Surgical Treatment Of Uterine Fibroids Research Articles

Racial Disparities in Surgical Treatment of Uterine Fibroids During the COVID-19 Pandemic

Racial Disparities in Surgical Treatment of Uterine Fibroids During the COVID-19 Pandemic

Psychosocial Stress and MicroRNA Expression Profiles in Myometrial Tissue of Women Undergoing Surgical Treatment for Uterine Fibroids.

Uterine leiomyomas (fibroids) are the most common non-cancerous tumors affecting women. Psychosocial stress is associated with fibroid risk and severity. The relationship between psychosocial stress and fibroid pathogenesis may involve alterations in microRNAs (miRNAs) although this has yet to be examined. We investigated associations between two psychosocial stress measures, a composite measure of recent stressful life events and perceived social status, with expression levels of 401 miRNAs in myometrium (n = 20) and fibroids (n = 44; 20 with paired fibroid and myometrium samples) among pre-menopausal women who underwent surgery for fibroid treatment. We used linear regressions to identify psychosocial stressors associated with miRNAs, adjusting for covariates (age, body mass index, race/ethnicity, and oral contraceptive use). The association between psychosocial stressors and miRNAs was considered statistically significant at an FDR p < 0.10 and showed a monotonic response (nominal p-trend < 0.05). In the myometrium, 21 miRNAs were significantly associated with a composite measure of recent stressful events, and two miRNAs were associated with perceived social status. No fibroid miRNAs were associated with either stress measure. Pathway analyses revealed miRNA-mRNA targets were significantly enriched (FDR p < 0.05) in pathways relevant to cancer/tumor development. Of the 74 differentially expressed miRNAs between myometrium and fibroids, miR-27a-5p and miR-301b were also associated with stress exposure. Our pilot analysis suggests that psychosocial stress is associated with myometrial miRNA expression and, thus, may have a role in the pathogenesis of fibroids from healthy myometrium.

Multi-Port Robotic-Assisted Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis of Comparative Clinical and Fertility Outcomes.

Uterine fibroids are the most frequently diagnosed gynaecological tumours, and they often require surgical treatment (conventional laparoscopic myomectomy-CLM). The introduction and evolution of robotic-assisted laparoscopic myomectomy (RALM) in the early 2000s has expanded the range of minimally invasive options for the majority of cases. This study aims to compare RALM with CLM and abdominal myomectomy (AM). Fifty-three eligible studies adhered to the pre-established inclusion criteria and were subsequently evaluated for risk of bias and statistical heterogeneity. The available comparative studies were compared using surgical outcomes, namely blood loss, complication rate, transfusion rate, operation duration, conversion to laparotomy, and length of hospitalisation. RALM was significantly superior to AM in all assessed parameters other than operation duration. RALM and CLM performed similarly in most parameters; however, RALM was associated with reduced intra-operative bleeding in patients with small fibroids and had lower rates of conversion to laparotomy, proving RALM as a safer overall approach. The robotic approach for surgical treatment of uterine fibroids is a safe, effective, and viable approach, which is constantly being improved and may soon acquire widespread adoption and prove to be superior to CLM in certain patient subgroups.

Myomectomy: surgical tactics, reproductive outcomes

The article highlights modern approaches to the surgical treatment of uterine fibroids in patients of reproductive age, depending on the size and type of localization of the node in the uterus in accordance with the FIGO classification. It has been established that submucosal uterine fibroids of types 0, 1, 2 are subject to hysteroscopic removal, since their effect on the onset, prolongation of pregnancy and reproductive outcomes has been proven. Intramural uterine leiomyomas are subject to removal if the node size is more than 5 cm or other unidentified causes of infertility in patients with reproductive plans. Subserous uterine leiomyomas do not affect fertility and do not require removal.

Determination of factors influencing the length of stay in a gynecological hospital among patients with uterine fibroids and ovarian cysts

Annotation. A combined (retrospective + prospective) study was conducted, involving 150 patients from gynecological departments of three different hospitals in the city who were hospitalized due to the need for surgical treatment of uterine fibroids and/or ovarian cysts. The purpose of this part of the study was to conduct a descriptive analysis of the data collected during the study and to determine the correlations between the factors that affect the length of stay of patients in gynecological departments. Statistical, epidemiological, and sociological methods of analysis were used in the study. The data obtained during the study made it possible to determine the factors affecting the length of stay in the hospital of patients with uterine fibroids and ovarian cysts, which included: the patient's diagnosis (r = 0.13166842); the presence of complications of the main diagnosis (r = 0.240506326); the presence of complications due to the surgical intervention (r = 0.266602573); the presence of concomitant pathology in female patients (r = 0.021249784); type of surgical intervention (r = 0.266390698); volume of surgical intervention (r = 0.1424499). The given results can be useful for more optimal use of the bed fund of inpatient gynecological departments.

Conservative surgical treatment of uterine fibroids in women of childbearing age

Uterine fibroids are benign gynecologic tumors, and women aged between 30 to 50 years are known to have a high incidence of uterine fibroids. A growing number of pharmacotherapies and minimally invasive organ-preserving treatments have been designed and conducted over the past few years. However, there has not been any therapeutic drugs exhibiting an ideal therapeutic effect and low recurrence rate, such that the surgical treatment continues to be primarily employed in the actual clinical treatment. In general, surgical treatment has been performed as the organ- and fertility-preserving hysteroscopic or laparoscopic resections of the fibroids. Minimally invasive surgical equipment (e.g., hysteroscopy, traditional porous laparoscopy, trans-umbilical laparoscopy, transvaginal laparoscopy, as well as robot-assisted laparoscopy) has been extensively applied to clinical treatment. Compared with traditional laparotomy, minimally invasive surgical equipment is characterized by minimally invasive surgery, high efficiency and safety. As medical technology has been leaping forward, interventional therapy and radiofrequency ablation can also be employed for treating uterine fibroids. In accordance with the research progress worldwide, the current situation, limitations, and advantages of the treatment of uterine fibroids in patients with fertility requirements are reviewed in this study.

Surgical Management of Huge Uterine Fibroids in a Northern Nigerian Teaching Hospital

Background: Uterine fibroids are the most common tumor of the uterus worldwide, especially in blacks. While surgery remains the goal standard for definitive treatment, huge uterine fibroids pose a peculiar surgical challenge, with a possibly higher risk of complications such as hemorrhage and deep surgical site infection. Methods: A 5-year retrospective review of patients' folders who had surgical treatment for huge uterine fibroids from January 2015 to December 2019 was done. Huge uterine fibroids were defined as uterine size of ≥16 weeks. The patients' sociodemographic profiles, surgical procedure performed, early and delayed post-operative complications were all documented on a structured proforma. Data was analyzed using SPSS version 21. Results: A total of 245 patients had surgical treatments for uterine fibroids. However, 152 case notes were retrieved, of which 135 had huge uterine fibroids. The mean age of the patients was 37.85 ± 7.05 years. Abdominal myomectomy was performed in 108 (80%) of patients, while others had abdominal hysterectomy. Early post-operative complications included 10 (7.2%) with surgical site infection (SSI), 4 (3%) with febrile morbidity, and 3 (2.2%) requiring blood transfusion. Late complications included 6 (4.4%) with delayed SSI, 5 (3.7%) with uterine synechiae, and 2 (1.5%) with endometritis. There was no peri-operative mortality. Uterine sizes, and type of surgery performed showed no differences in complication rates. Nulliparity, and age &lt;40 years showed higher odds of having myomectomy. Conclusion: The most common surgical treatment for huge uterine fibroids is abdominal myomectomy. Surgical treatment is generally safe with low morbidity.

Effect of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of genitourinary syndrome and ways of its reduction

The article presents the assessment and analysis of the most important predictors and manifestations of genitourinary disorders in women of reproductive age after radical surgical treatment for uterine fibroids in the remote postoperative period. Ways of reducing the severity of symptoms are offered.&#x0D; The aim of the study – to establish the influence of hysterectomy with opportunistic salpingectomy for uterine fibroids on manifestation and progression of genitourinary syndrome and ways of the reduction in its severity.&#x0D; Materials and methods. Comprehensive clinical and laboratory assessment of the impact of hysterectomy with opportunistic salpingectomy for uterine fibroids on the development of metabolic syndrome was conducted at the gynecological department of the “Kyiv Perinatal Center”. The study included 160 women: 90 patients underwent vaginal classical and laporoscopic hysterectomy including fallopian tubes removal; and 70 patients underwent abdominal hysterectomy including fallopian tubes removal. Data on the assessment of pelvic floor condition and urogenital dysfunction were provided using a standardized POP-Q system, both at the stage of preoperative observation and for 1, 3 and 5 years after the surgery.&#x0D; Research results and their discussion. The most important risk factors that allow forming groups of patients requiring individualized approach in the choice of surgical techniques and rehabilitation program were pointed out. The obtained results allowed to isolate UCDT markers in fractions above 20%. 19 women (11.86%) underwent ovarian surgeries and used gonadotropin-releasing hormone agonists. Genitourinary and sexual disorders were diagnosed in 27 cases (19.3%) 12 months after surgery. Vaginoscopy, performed 12 months after surgery, revealed atrophic vaginitis in 58 cases (36.25%) without significant difference in groups. Microscopy of urogenital smears was in norm only in 51 patients (31.86%). Complaints of dysuria were most common among patients (59 – 36.85%). The combination of sexual disorders and other manifestations (flatulence and intestinal discomfort, stool problems, vaginal microbiota disorders, pelvic floor descent, etc.) was revealed in a quarter of women (28 – 17.50%), and more often – after vaginal hysterectomy (17 – 18.89%). Clinical symptoms of urinary incontinence were observed against the background of a negative cough test in almost a third of patients (49 – 30.63%). They were combined with pollakiuria, nocturia, and imperative urgency, exacerbated by alcohol and accompanied by cystalgia and genital prolapse. The use of low doses of estradiol in the rehabilitation program improved the clinical and laboratory parameters of the urogenital tract, reducing the incidence of vulvovaginal atrophy by 13%, normalizing the biocenosis and vaginal pH, reducing clinical manifestations of urinary incontinence (pollakiuria and nocturnal pollakiuria) by 14%, feeling of incomplete bladder emptying – by 15%, stress urinary incontinence – by 16%, vaginal prolapse – by 11%, compared to the group with standard postoperative management, as well as reducing the severity of psycho-emotional and vegetative-vascular manifestations.&#x0D; Conclusion. The expected effect of surgical recovery may be insufficient, and clinical symptoms of genitourinary syndrome may manifest in the postoperative period, which requires the development of clear algorithms for diagnosing urinary incontinence and pelvic floor failure in the preoperative stage and application of long-term preventive measures after hysterectomy in the remote postoperative period. There is no statistically significant difference in the development of genitourinary syndrome with different surgical approaches.

Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective

BackgroundAs a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective.MethodsAn economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness.ResultsMean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03–264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35–4.71) for major surgical complications; 6.75% (95%CI: 6.45–7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23–1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76–5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81–3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97–210.95) per week saved to return to normal activities.ConclusionsTLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.

Current Methods of Tissue Extraction in Minimally Invasive Surgical Treatment of Uterine Fibroids.

Background and Objectives:Since the 2014 Food and Drug Administration communication regarding the use of power morcellation, gynecologists have adopted alternative tissue extraction strategies. The objective of this study is to investigate the current techniques used by gynecologic surgeons for tissue extraction following minimally invasive hysterectomy or myomectomy for fibroids.Methods:An online survey was distributed to all AAGL members and responses were collected between March 26, 2019 and April 17, 2019.Results:Four hundred thirty-six respondents completed the survey. For hysterectomy, the most common methods of tissue extraction were manual morcellation through the colpotomy (72.4%) or minilaparotomy (66.9%). Nearly one-third (31.7%) endorsed using power morcellation. For myomectomy, manual morcellation via minilaparotomy (71.9%) was the most common approach, followed by power morcellation (35.7%). Use of containment bags was common. Minilaparotomy incisions were typically three cm and most often at the umbilicus.Geographic differences were detected, particularly with power morcellation. During hysterectomy, 18.4% of US-based surgeons reported its use, compared to 56.9% of nonUS-based surgeons. During myomectomy, 20.5% of US-based surgeons reported its use compared to 67.5% of their international counterparts. Age, years in practice, fellowship training, and practice location were all significantly associated with power morcellator use.Conclusion:A large majority of practitioners are performing manual morcellation through the colpotomy or minilaparotomy. Use of containment bags is common with all routes of tissue removal. Power morcellation use is less common in the United States than in other countries.

Опыт ведения беременности высокой степени риска у больной миомой матки с эмболизацией маточных артерий в анамнезе

The increase in the frequency of uterine fibroids among women planning pregnancy is an actual problem. This pathology is the most common benign tumor of the female reproductive system, leading to complications during pregnancy and childbirth. One of the methods of surgical treatment of uterine fibroids in a significant number of patients is myomectomy. Patients with a history of uterine fibroids and myomectomy require close observation and a balanced choice of delivery tactics. This article describes a clinical case of high-grade management of a patient with uterine fibroids after embolization of the uterine nodes and subsequent surgical removal of the subserous node of uterine fibroids.

The Estimation Of The Quantity And Quality Of Oocytes And Embryos In The IVF Protocols In Women With Uterine Fibroids With And Without Surgical Treatment

Myoma periodically leads to infertility by causing impaired blood flow, aseptic inflammation in the endometrium, increased uterine contractility, impaired sperm migration with cerviсal myoma nodes and obstruction of the proximal fallopian tubes. Objective — The estimation of the quantity and quality of oocytes and embryos in the IVF (in vitro fertilization) protocols in women with uterine fibroids with and without surgical treatment. Material and Methods — The retrospective study included 37 IVF cycles from 37 patients that had infertility combined with myoma. The Group 1 patients were subjected to the IVF procedure without previous treatment of the myoma, while the Group 2 patients were subjected to IVF after myomectomy. Results — The total quantity of oocytes and the percentage of mature (MII) oocytes obtained during the ovarian puncture of the patients in the compared groups were slightly higher in the group without surgical treatment (p&gt;0.05). Any significant differences in the frequency of formation of high-quality embryos (р=0.43) and good-quality embryos (р=0.22) between the groups were not obtained. The number of embryos suitable for embryo transfer to the uterine cavity and/or cryopreservation in the women with myomectomy was 9% higher than the one in the group without surgical treatment. Conclusion — Surgical treatment of uterine fibroids does not significantly affect the quantity and quality of oocytes and embryos obtained in the IVF procedure.

On dissection of the uterine wall during laparoscopic myomectomy

BACKGROUND: Laparoscopic myomectomy is becoming the leading method of surgical treatment of uterine fibroids while preserving reproductive and menstrual functions. Increasingly, ultrasound energy is used to dissect the myometrium. Meanwhile, the mode and direction of the ultrasound energy supply to minimize damage to the underlying tissues have not been specified.&#x0D; AIM: The aim of this study was to perform a comparative analysis of the myometrium and the fibroid pseudocapsule in the projection of the myoma nodule after dissection using ultrasound energy with different initial characteristics of the surgical instrument.&#x0D; MATERIALS AND METHODS: For comparison, we selected two instruments with a longitudinal ultrasound energy supply with an output frequency of 80 MHz ... 2.5 GHz and 47 kHz at intermittent operating mode of 5/10 sec and one torsion instrument with a transverse ultrasound energy supply with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec.&#x0D; RESULTS: Our study has shown that the smallest zone of irreversible changes is formed when using ultrasound energy with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec with its transverse feed at 90 degrees to the blade, and the largest zone of irreversible changes is formed when using ultrasound energy with an output frequency of 47 kHz at intermittent operating mode of 5/10 sec with its longitudinal feed.&#x0D; CONCLUSIONS: Morphometric studies with an analysis of the depth of necrotic and necrobiotic changes in the myometrial tissue showed that from the standpoint of reproductive surgery, it is preferable to use USE with an output frequency of 36 kHz at intermittent operating mode of 3/30 sec with its transverse feed.

Risk factors for thromboembolic complications in patients with elevated body mass index during the perioperative period of laparoscopic myomectomy

Background. Uterine fibroid is one of the most common diseases in gynaecological practice accounting from 32 to 70 % according to various authors. In 80 % of cases, fibroids are observed in women of reproductive age. Laparoscopic myomectomy is one of the main methods of surgical treatment for uterine fibroids in women of reproductive age. A large number of advantages of this method of surgical treatment in many cases lead to underestimation of the existing risks such as the risk of thrombosis in women with elevated body mass index (BMI). The purpose of this study is to detect the risk of thrombosis in adequate comprehensive thromboprophylaxis of patients with elevated BMI in the perioperative period of laparoscopic myomectomy using an instrumental method of diagnosis such as low-frequency piezoelectric blood viscometer. Materials and methods. Patients aged 30–45 years undergoing laparoscopic myomectomy (n = 60) were examined. They were divided into 3 groups depending on the BMI and thromboprophylaxis method. Group 1 (n = 16) included women with the BMI &lt; 30 kg/m2, who did not receive thromboprophylaxis. Group 2 (n = 18) consisted of patients with the BMI &gt; 30 kg/m2, who were treated with enoxaparin thromboprophylaxis at a dose of 2,000 anti-Xa IU/0.2 ml subcutaneously (at the BMI of 30–40 kg/m2) and 4,000 anti-Xa IU/0.4 ml subcutaneously (at the BMI &gt; 40 kg/m2). Third group (n = 26) included individuals with the BMI &gt; 30 kg/m2 who received enoxaparin and pentoxifylline for thromboprophylaxis. Results. The low-frequency piezoelectric blood viscometry revealed statistically significant (p &lt; 0.05) deviations from the reference values of the coagulogram towards structural (increased maximum clot density) and chronometric hypercoagulation (acceleration of the time of formation of fibrin-platelet structure T5, shift of the blood clotting time T3 to the left, an increase in the intensity of coagulation drive), elevated thrombin activity (an increase in the constant of thrombin activity, a decrease in T2 time), activation of vascular-platelet hemostasis (reduced period of T1 reaction onset, increased intensity of contact coagulation), inhibition of the lytic activity (a decrease in the intensity of retraction and lysis of the clot) in groups 2 and 3. On the first day after surgery in groups 2 and 3, there was a significant increase (compared to preoperative indicators) in the chronometric indicators such as T1, T2 and T5; a decrease in the structural indicator of maximum clot density, as well as a significant decrease in the constant of thrombin activity, intensity of contact coagulation, which confirms the effectiveness of antithrombotic therapy. However, group 2 reported an increase in the activity of vascular-platelet hemostasis, higher intensity of contact coagulation compared to group 3, shorter T1 and T2 time, and the constant of thrombin activity was higher. On the 5th day after surgery, a normocoagulation trend of hemostatic potential was observed in all groups of patients. Conclusions. The use of low-frequency piezoelectric blood viscometry allows reliably and quickly assessing the kinetics of thrombosis formation.

High-intensity focused ultrasound: opportunities and prospects in the treatment of uterine fibroid and deep infiltrative endometriosis

This literature review is devoted to the use of focused ultrasound in gynecological practice as an alternative to the traditional surgical treatment of uterine fibroids and deep infiltrating endometriosis. According to available data, the effectiveness of the treatment of uterine fibroids with focused ultrasound varies widely, ranging from 16.4% to 93.0%. Due to the lack of prospective studies, it is not possible to draw reliable conclusions about the effect of ablation of uterine fibroid with focused ultrasound on fertility. However, unplanned pregnancies after such treatment occurred up to 19.5%, and in 66.3% of cases, pregnancies ended with the childbirth. Research results demonstrate that in 87% of cases, treatment of retrocervical infiltrative endometriosis using focused ultrasound is feasible. Further data accumulation is required to determine the range of patients with uterine fibroids and deep infiltrating endometriosis, to whom the treating technique could be most effective and safe.

Prognosis of endometrial cancer depends on intracrine ratio of sex steroids.

e17564 Background: Local imbalance of sex steroids (SS) plays a leading role in the development of gynecologic tumors. The purpose of the study was to investigate the effect of changes in SS and E6 protein levels on the course of endometrial cancer (EC). Methods: 50 patients with EC T1-2N0M0 (histologically - endometrioid adenocarcinoma, AC), aged 53.4±3.2 years, were recruited. Levels of SS and E6 protein were determined by standard ELISA systems in tumor samples. The coefficient of estrogens to the amount of testosterone and progesterone – C = (E1+E2):(T+P4) was calculated. Intact endometrium (IE) obtained in surgical treatment for uterine fibroids was used as the intact tissue. Results: AC patients demonstrated elevated estrone (E1) levels, compared to IE: by 2.2 times in 88% and by 5.9 times in 12% cases (p &lt; 0.05). Levels of estradiol (E2) were similar in AC and IE. Progesterone (P4) levels in 32 patients were 1.5 times lower than in IE, and testosterone (T) 1.5 times higher (p &lt; 0.05). P4 in 18 patients was 3 times lower than in IE, and T – 1.4 times lower in 12 women and 2.2 times lower in 6 women (p &lt; 0.05). The C coefficient increased in 32 patients by 1.3 times (p&lt; 0.05), in 12 patients by 2.7 times, in 6 patients by 8.2 times (p &lt; 0.05). E6 protein was found in tumor tissue of 18 patients with elevated C. 6 of 18 women with C = 24.54±2.4 and E6 = 420±32 ng/g of tissue developed recurrence during 6 months, and 12 patients with C = 8.15±1.2 and E6 = 28±2.1 ng/g of tissue developed recurrence in a period of 6 months to 1 year. Women with C = 4.04±0.39 without E6 oncoprotein in tumor tissue had a relapse-free period for more than 1 year. Conclusions: An analysis of C and E6 oncoprotein in tumor tissues allows identification of high-risk patients and a personalized approach to adequate treatment.

Analysis of modern views on the uterine fibroids and methods of its treatment

Despite a significant amount of research on the pathogenesis, diagnosis and treatment of uterine fibroids, many questions remain unanswered today. The appearance and progressive growth of this formation is the result of a whole complex of disorders in the female body: neurohumoral, genetic, inflammatory and others that suppress reproductive function and worsen the course of the disease. Given the number of key factors in the pathogenesis and pathophysiology of uterine fibroids, the treatment of this group of patients should be comprehensive, aimed at early detection, treatment of concomitant gynecological diseases and correction of hormonal disorders.In recent decades, hormone therapy has been widely used for the conservative treatment of uterine hyperplastic diseases. However, according to some data, the use of COCs or intrauterine hormonal releasing system has a slight blocking effect on fibroid growth processes. Pharmacotherapy of the disease can be both a stage for preoperative preparation on the organ, and an independent unit for stabilizing the nodes and getting rid of surgical treatment. And although the results of conservative treatments indicate their effectiveness, it should be stated that the main method of treatment of uterine fibroids is surgery.In the age of endoscopic surgery, this discussion has not exhausted itself and the modern approach to the treatment of uterine fibroids dictates the expansion of indications for organ-sparing operations. The choice of their methodology should be considered and determined by the size, location, clinical picture of the disease and the feasibility of preserving menstrual and reproductive function of women. Laparoscopic myomectomy is considered a minimally invasive and less traumatic intervention, contributes to a favorable course of the postoperative period and reduces pain. With effective organ-sparing surgical treatment of uterine fibroids in women of reproductive age, the menstrual cycle is normalized, reproductive function is restored, and pregnancies usually occur in 1,5-2 years after surgery.Endoscopic treatments are now successfully used both for planning a pregnancy and for its onset. A significant amount of patients have an uncomplicated course of pregnancy and childbirth, even in the presence of multiple and small nodes. Of course, pregnant women with fibroids can not be considered as a homogeneous group of patients, clearly recommending the preservation of pregnancy. The predominant location and size of the tumor, the degree of pathological changes in the myometrium, the duration of the disease, the state of health of the woman, the age of the woman giving birth for the first time, determine different degrees of risk of pregnancy and childbirth for mother and fetus. The division of patients into risk groups allows to differentiate the question of the feasibility of maintaining pregnancy, to carry out appropriate clinical and laboratory examinations and preventive measures to prevent complications.

Black Women's Psychosocial Experiences with Seeking Surgical Treatment for Uterine Fibroids: Implications for Clinical Practice.

Black women are more likely to undergo surgery for uterine fibroids compared with non-Black women. However, few studies have characterized the psychosocial experiences of Black women seeking fibroid treatment. We aimed to identify factors that shape Black women's fibroid management decisions; explore how discrimination based on race, class, and gender feature in treatment-seeking experiences, and compare experiences across age and socioeconomic status. We conducted semistructured interviews with 37 Black women undergoing surgery for fibroid management. We used a thematic analysis to code transcripts and identify themes. Participants were predominately single, college educated, and insured. Respondents reported that patient-doctor interactions, support from social networks, fertility consequences, and fear of fibroid malignancy influenced their fibroid management decisions. Knowledge and perceptions of fibroids were also influenced by community norms and differed by socioeconomic status; women of higher socioeconomic status had greater fibroid awareness than women of lower socioeconomic status. Discrimination was discussed in the context of historical inequity against Black women, with one participant questioning whether Black women were valued less in clinical settings compared with non-Black women. Although several women discussed positive experiences seeking fibroids care, others expressed medical mistrust or said that alternative management options were not offered by clinicians. Fibroid management decisions were influenced not only by interactions with clinicians and social networks, and concerns about fertility and fibroid malignancy, but also by broader social and historical conditions. These findings suggest that clinicians should deliver intersectional gynecologic care that centers the voices of Black women seeking fibroid treatment.

Predictors of genitourinary syndrome in women of elderly reproductive age after hysterectomy

The article presents an analytical assessment of risk factors for distant postoperative urogenital disorders in women of older reproductive age after radical surgical treatment for uterine fibroids. The aim of the study was to optimize the diagnostic algorithm of genitourinary syndrome in women of older reproductive age after hysterectomy for uterine fibroids. Materials and methods – 80 women aged 40 to 50 years were examined: 40 patients after vaginal and laparoscopically assisted vaginal hysterectomy, 40 patients with abdominal hysterectomy, control – 30 relatively healthy women with asymptomatic fibroids. The examination was performed at the stage of preoperative observation and for 3 years after surgery. Research methods: data on the assessment of pelvic floor and urogenital dysfunction using a standardized POP-Q system, physical examination, the ICS classification was used to assess the severity of urinary incontinence; quality of life assessment using the MOS SF-36 questionnaire; standard methods of variation statistics. Research results and their discussion. The most important risk factors for genitourinary syndrome have been identified. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth trauma, high birth parity, ovarian surgery, the use of gonadotropin-releasing hormone agonists), chronic diseases accompanied by increased intramuscularly; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. Conclusions. In the case of surgical treatment of uterine fibroids, it is advisable to take into account not only the presence of vaginal prolapse and initial dysuric manifestations, but also their predictors in the preoperative stage of the examination, as this may affect the choice of method and access in the case of surgical treatment of uterine fibroids. rehabilitation program and will obtain the expected effect of surgical recovery.

Urogenital disorders in women of reproductive age after radical surgeries about uterine myoma – optimization of diagnostic algorithm

The article presents an assessment and analysis of the most important medical and social risk factors for long-term postoperative urogenital disorders in women of reproductive age after radical surgical treatment for uterine fibroids. Radical operations for uterine fibroids cause an increase in the proportion of urogenital disorders, the clinical manifestations of which have a negative impact on the physical, psycho-emotional form and social significance of women in society. A survey of 80 women aged 40 to 50 years, the main group included 40 patients who underwent vaginal hysterectomy, the comparison group consisted of 40 patients with hysterectomy performed by abdominal access. Data on the assessment of pelvic floor condition and urogenital dysfunction using a standardized POP-Q system, both at the stage of preoperative observation and for 3 and 5 years after surgery. Сonducted surveys, filling diaries of pain, urination, physical examination and bimanual examination, determination of the pH of the vaginal contents, colposcopy, evaluated the index of the vaginal condition, the state of the microbiota of the mucous membranes, a comprehensive urodynamic examination, cystometry, ultrasound examination of the pelvic organs and assessment of ovarian structure.The most important risk factors are identified, which would allow to form groups of patients that require individualized approaches in the choice of surgical techniques and rehabilitation program. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth injuries, high birth parity); ovarian surgery, the use of gonadotropin-releasing hormone agonists. chronic diseases of the respiratory system and gastrointestinal tract, accompanied by increased intra-abdominal pressure; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. When choosing a method and access in case of surgical treatment for uterine fibroids, it is advisable to take into account the presence of pelvic prolapse and initial dysuric manifestations in women, the functional state of the sphincter apparatus and urethral hypermobility, obstetric and gynecological pathology and previous surgery on the organs of the uterus. the patient, her awareness of possible complications, the surgeon’s experience and his choice of surgical techniques.