Surgical Treatment Of Uterine Fibroids Research Articles

Der Einfluss des ärztlichen Aufklärungsgespräches auf die postoperative Zufriedenheit und Lebensqualität von Patientinnen mit Uterus myomatosus nach Myomenukleation oder Hysterektomie

The surgical treatment of uterine fibroids represents an important column in the therapy of this disease. Aim of this study was to find out preoperative factors that influence the treatment success of a minimal-invasive surgical -therapy.In a retrospective study 228 patients were assessed. Measures comprised questions on the decision for surgery, satisfaction with the treatment, and the EQ-5D as a measure of QoL.The sample revealed an overall satisfaction with treatment and high QoL. A better postoperative contentment and QoL in patients who felt well informed about the surgical methods and who felt secure with their decision for a specific surgery was found.Regardless of the surgical method, the preoperative consultation and the certainty of the decision turned out to be determinants of the patients' postoperative contentment and QoL. The counseling gynecologist has an essential part in the patients' decision for the treatment.

Impact of periodic health examination on surgical treatment for uterine fibroids in Beijing: a case-control study

BackgroundDuring the past 2 decades, there has been a rapid proliferation of "health examination center (HEC)" across China. The effects of their services on public's health have not been systemically investigated. This study aimed to assess the impact of periodic health examination (PHE) at HEC on surgical treatment for uterine fibroids in Beijing residents.MethodsWe identified 224 patients with a primary diagnosis of uterine fibroids who had surgical treatment at four Level-1 general hospitals in Beijing, from June 1, 2009 to October 20, 2009. Controls were women who did not have surgery for uterine fibroids, matched (1:1 ratio) for age (within 2 years). A standard questionnaire was used to inquire about whether participants had PHE at HEC during the previous 2 years.ResultsPHE at HEC within 2 years were associated with surgical treatment for uterine fibroids. Odds ratios was 4.05 (95% CI, 2.61-6.29 P < 0.001), after adjustment for marital status, whether have children, annual family income, health insurance, education level and self-rated uterine fibroids-related symptom severity.ConclusionsOur study showed PHE currently provided at HEC in China were associated with significantly increased use of surgical treatment for uterine fibroids in women. Further studies are needed to assess the effects of PHE on clinical as well as on broad societal outcomes in Chinese in contemporary medical settings.

Unsuspected Diagnosis of Uterine Leiomyosarcoma after Laparoscopic Myomectomy

Study Objective: To evaluate the risk of peritoneal dissemination after laparoscopic myomectomy and morcellment for unsuspected sarcoma. Design: Retrospective analysis of three consecutive cases of uterine leiomyosarcoma. Setting: University-affiliated hospital. Patients: Between January 2000 and December 2008, 588 patients had laparoscopic myomectomy at the Department of Obstetrics and Gynecology, University of Bari, Italy and among these 3 cases (0.5%) of uterine leiomyosarcoma were diagnosed at pathologic examination. Intervention: Following diagnosis of malignant condition all patients were extensively staged with pelvic examination, transvaginal ultrasound, hysteroscopy, Pap smear and total-body CT scan that did not revealed any sign of persistent disease. Within 28 days from primary surgery all patients, after informed consent, were submitted to a surgical staging including total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, resection of all trocar ports, pelvic lymphadenectomy and peritoneal washings. Measurements and Main Results: Pathologic examination did not revealed persistent tumor in the uterus, and no sign of peritoneal disease (negative cytology, adnexae and nodes). Conclusion: Uterine sarcomas are rare tumors, ultrasound and clinical findings are similar to their benign counterpart (uterine fibroids) and diagnosis is almost always made after pathologic examination. With the wide development of endoscopic procedures for surgical treatment of uterine fibroids the management of an unsuspected sarcoma after laparoscopy will be more common in the future. However, based on the reported cases no increased risk of dissemination within the abdominal cavity can be anticipated. This condition raises the question wheather laparoscopic procedure (gas insufflation and morcellment) may increase the risk of tumor dissemination within the abdominal cavity.

What Are the Total Costs of Surgical Treatment for Uterine Fibroids?

To investigate the direct and indirect costs of uterine fibroid (UF) surgery. Data were obtained from the MarketScan Commercial Claims and Encounters databases for 1999-2004. Our sample included 22,860 women with insurance coverage who were treated surgically for UF and 14,214 women who were treated nonsurgically for UF. Medical care costs and missed workdays were divided into baseline (1 year prior to surgery) and postoperative (1 year after surgery) periods. For a subsample of women, we calculated average annual costs 3 years before and after their surgery. Of patients electing surgery, 85.9% underwent hysterectomy, 7.6% myomectomy, 4.9% endometrial ablation, and 1.6% uterine artery embolization (UAE). Women undergoing UAE incurred the highest medical care costs in the operative year ($16,430 unadjusted, $20,634 adjusted for confounders), followed by hysterectomy ($15,180 unadjusted, $17,390 adjusted), myomectomy ($14,726 unadjusted, $18,674 adjusted), and endometrial ablation ($12,096 unadjusted, $13,019 adjusted). Women treated nonsurgically incurred costs of $7,460 unadjusted and $8,257 adjusted during the year after they were diagnosed with UF. Three years after surgery, patients treated with hysterectomy had the lowest annual costs. Missed workdays in the year after surgery were high, resulting in significant losses to employers in the magnitude of $6,670-$25,229, depending on treatment, values assigned to missed workdays, and whether the analyses adjusted for confounders. UF surgical treatment costs were high. Absenteeism and disability were important components of the cost burden of UF treatment for women, their employers, and the healthcare system.

Cost‐effectiveness of magnetic resonance‐guided focused ultrasound surgery for treatment of uterine fibroids

ObjectiveTo estimate the cost-effectiveness of a treatment strategy for symptomatic uterine fibroids, which starts with Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) as compared with current practice comprising uterine artery embolisation, myomectomy and hysterectomy.DesignCost-utility analysis based on a Markov model.SettingNational Health Service (NHS) Trusts in England and Wales.PopulationWomen for whom surgical treatment for uterine fibroids is being considered.MethodsThe parameters of the Markov model of the treatment of uterine fibroids are drawn from a series of clinical studies of MRgFUS, and from the clinical effectiveness literature. Health-related quality of life is measured using the 6D. Costs are estimated from the perspective of the NHS. The impact of uncertainty is examined using deterministic and probabilistic sensitivity analysis.Main outcome measuresIncremental cost-effectiveness measured by cost per quality-adjusted life-year (QALY) gained.ResultsThe base-case results imply a cost saving and a small QALY gain per woman as a result of an MRgFUS treatment strategy. The cost per QALY gained is sensitive to cost of MRgFUS relative to other treatments, the age of the woman and the nonperfused volume relative to the total fibroids volume.ConclusionsA treatment strategy for symptomatic uterine fibroids starting with MRgFUS is likely to be cost-effective.Please cite this paper as: Zowall H, Cairns J, Brewer C, Lamping D, Gedroyc W, Regan L. Cost-effectiveness of magnetic resonance-guided focused ultrasound surgery for treatment of uterine fibroids. BJOG 2008;115:653–662.

Neglected case of uterine leiomyoma: Case report

Uterine leimyomas are the most common gynaecologacal tumors and represent 30% of all benign gynecological tumors. The vast majority of leiomyomas are asymptomatic and do not need to be treated. Pelvic pain and abnormal uterine bleeding should be considered as the most important reasons for surgical treatment of uterine fibroids. A female patient, age 69, was treated at the Institute of Oncology in Sremska Kamenica because of a huge abdominal tumor. Major symptoms were increased body temperature, abnormal uterine bleeding and extensive abdominal enlargement. After the clinical, laboratory and imaging evaluation, the offered hysterectomy was performed. The evacuated tumor was 18 kg heavy and 40 cm in length. The pathohystological diagnosis was leiomyoma per magnum. The patient was released after 11 days of hospitalization without any postoperative complications and in good general condition. Uterine fibroids can be managed medically and surgically. Hysterectomy should be performed in every case with dominant symptoms like abnormal uterine bleeding, tumor growth and increasing abdominal pain (when other causes are excluded) in postmenopausal women. This particular case is an example of low general and health culture of the reported patient and maybe caused by fear from medical and surgical treatment. Sometimes, making a diagnosis of the nature of pelvic tumor is very hard, but by respecting diagnostic procedure an adequate treatment of those patients can be ensured.

Review of the conservative surgical treatment of uterine fibroids

The conventional surgical treatment for women with symptomatic uterine fibroids is a hysterectomy. Hysterectomy guarantees the removal of all uterine fibroids without a risk of recurrence. It also guarantees the cure of symptoms such as menorrhagia and pressure effects and has been shown to be associated with a high degree of patient satisfaction and improved quality of life scores. However, in addition to women who desire fertility, there are a growing number of women who have completed their family who do not wish to undergo a hysterectomy. Uterine conserving surgical methods include myomectomy or fibroid shrinkage either by embolisation/laparoscopic clipping of both uterine arteries or myolysis. This article reviews the surgical alternatives to hysterectomy and analyses the data that is currently available with each method. Laparoscopic interstitial laser photocoagulation of uterine fibroids is a relatively new modality of treatment and is carried out in our centre. Results of this method are presented and discussed in this article. Myomectomy is associated with significant morbidity and difficulty in long term management because of high recurrence rates. Surgical alternatives to myomectomy are still limited to large series in a few centres with a special interest in the procedure developed. Well designed long term studies are required to properly evaluate the efficacy and feasibility of each procedure in normal practice and its effect on infertility.

Surgical treatment of uterine fibroids

The close attention of researchers to such a disease as uterine fibroids is due to its significant spread [1, 30] In possible complications after surgical treatment [7, 10]. Despite the ongoing conservative therapy, in 75% of patients with uterine myoma there is a need for radical intervention [21, 37]. And although the main method of treating this pathology remains the operation, until now there is no single view regarding its rational volume.

SURGERY IN THE UTERINE FIBROID, A PLEA FOR MYOMECTOMY

Abstract 1. 1. The uterine fibroid is a benign neoplasm, and its mere presence should be no cause for surgery. 2. 2. Only incontrovertible reasons, such as hemorrhage, pain, pressure symptoms, signs of tumor degeneration, rapid growth, interference with the pregnant states, cosmetic, and marital purposes should indicate surgical intervention. 3. 3. Myomectomy, even multiple, whereby endocrine balance, menstruation, and reproductive possibility are preserved, should be preferable to hysterectomy. 4. 4. The preoperative, operative, and postoperative preparation, technique, and care, respectively, as herein outlined, have enabled us to perform successfully 900 consecutive myomectomies for the interstitial and submucous types of fibroids with complete control and/or prevention of infection. 5. 5. The objections by opponents of myomectomy such as hemorrhage, infection, adhesions, and tumor recurrence have been effectively overcome in our procedures. 6. 6. This paper is presented with the hope that the widespread use of myomectomy, as described, will merit its recognition as the procedure of choice in the surgical treatment of uterine fibroids.

Surgery in the uterine fibroid, a plea for myomectomy

1.1. The uterine fibroid is a benign neoplasm, and its mere presence should be no cause for surgery.2.2. Only incontrovertible reasons, such as hemorrhage, pain, pressure symptoms, signs of tumor degeneration, rapid growth, interference with the pregnant states, cosmetic, and marital purposes should indicate surgical intervention.3.3. Myomectomy, even multiple, whereby endocrine balance, menstruation, and reproductive possibility are preserved, should be preferable to hysterectomy.4.4. The preoperative, operative, and postoperative preparation, technique, and care, respectively, as herein outlined, have enabled us to perform successfully 900 consecutive myomectomies for the interstitial and submucous types of fibroids with complete control and/or prevention of infection.5.5. The objections by opponents of myomectomy such as hemorrhage, infection, adhesions, and tumor recurrence have been effectively overcome in our procedures.6.6. This paper is presented with the hope that the widespread use of myomectomy, as described, will merit its recognition as the procedure of choice in the surgical treatment of uterine fibroids.

Surgical treatment of uterine fibroids

From the point of view of treatment, uterine fibroids can be divided into 4 main groups: the 1st group should include all fibroids that do not require any treatment (such fibroids, according to Franz's statistics, occur in 23.1%), the 2nd group - those cases , where the operation is indicated, in the 3rd group those tumors that are subject to radiation treatment, and, finally, in the 4th group those cases where you can choose between bloody and non-bloody methods of treatment. For 10 years (1925-1934) in a gynecologist, dep. 1 Sov. b-tsy underwent surgery for fibroids in 435 patients.

The operative risk in surgical treatment of uterine fibroids: Chifoliau: Le Progrés Médical, 1924, No. 42, p. 622

The operative risk in surgical treatment of uterine fibroids: Chifoliau: Le Progrés Médical, 1924, No. 42, p. 622

Surgical Treatment of Uterine Fibroids

Surgical Treatment of Uterine Fibroids