in the women’s genital tract and causing some implications such as miscarriages, anemia or even infertility. Since tumorigenesis is associated with a hypercoagulant state, we investigate the role of coagulation related variations in methylene-tetra hydrofolate reductase (MTHFR) and endothelial protein C receptor (EPCR) genes in patients with uterine myoma. Methods: In this case- control study, genotyping was performed for rs867186, rs1801131 and rs1801133 by amplification-refractory mutation system- polymerase chain reaction (ARMS-PCR) method in 73 patients with myoma and 73 healthy women. Data was analyzed by logistic regression and χ2 test through software SPSS 16. Results: A statistically significant difference was observed between patients and the control group regarding the frequency of allele C in the MTHFR (A1298C) gene (P = 0.01). The frequency of the genotypes carries at least one C allele (CC + AC) is higher in patients (13.7%) compared to controls (2.7%). This means the C allele increases the risk of the disease (P = 0.01). Although the frequency of the T allele in patients was higher than controls, no significant relationship was observed between it and the risk of the disease. Our studied population was completely homogeneous for allele A at EPCR locus. Conclusions: In conclusion, results revealed a significant association between A1298T variation and myoma incidence, but more research is needed to verify the role of this mutation as a genetic marker in uterine myoma.

How to avoid risks for patients in minimal-access trials: Avoiding complications in clinical first-in-human studies by example of the ADBEE study

A clinical trial is a prospective study designed to establish the safety and efficacy of investigational devices in humans, in accordance with the strict guidelines of the Food and Drug Administration (FDA; USA) or European Medicines Agency (EMA; Europe). Before a clinical first-in-human study is initiated, preclinical studies of the investigational product are mandatory, and the results should be sufficient to indicate that the investigational device is acceptably safe for the proposed evaluation in human subjects. The present paper describes an experience of clinical trials, highlighting ways of avoiding possible complications in clinical first-in-human studies. For a better approach to our aim, we exemplified a prospective, randomized, single-blind study, ADBEE. The primary objective was to assess the safety of the ADBLOCK system when used as an adjunct to laparoscopic primary removal of myomas in women wishing to improve pregnancy outcomes.

Prevalence of uterine myomas in women in Germany: data of an epidemiological study.

Currently, no reliable data are available concerning the prevalence of uterine myomas in Germany. In this prospective study, we examined the prevalence of myomas in women older than 30years by means of vaginal ultrasound. 2296 women, who consented to the procedure, were examined by means of vaginal ultrasound for the presence of myomas in seven gynaecological outpatient departments in Germany. myomas were detected in 41.6% of all women. Age dependence: With increasing age, the prevalence of uterine myomas rose from 21.3% (30-35years) to 62.8% (46-50years). Later, the number of myomas decreased again from 56.1% (51-55years) to 29.4% in women older than 55years. Menarche/BMI: no correlation could be found between the age at first menstrual period or the body mass index and the occurrence of myomas. Parity: since the group of nulliparous women and the group of women with more than four deliveries stand out by increased occurrence of myomas, a non-linear correlation seems to exist, necessitating more in-depth discussion with regard to age dependency. The results of this study suggest that more than 40% of women over 30years of age suffered from myomas and more than 50% of all women in Germany may develop uterine myomas at some time in their life.

Outpatient transcervical microwave myolysis assisted by transabdominal ultrasonic guidance for menorrhagia caused by submucosal myomas

Purpose: The aim of this paper was to evaluate the effectiveness in day clinics of microwave endometrial ablation (MEA) on transcervical microwave myolysis for patients with menorrhagia caused by submucosal myomas. Materials and methods: Thirty-five outpatients (average age 44.8 ± 5.2 years (mean ± SD), range 34–58) with a single submucosal myoma that was 4–7 cm (5.5 ± 2.1 cm) in size underwent MEA with transcervical microwave myolysis using a specifically developed transabdominal ultrasound probe attachment for transcervical puncture. Primary outcomes were the changes in the blood haemoglobin level and the volume of myoma before and after the treatment. Secondary outcomes were the improvement in menorrhagia and satisfaction after the operation, assessed by visual analogue scale (VAS). Results: The mean operation time was 27.9 ± 13.6 min. The myomas had shrunk by 56.2% at 3 months and 73.8% at ≥6 months after the operation. Blood haemoglobin levels had increased significantly at 3 months (10.2 ± 2.0 vs. 12.7 ± 1.2, p < 0.001). The average VAS assessment of menstrual bleeding had decreased to 1.7 ± 1.7 at 3 months after the operation (preoperative VAS = 10). The average VAS score for feelings of satisfaction 3 months after the operation was 9.8 ± 0.5 (full score = 10). Conclusions: MEA with transcervical microwave myolysis is a feasible and effective procedure in a day surgery clinic for menorrhagia caused by submucosal myomas. The procedure may be an alternative to hysterectomy for menorrhagia caused by submucosal myomas in women during the perimenopausal period.

Uterine Fibroid Embolisation - Potential Impact on Fertility and Pregnancy Outcome.

The current standard therapy to treat myomas in women wishing to have children consists of minimally invasive surgical myomectomy. Uterine artery embolisation (UAE) has also been discussed as another minimally invasive treatment option to treat myomas. This review evaluates the literature of the past 10 years on fibroid embolisation and its impact on fertility and pregnancy. Potential problems associated with UAE such as radiation exposure of the ovaries, impairment of ovarian function and the impact on pregnancy and child birth are discussed in detail. Previously published reports of at least 337 pregnancies after UAE were evaluated. The review concludes that UAE to treat myomas can only be recommended in women with fertility problems due to myomas who refuse surgery or women with an unacceptably high surgical risk, because the evaluated case reports and studies show that UAE significantly increases the risk of spontaneous abortion; there is also evidence of pathologically increased levels for other obstetric outcome parameters. There are still very few prospective studies which provide sufficient evidence for a definitive statement on the impact of UAE therapy on fertility rates and pregnancy outcomes.

Polymorphisms of the GSTT1 and GSTM1 genes in women of central Serbia: Absence of association with uterine myoma

Since glutathione S-transferase (GST) enzymes are involved in cellular protection, we aimed to determine the distribution of GSTT1 and GSTM1 null genotypes in women in central Serbia in order to assess the risk of development of uterine myoma. The study consisted of 34 clinically diagnosed uterine myoma patients and 35 healthy control women. Analyses of GST polymorphism were carried out by multiplex PCR. Our results showed no significant differences in the GSTT1 and GSTM1 null genotypes between the patients and controls. Using the GSTT1 positive/GSTM1 positive combination as reference, there was no statistically significant risk of uterine myoma with the combination of GSTT1 null and GSTM1 null genotypes. We conclude that polymorphism of both GSTT1 and GSTM1 genes, alone or in combination, did not present the main risk for uterine myoma in women from central Serbia.

Complications during cesarean delivery in a patient with two previous myomectomies

Myomas are associted with numerous pregnancy-related maternal and fetal complications, including high rate of cesarean deliveries. We present a woman with huge posterior myoma who had two previous myomectomies. During the cesarean section, the anatomy was found to be grossly distorted. Thus it was necessary to make an inverted T-incision on the uterus, which facilitated delivery of the fetus. The patients postoperative recovery was uneventful. This case illustrates the difficulties that may arise during cesarean section in the presence of uterine myomas in women with previous myomectomies. Clinicians should be prepared to manage those difficulties with inverted T-incision in order to prevent fetal injuries. Such operations should be performed by an experienced obstetrician.

Alternatives endocavitaires à la myomectomie dans le traitement des fibromes symptomatiques

Endometrial ablation can be used in heavy menstrual bleeding due to symptomatic submucosal myomas in women without desire of pregnancy. Those methods used alone, lead to an improvement on bleeding but results are not as good as in women without myomas. They can be associated with hysteroscopic myomectomy and, then, the results on bleeding are better than myomectomy alone. Second generation endometrial ablation methods must be used preferentially as they present less surgical complications than first generation methods. As the pregnancies that may occur after endometrial ablation have high risk of complications, a contraceptive mean is highly recommended after surgery. Transcervical sterilisation by intratubal insert (Essure) can also be proposed, but for women with Essure placed before endometrial ablation, only Thermachoice and bipolar resection have proven their safety. Finally, economical outcomes of endometrial ablation in myomas haven't been assessed yet.

Hysteroscopic Myomectomy: An Effective and Minimally Invasive Surgical Option for Submucous Myoma

Study Objective: Hysteroscopic myomectomy is a minimally invasive technique for treatment of submucous myomas. It averts need for laparotomy, reduces morbidity and hospital stay considerably and improves conception in patients with infertility. To assess the safety and effectiveness of submucous myomectomy.Design: Retrospective study of forty patients undergoing hysteroscopic myomectomy.Setting: Tertiary care center.Patients: Forty patients with submucosal uterine myoma.Intervention: Hysteroscopic myomectomy.Measurements and Main Results: The indication for surgery were infertility in 25 (62.5%), menorrhagia in 14 (40%) and recurrent abortions in 1 (2.5%). Twenty-eight (70%) patients had single myoma and 12 (30%) had multiple myoma. Size of myoma varied from 3 x 3cm to 20 x20cm. Most (28, 70%) of the myoma were arising from fundus of the uterus, 3(7.5%) from anterior wall, 5(12.5%) from posterior wall and 4 (10%) from the side wall of the uterus. Twenty one (52.5%) myomas were confined to endometrium, 14 (35%) were infiltrating myometrium less than 50% and 5(12.5%) were infiltrating more than 50%. Four (10%) patients received preoperative uterine preparation (danazol in 2: GnRH analogues in 2). Procedure could be performed in single sitting in all except one (39, 97.5%). Laparotomy was needed in two patients (those with myoma infiltrating >50% of myometrium). None required blood transfusion. There was no perioperative or postoperative complication. All except two (95%) were discharged within 24 hrs. On follow up menorrhagia was persistent in 4 patients. One (2.5%) had recurrence of myoma. Conception rate in patient with infertility was 60% (15/25).Conclusion: Hysteroscopic myomectomy is safe and effective surgical option for submucous myoma in women presenting with abnormal uterine bleeding and infertility. Study Objective: Hysteroscopic myomectomy is a minimally invasive technique for treatment of submucous myomas. It averts need for laparotomy, reduces morbidity and hospital stay considerably and improves conception in patients with infertility. To assess the safety and effectiveness of submucous myomectomy. Design: Retrospective study of forty patients undergoing hysteroscopic myomectomy. Setting: Tertiary care center. Patients: Forty patients with submucosal uterine myoma. Intervention: Hysteroscopic myomectomy. Measurements and Main Results: The indication for surgery were infertility in 25 (62.5%), menorrhagia in 14 (40%) and recurrent abortions in 1 (2.5%). Twenty-eight (70%) patients had single myoma and 12 (30%) had multiple myoma. Size of myoma varied from 3 x 3cm to 20 x20cm. Most (28, 70%) of the myoma were arising from fundus of the uterus, 3(7.5%) from anterior wall, 5(12.5%) from posterior wall and 4 (10%) from the side wall of the uterus. Twenty one (52.5%) myomas were confined to endometrium, 14 (35%) were infiltrating myometrium less than 50% and 5(12.5%) were infiltrating more than 50%. Four (10%) patients received preoperative uterine preparation (danazol in 2: GnRH analogues in 2). Procedure could be performed in single sitting in all except one (39, 97.5%). Laparotomy was needed in two patients (those with myoma infiltrating >50% of myometrium). None required blood transfusion. There was no perioperative or postoperative complication. All except two (95%) were discharged within 24 hrs. On follow up menorrhagia was persistent in 4 patients. One (2.5%) had recurrence of myoma. Conception rate in patient with infertility was 60% (15/25). Conclusion: Hysteroscopic myomectomy is safe and effective surgical option for submucous myoma in women presenting with abnormal uterine bleeding and infertility.

Minimally Invasive Approach for Myomectomy

Uterine fibroids are the most common benign tumor of the uterus in women of reproductive age. However, most of them are asymptomatic and do not require any treatment. Menorrhagia and pelvic pain are the most usual symptoms, and some women may present with infertility or pregnancy-related complications. In those with abnormal uterine bleeding, one should exclude other causes of abnormal vaginal bleeding including endometrial cancer. Diagnosis of uterine fibroid is established by pelvic ultrasonography with or without saline infusion hysterosonography. Management options depend on the patient's fertility potential and desire for future pregnancy. Submucous myoma should be treated by a hysteroscopic approach. Intramural and subserous myomas in women who opt for nonsurgical treatment could be treated with uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), or medical treatment such as selective gonadotropin-releasing hormone agonists, progesterone receptor modulators, or aromatase inhibitors. All interventions aside from hysterectomy provide temporary relief, although myomectomy, UAE, and HIFU provides more durable symptom relief relative to current medical management. Patients wishing to preserve their fertility are best treated by myomectomy, which can be done by laparoscopy. A laparoscopic approach is more advantageous than laparotomy, but laparoscopic suturing is more demanding. This can be overcome by robotic-assisted laparoscopic myomectomy.

Assessment of the feasibility of bipolar coagulation use to reduce hemorrhage in myomectomy performed by minilaparotomy

The major problem with myomectomy is excessive bleeding from increased uterine blood supply, and this can be a life-threatening condition and prolong postoperative stay. The aim of our study was to evaluate our experience in symptomatic myoma excision with bipolar electrode by mini-laparotomy; we compared 67 procedures with bipolar electrode, in normal saline as distension fluid, to 42 cases performed with unipolar electrode. All participants were pre-menopausal women who had symptomatic myomas ≤ 10 cm and had similar demographic characteristics. According to our findings we observed a mean of 159.04 ml (SD 50.59) of blood loss during the unipolar method and a mean of 104.47 ml (SD 50.55) during the bipolar method. Postoperative complications were more frequent in the unipolar group. The group treated with bipolar coagulation was associated with less recurrence of myoma, independent of their location, and an increased postoperative pregnancy rate. In our experience the use of bipolar coagulation led to a satisfactory improvement of the surgical treatment of symptomatic myoma in women who wished to retain their uteri.