Fibroid Recurrence Research Articles

Revolutionizing diffuse uterine leiomyomatosis treatment: A case report and literature review on "no-distension" hysteroscopic myomectomy with thoracic tissue forceps.

Diffuse uterine leiomyomatosis (DUL) is a prevalent leiomyoma variant in women of childbearing age, characterized by a uniformly enlarged uterus with numerous interconnected small myomas. Given that most DUL patients are in their reproductive years, treatments that preserve fertility are increasingly vital. This case report introduces an innovative hysteroscopic technique that forgoes uterine distension to remove multiple submucosal fibroids in a single procedure, maintaining endometrial integrity and fertility. A 27-year-old single woman experienced prolonged and heavier menstruation. Magnetic resonance imaging (MRI) scans showed an enlarged uterus with several round-like masses in the uterine wall/submucosa. Addressing the patient's financial limitations and treatment preferences, a groundbreaking hysteroscopic surgery was performed using thoracic tissue forceps, alongside bedside ultrasonography, enabling fibroid excision without uterine distension. In total, 38 uterine fibroids were successfully excised without complications such as uterine perforation or hyponatremia. According to the FIGO classification system: three were type III, nine were type II, 15 were type I, and 11 were type 0. Postoperative follow-up indicated normalized menstrual cycles, improved hemoglobin levels, and no recurrence of fibroids. A hysteroscopic examination 1 month after surgery revealed no significant fibroids or endometrial thickening. This case report underscores the effectiveness of a novel hysteroscopic surgical approach in treating DUL. This method eliminates the need for multiple staged surgeries and the risks of endometrial damage inherent in traditional techniques. It offers a minimally invasive, fertility-preserving alternative for young DUL patients, marking a significant advancement in gynecologic surgery.

Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study

ObjectiveThis study aimed to introduce a novel laparoscopic haemostasis for myomectomy and investigate the independent risk factors for uterine fibroid recurrence.DesignA retrospective cohort study.SettingFollowing strengthening the reporting of observational studies...

Long-term obstetric, perinatal, and surgical complications in singleton pregnancies following previous cesarean myomectomy: a retrospective multicentric study.

The safety of cesarean myomectomy has been proven by previous studies. Our study aimed to reveal the long-term perinatal, obstetric, and surgical outcomes of cesarean myomectomy (CM) by comparing different CM techniques. This retrospective multicentric case-control study involved 7 hospitals and included 226 singleton pregnancies that underwent repeated cesarean section (CS) between 2015 and 2020. Among these pregnancies, 113 of 226 cases had CM (Group A), and 113 had only CS (Group B). Of the 113 cases in which CM was performed, 58 underwent endometrial myomectomy (EM) (Subgroup A1) and 55 underwent serosal myomectomy (SM) (Subgroup A2). The groups were compared in terms of obstetric, perinatal, and surgical outcomes, and fibroid recurrence, myomectomy scar healing rate, and adhesion formation were noted. There was no significant difference between the groups in terms of maternal age, body mass index, gravidity, parity, and fibroid diameter in previous CS (p > 0.05). In the perinatal and obstetric evaluation of the groups, there was no significant difference between the groups in terms of neonatal weight, Apgar score, fetal growth restriction, preterm premature rupture of membranes, preterm delivery, hypertension in pregnancy, and diabetes mellitus (p > 0.05). The fibroid recurrence rate was 28.3%, and the myomectomy scar good healing rate was 99.1%. There was no difference between the groups in terms of CS duration, preoperative and postoperative hemoglobin levels, perioperative blood transfusion rates, febrile morbidity, and prolonged hospitalization (p > 0.05). In terms of adhesion formation, although the adhesion rate of the SM group was higher than that of the EM group, no statistically significant difference was detected between the groups. This study showed that in pregnancies following CM, obstetrical, perinatal, and surgical outcomes were unaffected. Obstetricians can safely use CM, either the trans-endometrial or serosal technique, as it is a safe and effective method with long-term results.

Recurrence of Uterine Fibroids After Conservative Surgery or Radiological Procedures: a Narrative Review.

The present narrative review aims to discuss the available data on the incidence and the risk factors of uterine fibroids (UFs) recurrence after different types of conservative surgical or radiologic procedures in women wishing to preserve their uterus. UFs are the most common benign tumors in women all over the world. Clinical presentation, including abnormal uterine bleeding (AUB), pelvic pain, bulky symptoms, and infertility affect patients' quality of life, and a large variety of conservative treatments are available especially for those with desire of pregnancy. Fertility sparing surgery, by either laparoscopy, hysteroscopy or laparotomy, or radiological interventions (uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound), are the most common therapeutic approaches. However, the genetic or acquired predisposition to UFs remain despite the treatments, and the recurrences are frequently described in a large percentage of patients. The most relevant risk factors for recurrence of UFs are young age at the first surgery, incomplete fibroid resection, the presence of multiple lesions, an enlarged uterus, and the coexistence with other pelvic diseases. The discussion on the possible medical strategy to reduce the recurrence is an open field of clinical investigation, in particular by using hormonal drugs.

Short-Term Risk of Fibroid Recurrence After Laparoscopic Myomectomy and Its Associated Risk Factors

Background: Although laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma, there is no clear consensus regarding its rate of recurrence and associated risk factors. Objectives: This study aimed to investigate the recurrence rate of myoma and its risk factors after laparoscopic myomectomy. Methods: In a historical cohort study, 172 patients who underwent laparoscopic myomectomy and had a minimum follow-up of 2 years were included. Myoma recurrence was checked semiannually by ultrasound imaging. The demographic, clinical, surgical, sonographic, and laboratory indices of the patients were compared between the recurrent and nonrecurrent groups, both in logistic regression models. Results: The mean age of the patients was 35 ± 5.7 years (range: 18 - 47 years). Their mean follow-up time was 26.3 ± 4.2 months (range: 24 - 28). The lesion recurred in 25 (14.5%) out of 172 patients. In the univariate analysis, higher age (OR:1.111, P = 0.015), higher body mass index (OR: 1.124, P = 0.024), gonadotropin-releasing hormone (GnRH) therapy (OR = 3.83, P = 0.027), and more than 1 myoma (OR: 2.60, P = 0.032) were associated with myoma recurrence. In the multiple analysis, a higher body mass index (OR: 1.222, P = 0.003) was a significant risk factor for myoma recurrence. Conclusions: Laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma and can be used as a uterus-preserving surgical alternative in patients of reproductive age. A more radical surgical procedure might be used for patients with multiple risk factors, as revealed in the present study.

Infertility in patients with uterine fibroids: a debate about the hypothetical mechanisms.

Fibroids are benign tumours of the myometrium and are the most common gynaecologic abnormality. Although most fibroids are asymptomatic, they can cause symptoms like heavy menstrual bleeding, pelvic pain, sexual dysfunction, pressure complaints, and infertility. The association between fibroids and infertility has been debated for decades. It is generally acknowledged that the closer the fibroid is to the uterine cavity and the endometrium lining, the more unfavourable effect it might have on fertility, reducing the odds for successful implantation and gestation. Based on the limited available literature, we propose and discuss seven hypotheses on the underlying mechanism by which fibroids may reduce fertility. (i) Fibroids can cause sexual dysfunction, as fibroids can cause dyspareunia, pelvic pain, and prolonged and heavy menstrual bleeding, which could interfere with sexual arousal and as a consequence the frequency of intercourse, resulting in a reduced probability of conception. (ii) Mechanical compression by fibroids on theinterstitial part of the fallopian tubes or deformation of uterine cavity could disturb oocyte and sperm transport. (iii) Fibroids can disturb peristalsis of the junctional zone in the myometrium, which could negatively influence oocyte and sperm transport as well as implantation. In addition, fibroids could induce a detrimental environment for implantation in other ways, by: (iv) changing the vagino-uterine microbiome; (v) disturbing the levels of inflammation and autophagy; (vi) inducing molecular changes in the endometrium; and (vii) inducing aberrant angiogenesis and altering the endometrial blood supply. After the discussion of these hypotheses, the implication of the influence of fibroids on early pregnancy loss is discussed. Surgical fibroid treatment is not tailored nor focussed on the pathophysiology of the fibroid; consequently it may be accompanied by recurrence of fibroids and risks of complications. Unravelling the pathogenic mechanisms about how fibroids influence fertility is essential to evolve classic surgical fibroid treatment. Instead of treatment of fibroid-related symptoms, the research should supports development of fibroid-targeted (pharmaceutical) treatment that is compatible with an active wish to become pregnant.

Comparison of Recurrence and Quality of Life Between Myoma Embolization and Myomectomy.

Uterine myomas represent the most frequently diagnosed tumors amongwomen of childbearing age. Symptoms often include profuse menstrual bleeding, diminished quality of life, and in some cases, infertility. The size and position of the fibroids typically influencethe condition's manifestations. Moreover, symptomatology often varies depending on the fibroids' location. This investigation aimed to discern if there exists a significant correlation between life quality, reoccurrence rate, quality of life, and recurrence levels among patients who have undergone myomectomy and uterine fibroid embolization, respectively. A retrospective cross-sectional study was conducted to compare the rates of recurrence and impacts on life quality between uterine fibroid embolization and myomectomy in women diagnosed with uterine myomas. Data were collected from 152 women who sought treatment at the Obstetrics and Gynecology clinic and also theInterventional Radiology clinicbetween January 2009 and January 2021. Thirteen participants were excluded due to the inability to maintain contact. The trial encompassed 76 patients who underwent myomectomy and 63 who had uterine fibroid embolization. In both groups, the life quality of 50 patients, five years postsurgery, was assessed using the UFS-QOL measure. Eligible participants were females between 20 and 40 years, with symptomatic Type 3-5 fibroids as per the FIGO classification, and with no comorbidities. Individuals under 20 or over 40 years, or those with fibroids classified as FIGO types 1,2,6,7,8, were not included. Other exclusion criteria included pregnancy status, abnormal endometrial biopsy results, abnormal smear tests, polyps, cancer, adenomyosis and coagulation disorders. The recurrence of fibroids was identified through symptomatology and diagnostic radiological methods. The recurrence rate was found to be 31.6% (n=24) for myomectomy patients and 14.3% (n=9) for those who underwent uterine fibroid embolization, with no statistically significant difference between the two groups (p > 0.05). The group subjected to myomectomy exhibited fewer symptoms, lower anxiety, and better physical mood scores. The myomectomy group displayed higher average anxiety scores (p<0.01). There were no significant disparities in control, consciousness, sexual function, or overall scores between the two groups. Symptoms and anxiety saw a marked reduction in the first postoperative year compared to the preoperative period (p<0.01). Compared to presurgery, energy, mood, awareness, and sexual function exhibited significant improvements in the first and fifth postoperative years (p<0.01). Our findings suggest a nonsignificant recurrence rate in the myomectomy group compared to the uterine artery embolization group. Notably, the decrease in symptom occurrence and anxiety following myomectomy was significantly favorable in terms of quality of life. While embolization was offered as a therapeutic option, myomectomy yielded more favorable results concerning quality of life.

Патоморфологические маркеры рецидивирующей лейомиомы матки в репродуктивном возрасте

Aim. To determine the pathomorphological markers and clinical factors of recurrent uterine fibroids in reproductive age. Design. Prospective, non-randomized, longitudinal study. Materials and methods. The study included 75 patients, of whom 52 had uterine fibroids without recurrence (group I), 23 with relapse (group II). Indications for surgical treatment were: prolonged, heavy menstruation leading to anemia, pain syndrome, recurrent abnormal uterine bleeding, compression syndrome of adjacent organs. The study included patients with myomatous nodes of types 0–7 according to the FIGO (International Federation of Gynaecology and Obstetrics) classification. Results. During morphological examination, leiomyoma was macroscopically presented as a dense nodular formation with an uneven surface, whitish in color, and fibrous in appearance when cut. When comparing the size of the uterus (weeks of conditional pregnancy) in the comparison groups, it was revealed that in group I Me (Q1–Q2) was 13.00 (10.0–15.0), in group II - 13.0 (11.0–15.0) without statistically significant differences (p = 0.58). At the same time, in patients of group II with uterine sizes up to 10 weeks. – recurrence of uterine fibroids occurs in every fifth (21.7%), from 10 to 15 weeks. almost every second (60.9%) and more than 15 weeks. – every sixth (17.4%) (see diagram 1). As for the number of myomatous nodes, in group II, multiple uterine fibroids were detected in every second patient (60.9%). When comparing the growth rate of myomatous nodes in half (43.5%) of the examined women with relapse, their growth rate ranged from 6 months to 1 year, in every third (39.1%) — more than 1 year. Conclusion. According to our data, patients with recurrent uterine myoma have a number of clinical features compared to those with simple uterine myoma — younger age and duration of the disease. Recurrent uterine fibroids are characterized by rapid growth of myomatous nodes, large size and growth rate of nodes. Thus, understanding all of the mechanisms underlying leiomyoma through the integration of differential cellular/molecular characteristics may contribute to the discovery of tumor-specific biomarkers as well as the development of targeted therapeutic approaches that specifically target the affected pathways. Key words: uterine leyomioma, pathomorphology of uterine leyomioma, growth zones of leiomyoma.

LBMON236 Investigating The Effect Of Social Vulnerability Index On Fibroid Recurrence And Metabolic Dysfunction

Abstract Fibroids and metabolic dysfunction disproportionately affect women of color. We have previously shown that recurrent fibroids and metabolic dysfunction lead to increased healthcare utilization. The impact of socioeconomic factors on access to care for these women is poorly understood. Our objective was to evaluate the social vulnerability indices of women with fibroids with and without metabolic dysfunction, and determine the association of social vulnerability with fibroid recurrence. We conducted a retrospective cohort study of 918 geocoded patients who underwent myomectomy at a tertiary health care system. The primary exposure was the Social Vulnerability Index (SVI), a measure of socioeconomic disadvantage developed by the CDC with four thematic subgroups (socioeconomic status, household composition, Race/Ethnicity/Language, and Housing/Transportation). The primary outcome was clinically significant fibroid recurrence after initial myomectomy, defined as symptomatic fibroids requiring re-imaging or surgery. SVI was analyzed as an overall score and by quartiles. Models were adjusted for age, race, and insurance status, with metabolic dysfunction analyzed separately as a covariate. Patients were classified as having metabolic dysfunction (MD) if they met any 2 of 5 WHO or NCEP ATP III criteria for metabolic syndrome with BMI as proxy for waist circumference. Appropriate parametric and non-parametric tests and logistic regression were used to determine the association of SVI with fibroid recurrence. The mean SVI score for the cohort was 0.58 (SD 0.31). Mean SVI scores for patients with and without clinically significant fibroid recurrence were similar at 0.56 (SD 0.30) and 0.57 (SD 0.30), respectively. There remained no association between mean SVI score and odds of fibroid recurrence in adjusted models (OR 0.35, CI 0.10-1.24, p 0.11). Notably, there was a decreased rate of radiologic fibroid recurrence in the highest quartile of SVI (p=0. 011) and an increased rate in the third quartile (p=0. 015). When isolating the individual themes of the SVI index, there was a significant decrease in surgical and radiologic fibroid recurrence in individuals with the highest quartile of minority and language vulnerability (p=0. 03). The odds of metabolic dysfunction increased by 2.9 with each unit increase in SVI (OR 2.85, CI 1.34-6. 07, p 0. 006) after adjusting for age, race, and insurance status. We report that while patients with a higher SVI have increased risk of metabolic dysfunction, this does not translate to higher rates of clinical significant fibroid recurrence. Higher SVI is associated with lower resourced settings and reduced access to care and can therefore be used as a starting point for public health policy. SVI should be considered when studying fibroids, and may illuminate potential barriers in access to care for fibroid recurrence in patients with a history of myomectomy. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

8636 Metabolic Profiling of the Endometrium in Patients with Recurrent Uterine Myoma.

<h3>Study Objective</h3> Identification of biomarkers for recurrent uterine fibroids based on metabolomic analysis of the endometrium. <h3>Design</h3> Level II Canadian Task Force. <h3>Setting</h3> Operative Gynecology Department, National Medical Institute of Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Moscow, Russia. <h3>Patients or Participants</h3> 35 patients with newly diagnosed uterine fibroids (UF) and 31 patients diagnosed with recurrent uterine fibroids (RUF) underwent laparoscopic myomectomy. 15 patients in the comparison group (CG)underwent intrauterine septum resection. <h3>Interventions</h3> Endometrial biopsy was performed in the 1st phase of the menstrual cycle during the surgery. Histopathological examination and lipidomic analyses of the specimens took place. Qualitative and quantitative assessment of lipidoma was performed using electrospray mass spectrometry. <h3>Measurements and Main Results</h3> Statistically significant differences in lipidomic status of the compared clinical groups were revealed. The lowest level of lipids of the following classes was noted in patients with RUF: ceramides, sphingomyelins, phosphatidylserines (exceptions - PS 34:0, PS 36:0, PS 42:5, PS 46:1), significant phosphatidylethanolamines (exceptions - PE 44:2, PE 38:3, PE 42:6, PE 44:6, PE O-38:3, PE O-38:4), phosphatidylcholines (exceptions - PC 38:5, PC 36:4, PC O-38:1, PC O-38:0, PC O-38:2, PC 38:2, PC 40:0), phosphatidylglycerols with a total chain length of less than 40 carbon atoms. The highest level of lipids of the following classes was noted in RUF when comparing with lipidomic data of patients with UF and CG: lysophosphatidylcholines, phosphatidylglycerols with a total chain length of more than 40 carbon atoms. <h3>Conclusion</h3> Analysis of the lipid composition of the endometrium revealed ceramides, sphingomyelins, phosphatidylserines, phosphatidylethanolamines, phosphatidylcholines, the levels of which differ significantly in endometrial tissues of patients with RUF as compared with patients in uterine fibroids and comparison groups. This data opens new possibilities for lipidomic-based analysis of the endometrium for prediction of recurrence of uterine fibroids.

A Case Report on Pulmonary Benign Metastasizing Leiomyoma with Recurrent Uterine Fibroids

Pulmonary benign metastasizing leiomyoma (PBML) is a type of benign metastasizing leiomyoma (BML), which metastasizes to lungs. In view of the rarity and nonspecific imaging characteristics of PBML, this condition is easily misdiagnosed as malignant lung cancer. This is a case report of a 39-year-old lady in whom multiple bilateral lung nodules were found during a health checkup and was diagnosed with PBML. The patient had recurrent uterine fibroids and underwent myomectomy twice, 7 years and 3 years ago, respectively, before the diagnosis of PBML was made. This patient was asymptomatic, and regular examinations were normal. Her laboratory investigations were all within normal range. Computed tomography (CT) showed multiple nodules in bilateral lungs. In order to confirm the disease, thoracoscopic nodule resection and tissue biopsy were performed. Hematoxylin eosin (HE) staining showed spindle-shaped cells, while immunohistochemical staining revealed positive for desmin, smooth muscle actin (SMA), estrogen receptor (ER), and progesterone receptor (PR), which are all PBML markers. The patient was followed-up without any further treatment. After 8 months of follow-up, CT scan revealed an increased number of nodules. This is unique case because of the recurrence of uterine fibroids, which means that the patient is susceptible to it. Our report may give a new insight to the relationship between the susceptibility of uterine fibroids and the onset and progression of PBML.

Uterine fibroids: a look at the problem

Despite scientific progress, there is currently no sigle opinion about the cause of the occurrence and recurrence of uterine fibroids, but due to the high level of molecular medicine, progress is being made in the hormonal and molecular genetic mechanisms of initiation, formation and growth of the fibroisds. The issue of pathogenetic treatment and prevention of recurrence of uterine fibroids in reproductive age remains relevant. The aims of the review. The aim of this review is to summarize current data about microRNA in biology of uterine leiomyoma (LM). This information can improve our understanding of the broad molecular interaction of signaling pathways in the formation of LM, and further maintaining epigenetic regulation as an important mechanism in the pathogenesis of uterine leiomyoma. In leiomyomas, the expression of a number of non-proteincoding genes is altered, such as microRNAs (miRNAs), which target genes that code protein. Material and research methods. Original and review articles, book chapters in the PubMed database related to the study of the pathogenesis of uterine fibroids in the period from 2004 to 2022 were found and analyzed. Results and discussions. Based on an analytical review of the literature, it becomes obvious that as evidence should be considered: 1. Abnormal myometrial and fibroid stem cells show an increased response to estrogen and progesterone exposure, stimulating processes such as cell proliferation, inhibition of apoptosis, and extracellular matrix (ECM) formation. 2. A number of tumor suppressor genes are abnormally hypermethylated in the LM when compared to normal myometrium, genes that form and regulate collagen, and a subset of estrogen receptor genes. 3. Multiple studies using microarray analysis or sequencing have demonstrated the existence of dysregulation of a number of protein-coding genes involved in cell proliferation and apoptosis, which are critical for the growth and progression of uterine fibroids. There are no reliable evidence base and do not provide an opportunity for practical application of clinically significant risk factors, the possibility of mathematical prediction of the growth of uterine fibroids in women of reproductive age. Data on the effect of the expression of a number of microRNAs on the growth of uterine fibroids in vivo are rather contradictory. The epigenetic processes of regulation and pathogenesis of the growth of leiofibromyomas in reproductive age have not been fully studied and substantiated. There are practically no data on predicting the growth of uterine fibroids in reproductive age, which will allow us to assess the risk of growth and determine further treatment tactics. Conclusion. Further work on the identification of specific genes, miRNAs, that are involved in the pathogenesis of LM may inspire the creation of new pathogenetic treatments. Such treatment is especially relevant for those groups of patients of reproductive age for whom surgical treatment may be ineffective. Targeted treatment can also prevent the recurrence of uterine fibroids, hence the need for repeat surgery.

The effect of vitamin D on recurrence of uterine fibroids: A randomized, double-blind, placebo-controlled pilot study

Backgroundand purpose: A deficiency of vitamin D has been suggested as one of the principal risk factors for uterine fibroids (UFs). We aimed to investigate the effect of vitamin D supplementation on the recurrence of UFs. Materials and methodsIn a randomized, double-blind, placebo-controlled pilot study, women who had undergone hysteroscopic myomectomy from November 2017 to June 2020 were randomly given either vitamin D (1000 IU tablet; n = 55), or placebo (n = 54) daily for 12 months. Both groups were followed and compared in regard of the primary outcomes of the study, which were recurrence rates, size, and numbers of UFs based on three-dimensional transvaginal ultrasound investigation (3D-TVS). Data analysis was performed by the intention-to-treat (ITT) approach. ResultsThe mean age of the study participants was 37.9 ± 6.5 years. The two groups did not differ significantly in terms of demographic and pre-intervention clinical characteristics. The administration of vitamin D supplements for one year reduced recurrence rates of UFs by 50% (p = 0.17). Vitamin D also reduced the size of recurrent UFs in the intervention group compared to controls (−7.7 mm), the difference was statistically different (p < 0.001). No adverse effect of vitamin D was reported in the present study. ConclusionBased on these results, vitamin D appears to be a promising and safe agent in the prevention of recurrence and reduction of the size of recurrent UFs, although further well-designed and appropriately powered studies are required to demonstrate a significant difference in the size and number of recurrent UFs.

The association between chronic endometritis and uterine fibroids.

Background:Some studies reported the association between fibroids with uterine inflammation. By considering this hypothesis, the formation and recurrence of uterine fibroids can be prevented by diagnosis and treatment of inflammation, and complications and costs can be reduced. This study aimed to evaluate the association between chronic endometritis and uterine fibroids in non-menopausal women.Materials and Methods:This prospective case-control study was performed on non-menopausal women referred to Al-Zahra Hospital in Rasht during April 2019-April 2020. Non- menopausal women of reproductive age (20-55 years old) with abnormal uterine bleeding who were candidates for hysteroscopy based on medical history and ultrasound reports were included in this study. The case group with fibroids were divided into two groups of intramural and subserosal myoma group and submucosal group based on the location of fibroids. The control group was patients with abnormal uterine bleeding complaints and no uterine fibroid. Endometrial specimens were examined by a pathologist for histological and immunochemistry assessments. In interpreting the results of endometrial biopsy, a positive result was indicated by the presence of one or more plasma cells per 10 high power field. Data were gathered by a form including age, parity, history of recurrent miscarriage, patient’s complaint (abnormal uterine bleeding), hysteroscopic results (submucosal myoma-polyp-normal), uterine histology (polyp, endometritis, and hyperplasia) and prevalence of chronic endometritis based on plasma cell in the biopsy. Data were analyzed by SPSS software version 21. Data were reported by descriptive statistics including number, percent, mean and standard deviation. The normality of quantitative data was assessed by the Kolmogorov- Smirnov test. Mann-Whitney U test, Chi-square and Fisher exact tests were used to compare groups and logistic regression was used to control the effect of confounders.Results:The incidence of chronic endometritis was 39% (38 out of 97) and a higher incidence of chronic endometritis was noted in the case group than the control group (46% vs. 31%), No significant difference was observed between the two groups (P > 0.05). However, the incidence of chronic endometritis in women with submucosal myoma was higher than the intramural and subserosal groups (64% vs. 37%) (P = 0.04). To control the effect of age on the rate of chronic endometritis in both groups, no significant effect was observed in logistic regression.Conclusions:The results showed the overall incidence of chronic endometritis was higher than previous studies and also the incidence was higher and more significant in women with submucosal myoma than in the intramural and subserosal group. As in this study, authors assessed the association between chronic endometritis and uterine fibroids, further studies assessing the cause and effect relationships are recommended.

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&lt;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.

Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus.

BackgroundThe population of women undergoing abdominal myomectomy for symptomatic large fibroid uterus is unique. We seek to characterize the timing, risk factors as well as the presenting symptoms which led patients to undergo repeat surgery in this patient population.Methods and findingsWe followed 592 patients who underwent an abdominal myomectomy from March 1998 to June 2010 at St. Vincent’s Catholic Medical Center and presented later during the study period with a recurrence of symptoms attributable to a reemergence of fibroids and who chose to undergo repeat surgical management. Twelve percent of patients exhibited symptoms of fibroid uterus which led to reoperation within the study period. The mean age at repeat surgery was 44.1 ± 0.6 years old (n = 69) and the mean time between operations was 7.9 ± 0.3 years. Presentation was variable but included bleeding, pain and infertility. Patients presented for surgery with a significantly smaller sized uterus than at their initial surgery. Timing between surgeries correlated with age at initial surgery and uterine size but race, number of fibroids, aggregate weight of fibroids removed, operative time or blood loss at the initial surgery did not correlate. Data is suggestive that intraperitoneal triamcinolone may reduce reoperation rates but not timing of recurrence.ConclusionThese results may help in counseling patients, particularly younger women, on the risks of fibroid recurrence necessitating repeat surgery. Further research is necessary to assess if triamcinolone can alter fibroid reurrence in patients who undergo uterus sparing procedures.

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 %).

A predictive model for calculating the likelihood of recurrent uterine fibroids after surgical intervention

Aim. To develop a predictive model for calculating the likelihood of recurrent uterine fibroids after myomectomy.Materials and Methods. We consecutively recruited 149 women aged 19 to 45 years who underwent myomectomy. Prediction of uterine fibroids was carried out using multivariate analysis including a classification tree (IBM SPSS Statistics). To construct a classification tree for predicting recurrent uterine fibroids, the following patient-related parameters were used as the input features: age, family history, nulliparity, past medical history of myomectomy, obesity, rapid fibroid growth, multiple fibroids at myomectomy, BCL-2, Ki-67, and VEGF expression.Results. When analyzing the resulting classification tree, we can conclude that the most significant factors defining the recurrence of uterine fibroids are low parity, multiple fibroids at myomectomy, intensive VEGF expression, and weak expression of BCL-2.Conclusion. Our original model allows the identification of the most significant predictors of recurrent uterine fibroids and might be proposed as a useful tool for clinical practice.

METABOLIC DYSFUNCTION AS A PREDICTOR OF FIBROID RECURRENCE

A growing body of research suggests a relationship between metabolic syndrome and fibroid prevalence. The role of metabolic dysfunction on fibroid recurrence is less clear. The objective of this study was to investigate the association between metabolic dysfunction and fibroid recurrence risk after index myomectomy, with a secondary aim of assessing the impact of metabolic dysfunction on healthcare utilization after surgical fibroid management in a large urban healthcare system over 10 years.

EPIGALLOCATECHIN GALLATE (EGCG) FOR TREATMENT OF UNEXPLAINED INFERTILITY ASSOCIATED WITH UTERINE FIBROIDS (PRE-FRIEND TRIAL): EARLY SAFETY ASSESSMENT

Uterine fibroids are the most common pathology associated with unexplained infertility in reproductive aged women worldwide. Compared with women without fibroids, women with intramural and submucosal fibroids have a decreased likelihood of pregnancy. Surgical removal of fibroids is commonly offered, but are associated with postoperative adhesions and fibroid recurrence, so the net fertility gain is often compromised. Thus, there is a crucial need for innovative, non-hormonal and non-surgical fertility treatment options for women with fibroids and infertility.