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Sinha R, Rupa B, Reddy M. Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy. J Robot Surg 2023; 17:847-852. [PMID: 36319791 DOI: 10.1007/s11701-022-01470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/13/2022] [Indexed: 05/25/2023]
Abstract
Uterine myomas are benign tumours frequently seen in women of reproductive age. Myomectomy remains a viable option for treating this condition in women who wish to preserve their uterus. We undertook this study to compare the peri-operative surgical outcomes of Robotic myomectomy (RM) with laparoscopic myomectomy (LM) in Indian patients of uterine myomas after the initial learning curve of RM was achieved. A retrospective chart review was performed for the patients who underwent RM or LM for the treatment of uterine myomas. A total of 177 patients, 116 in the RM group and 61 in the LM group, were included in the study. The mean age in the RM and LM group was 34.31 ± 5.40 years and 33.54 ± 4.96 years, respectively (p = 0.355). The mean total operative time was marginally more in RM group (127.37 ± 110.67 vs. 120.66 ± 44.27, p = 0.650) but the difference was not statistically significant. Patients in the RM group had significantly less blood loss (115.43 ± 79.43 vs. 340.98 ± 453.9 ml, p = < 0.0001), hospital stay (1.28 ± 0.49 vs. 1.92 ± 1.05 days, p = < 0.0001), requirement of blood transfusion (93.97 vs. 81.97%, p = 0.031) and requirement of intravenous (IV) analgesia (41.38 vs. 34.43%, p = 0.019) as compared to the patients in the LM group. The Robotic myomectomy significantly reduces blood loss, the duration of hospital stay, and requirement of blood transfusions and IV analgesia as compared to the laparoscopic myomectomy.
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Affiliation(s)
- Rooma Sinha
- Department of Gynaecology, Laparoscopic and Robotic Surgery, Apollo Hospital, Hyderabad, Telangana, India.
| | - Bana Rupa
- Department of Gynaecology, Laparoscopic and Robotic Surgery, Apollo Hospital, Hyderabad, Telangana, India
| | - Mamatha Reddy
- Department of Gynaecology, Laparoscopic and Robotic Surgery, Apollo Hospital, Hyderabad, Telangana, India
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Knipprath-Mészáros AM, Tozzi A, Butenschön A, Reina H, Schoetzau A, Montavon C, Heinzelmann-Schwarz V, Manegold-Brauer G. High negative prediction for the Basel sarcoma score: Sonographic assessment of features suspicious of uterine sarcoma. Gynecol Oncol 2023; 174:182-189. [PMID: 37210928 DOI: 10.1016/j.ygyno.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/23/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION In the management of uterine myomas, laparoscopic surgery with morcellation enables a minimal invasive procedure. Cases of unsuspected uterine sarcoma dissemination have been reported and led to regulative restrictions. To help to distinguish preoperatively myomas from sarcomas, we assessed the value of six sonographic criteria (Basel Sarcoma Score, BSS) in a prospective outpatient cohort of consecutive patients with uterine masses. MATERIAL AND METHODS We prospectively evaluated all patients presenting with myoma-like masses planned for surgery with standardized ultrasound examination. BSS including the following criteria was investigated: rapid growth in past three months, high blood flow, atypical growth, irregular lining, central necrosis and oval solitary lesion. For each criterion, a score 0/1 was given. BSS (0-6) equals the sum of all given scores. Histological diagnosis was used as reference. RESULTS Among 545 patients, 522 had the final diagnosis of myoma, 16 had peritoneal masses with sarcomatous components (PMSC), and seven had other malignancies. Median BSS for PMSC was 2.5 (range: 0-4) vs 0 for myomas (range: 0-3). The most common sonographic criteria leading to a false positive score in myomas were rapid growth in past three months and high blood flow. For the detection of sarcomatous masses with BSS threshold of >1, sensitivity was 93.8%, specificity 97.9%, and positive predictive value (PPV) and negative predictive value (NPV) were 57.7% and 99.8%, respectively (AUC 0.95). CONCLUSION BSS can help distinguishing between myomas and sarcomatous masses, with high NPV. Caution is required when >1 criterion is present. As a simple tool, it could easily be integrated into routine myoma sonographic examination and help develop standardized assessment of uterine masses for better preoperative triage.
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Affiliation(s)
| | - Alessandra Tozzi
- Department of Gynecologic Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital Basel, Basel, Switzerland
| | - Annkathrin Butenschön
- Department of Gynecologic Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital Basel, Basel, Switzerland
| | - Hubertina Reina
- Department of Gynecologic Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital Basel, Basel, Switzerland
| | - Andreas Schoetzau
- Ovarian Cancer Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Céline Montavon
- Gynecological Cancer Center, Women's Hospital, University Hospital Basel, Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Gynecological Cancer Center, Women's Hospital, University Hospital Basel, Basel, Switzerland; Ovarian Cancer Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Gwendolin Manegold-Brauer
- Department of Gynecologic Ultrasound and Prenatal Diagnostics, Women's Hospital, University Hospital Basel, Basel, Switzerland.
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Simko S, Dallas K, Molina AL, Siedhoff MT, Wright KN, Anger JT, Truong MD. Rates of Complications and Reoperation after Myomectomy-the Impact of Surgical Approach: A Statewide Population-based Cohort Study from 2005-2018. J Minim Invasive Gynecol 2022; 29:1157-1164. [PMID: 35781056 DOI: 10.1016/j.jmig.2022.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/30/2022]
Abstract
STUDY OBJECTIVE To assess rates of and factors associated with complications and reoperation after myomectomy. DESIGN Population-based cohort study. SETTING All non-Veterans Affairs facilities in the state of California from January 1, 2005, to December 31, 2018. PARTICIPANTS Women undergoing abdominal or laparoscopic myomectomy for myoma disease were identified from the Office of Statewide Health Planning and Development datasets using appropriate International Classification of Diseases, Ninth and Tenth Revision and Current Procedural Terminology codes. INTERVENTIONS Demographics, surgery facility type, facility surgical volume, and surgical approach were identified. Primary outcomes included complications occurring within 60 days of surgery and reoperations for myomas. Patients were followed up for over an average of 7.3 years. Univariate and multivariable associations were explored between the above factors and rates of complications and reoperation. All odds ratios (ORs) are adjusted ORs. MEASUREMENTS AND MAIN RESULTS Of the 66 012 patients undergoing myomectomy, 5265 had at least one complication (8.0%). Advanced age, black, Asian race, MediCal and Medicare payor status, academic facility, and medical comorbidities were associated with increased odds of a complication. Minimally invasive myomectomy (MIM) was associated with decreased complications compared with abdominal myomectomy (AM) (OR, 0.29; 95% confidence interval [CI], 0.25-0.33; p <.001). Overall, 17 377 patients (26.3%) underwent reoperation. Medicare and MediCal payor status and medical comorbidities were associated with increased odds of a repeat surgery. Reoperation rates were higher in the MIM group over the entire study period (OR, 2.33; 95% CI, 1.95-2.79; p <.001). However, the odds of reoperation after MIM decreased each year (OR, 0.93; 95% CI 0.92-0.95; p <.001), with the odds of reoperation after AM surpassing MIM in 2015. CONCLUSION This study identifies outcome disparities in the surgical management of myomas and describes important differences in the rates of complications and reoperations, which can be used to counsel patients on surgical approach. These findings suggest that MIM can be considered a lasting and safe approach in properly selected patients.
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Affiliation(s)
- Sarah Simko
- Department of Obstetrics and Gynecology, Adventist Health White Memorial Medical Center (Dr. Simko), University of California San Diego, Los Angeles, California.
| | - Kai Dallas
- Division of Urology, Department of Surgery, City of Hope Medical Center (Dr. Dallas), University of California San Diego, Los Angeles, California
| | - Andrea L Molina
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center (Drs. Molina, Siedhoff, Wright, and Truong), University of California San Diego, Los Angeles, California
| | - Matthew T Siedhoff
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center (Drs. Molina, Siedhoff, Wright, and Truong), University of California San Diego, Los Angeles, California
| | - Kelly N Wright
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center (Drs. Molina, Siedhoff, Wright, and Truong), University of California San Diego, Los Angeles, California
| | - Jennifer T Anger
- Division of Urology, Department of Surgery, University of California San Diego (Dr. Anger), Los Angeles, California
| | - Mireille D Truong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center (Drs. Molina, Siedhoff, Wright, and Truong), University of California San Diego, Los Angeles, California
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Jacob M, Richter R, Sehouli J, David M. Evaluation of Biomarkers in Myoma Patients: A Prospective Study Investigating the Role of LDH, CA 125, and IGF-1 after Uterus-Preserving Surgical Therapy. Gynecol Obstet Invest 2021; 86:100-107. [PMID: 33582665 DOI: 10.1159/000513045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 10/09/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Myomas are one of the most common tumors of the lower abdomen in women. At present, sonography and clinical examination are the prevalent diagnostic standards for these tumors, and no biomarkers have been established yet. The primary aim of this study was to determine if the surgical removal of myomas leads to a drop of lactate dehydrogenase (LDH), CA 125, and/or insulin-like growth factor (IGF-1) and therefore if these parameters are suitable as potential biomarkers for the presence or recurrence of a myoma. STUDY DESIGN The blood levels of LDH, CA 125, and IGF-1 were determined in 83 patients (age 18-50) with a verified diagnosis of myomas and surgical therapy at 3 different timepoints: preoperative (T0), 2 days postoperative (T1), and 6 months postoperative (T2). Vaginal sonography was performed preoperatively and once again at 6 months postoperatively. RESULTS The median (Q1-Q3) LDH values dropped significantly postoperatively: 239 (217-266) U/L at T0 versus 217 (190-255) U/L at T1, p < 0.001. The median (Q1-Q3) IGF-1 values also dropped: 140.4 (118.6-179.0) ng/mL versus 112.4 (99.5-143.0), p < 0.001. By contrast, the CA 125 values rose slightly but not significantly. At 6 months (n = 34), the LDH values were not significantly different from either the preoperative or the immediate postoperative values. This was observed both in patients with and without a recurrence of myoma. In contrast, the median (Q1-Q3) IGF-1 level at T2 was significantly elevated both in patients with sonographic evidence of new myomas (129.0 [116.0-163.1] ng/mL, p = 0.023) and in patients with sonographic proof of no new myomas (161.0 [130.2-198.5] ng/mL, p < 0.001). CONCLUSION Both LDH and IGF-1 dropped significantly in the immediate postoperative days in women with myomas after uterus-preserving surgeries were performed. The postoperative concentration of IGF-1 was correlated with the evidence of new myomas and can be potentially used for further monitoring. Future studies should be able to confirm these results. This study concludes that myomas do influence LDH and IGF-1 and could possibly be suitable as biomarkers.
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Affiliation(s)
- Michaela Jacob
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Charité University Hospital Berlin, Berlin, Germany
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Charité University Hospital Berlin, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Charité University Hospital Berlin, Berlin, Germany
| | - Matthias David
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Charité University Hospital Berlin, Berlin, Germany,
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Ko JS, Suh CH, Huang H, Zhuo H, Harmanli O, Zhang Y. Association of Race/Ethnicity with Surgical Route and Perioperative Outcomes of Hysterectomy for Leio myomas. J Minim Invasive Gynecol 2021; 28:1403-1410.e2. [PMID: 33242598 DOI: 10.1016/j.jmig.2020.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the associations among race/ethnicity, route of surgery, and perioperative outcomes for women undergoing hysterectomy for uterine leiomyomas. DESIGN Retrospective cohort study. SETTING Multistate. PATIENTS Women who underwent hysterectomies for leiomyomas from the American College of Surgeons National Surgical Quality Improvement Program database, 2014 to 2017. INTERVENTIONS None. Exposures of interest were race/ethnicity and route of surgery. MEASUREMENTS AND MAIN RESULTS Racial/ethnic variation in route of surgery and perioperative outcomes. Propensity score matching was employed to control for possible confounders. We identified 20 133 women who underwent nonemergent abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or vaginal hysterectomy (VH) for leiomyomas. We defined minimally invasive hysterectomy (MIH) as LH or VH. Black women were more likely to have open surgery (AH vs MIH adjusted odds ratio [aOR], 2.22; 95% confidence interval [CI], 2.07-2.38; AH vs VH aOR, 1.79; 95% CI, 1.54-2.08; AH vs LH aOR, 2.27; 95% CI, 2.13-2.44) than white women. Likewise, Hispanic women were more likely to have open surgery (AH vs MIH aOR, 1.76; 95% CI, 1.58-1.96; AH vs LH aOR, 1.82; 95% CI, 1.61-2.00) than white women. Black women were more likely to experience any complication after hysterectomy (AH aOR, 1.54; 95% CI, 1.31-1.80; VH aOR, 1.65; 95% CI, 1.02-2.68; LH aOR, 1.37; 95% CI, 1.13-1.66) than white women. Hispanic women were less likely than white women to experience major complications after VH (aOR, 0.28; 95% CI, 0.08-0.98). Compared with white women, the mean length of stay was longer for black women who underwent AH or LH. The mean total operation time was higher for all minority groups (except for Asian/other undergoing AH) regardless of surgical approach. CONCLUSION Women of minority race/ethnicity were more likely to undergo abdominal rather than MIH for leiomyomas. Even when controlling for route of surgery, they were more likely to experience perioperative complications.
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Rault E, Delorme P, Goffinet F, Girault A. Impact of history of myomectomy on preterm birth risk in women with a leiomyomatous uterus: a propensity score analysis. BMC Pregnancy Childbirth 2020; 20:720. [PMID: 33228570 PMCID: PMC7686718 DOI: 10.1186/s12884-020-03413-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy. METHODS Retrospective cohort study including all women with a history of myomectomy (operated group) or uterine myomas during pregnancy (unoperated group) who delivered in a tertiary center between January, 2011 and December, 2017. The operated group included women who had a myomectomy history with or without myomas during the ongoing pregnancy. The unoperated group included women with uterine myoma(s) seen on at least one ultrasound during pregnancy without history of myomectomy. The primary outcome was preterm birth < 37 weeks, and the secondary outcome spontaneous preterm birth < 37 weeks. To control for confounding factors, a propensity score approach was used. Two sensitivity analysis were performed, one repeating the analysis using the propensity score after excluding operated women with persistent myomas and one using a classical multivariable logistic regression model. RESULTS The cohort included 576 women: 283 operated women and 293 unoperated women. The rate of preterm birth was similar in the two groups: 12.6% in the unoperated group and 12.0% in the operated group (p = 0.82). No difference in preterm birth risk was shown between unoperated and operated women in the cohort matched on the propensity score: OR 0.86; 95%CI [0.47-1.59]. These results were consistent for spontaneous preterm birth (OR 1.61; 95%CI [0.61-4.23]) and for the sensitivity analyses. CONCLUSION In women with a leiomyomatous uterus, a history of myomectomy is not associated with a reduced preterm birth risk.
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Affiliation(s)
- Emmanuel Rault
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France
| | - Pierre Delorme
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France.,Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France
| | - François Goffinet
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France.,Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France
| | - Aude Girault
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France. .,Université de Paris, INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, 123 boulevard Port Royal, 75014, Paris, France.
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Knudsen NI, Richter R, Kentenich H, Sehouli J, David M. Anxiety of myoma patients: results of standardized interviews with the State Trait Anxiety Inventory and the Kessler 10 questionnaire. J Psychosom Obstet Gynaecol 2020; 41:122-130. [PMID: 31179813 DOI: 10.1080/0167482x.2019.1624951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: The aim of this study was to explore a possible relation between myoma-related anxieties and general state or trait anxiety or psychological distress, to get a better understanding of the impact of anxiety on the patients.Methods: This prospective study was conducted at the myoma clinic of a large university hospital in a major European city from November 2016 to February 2017. Patients completed standardized questionnaires on myoma-related fears, the State Trait Anxiety Inventory (STAI), and the Kessler 10.Results: Eighty-five out of 88 women agreed to participate. State-anxiety on the STAI had a mean of 49.4 (11 points above the norm (p < .001)), and trait-anxiety had a mean of 42.0 (5 points above the norm (p = .001)). Thirty-seven percent of the patients had distress values on the K10 above the norm (defined as <20). More myoma-related fears correlated with higher scores on the Kessler and STAI. The scores were not related to the level of information about myomas or duration of illness.Conclusions: Myoma-related fears correlated with higher mental distress and elevated state and trait anxiety levels. Thus, physicians can contribute to the overall well-being of patients when they relieve them of the myoma-related anxiety. Further research is needed to determine whether treatment has any impact on anxiety or mental distress.
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Affiliation(s)
- Nina Isabelle Knudsen
- Department of Gynecology, Virchow Campus; Charité - University Hospital Berlin, Humboldt University of Berlin, Berlin Institute of Health, Berlin, Germany
| | - Rolf Richter
- Department of Gynecology, Virchow Campus; Charité - University Hospital Berlin, Humboldt University of Berlin, Berlin Institute of Health, Berlin, Germany
| | | | - Jalid Sehouli
- Department of Gynecology, Virchow Campus; Charité - University Hospital Berlin, Humboldt University of Berlin, Berlin Institute of Health, Berlin, Germany
| | - Matthias David
- Department of Gynecology, Virchow Campus; Charité - University Hospital Berlin, Humboldt University of Berlin, Berlin Institute of Health, Berlin, Germany
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Delli Carpini G, Verdecchia V, Papiccio M, Grelloni C, Ciavattini A. Comparison of uterine fibroids' growth pattern during pregnancy according to fetal sex: an observational study. Biol Sex Differ 2019; 10:53. [PMID: 31775886 PMCID: PMC6880545 DOI: 10.1186/s13293-019-0266-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the effect of fetal sex on fibroids' growth during pregnancy according to the hCG serum levels METHODS: Observational study conducted from January 2007 to December 2016 on women with ultrasound identification of uterine fibroids who had a pregnancy within 1 year from diagnosis. The fibroids diameter was determined during the pre-pregnancy ultrasound, early first trimester (5-7 weeks), late first trimester (11-13 weeks), second trimester (19-21 weeks), and third trimester (31-33 weeks). The diameter growth was calculated in each interval between two ultrasounds. The hCG serum levels were determined both in early and late first trimester. The correlation between hCG levels and fibroid diameter was evaluated. Obstetric outcomes collected were gestational weeks at birth and the rate of cesarean section. Neonatal outcomes were birthweight and Apgar score at 1 min. RESULTS Eighty-seven of the included women had a male fetus, and 70 had a female fetus. A progressive increase of fibroid diameter was observed from pre-pregnancy to second trimester for both fetal sexes. In third trimester, the mean ± SD fibroid diameter of female fetuses showed a slowdown, while the mean ± SD fibroid diameter of male fetuses continued to grow. Women carrying a female fetus presented a higher fibroid diameter in early first trimester (33.5 ± 13.3 mm vs 27.4 ± 11.0 mm, p < 0.01), late first trimester (40.2 ± 13.9 mm vs 34.6 ± 11.7 mm, p < 0.01), and second trimester (40.5 ± 14.9 mm vs 34.7 ± 10.3 mm, p < 0.01). The hCG serum levels resulted higher in women with a female fetus: 61406 (50554-71760) mU/ml vs 46016 (37160-56744) mU/ml (p < 0.01). A positive correlation between hCG levels and fibroid diameter was found both for male and female fetuses (male r = 0.77, 95% CI 0.71-0.82, p < 0.01 and female r = 0.82, 95% CI 0.76-0.86, p < 0.01). CONCLUSION Women with female fetus seem to have a higher growth of fibroids up to second trimester of pregnancy. This process may be mediated by the higher serum hCG levels found in women expecting a female fetus.
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Affiliation(s)
- Giovanni Delli Carpini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Via F. Corridoni, 11-60123, Ancona, Italy
| | - Valeria Verdecchia
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Via F. Corridoni, 11-60123, Ancona, Italy
| | - Maria Papiccio
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Via F. Corridoni, 11-60123, Ancona, Italy
| | - Camilla Grelloni
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Via F. Corridoni, 11-60123, Ancona, Italy
| | - Andrea Ciavattini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Via F. Corridoni, 11-60123, Ancona, Italy.
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Mourgues J, Villot A, Thubert T, Fauvet R, Pizzoferrato AC. Uterine myomas and lower urinary tract dysfunctions: A literature review. J Gynecol Obstet Hum Reprod 2019; 48:771-774. [PMID: 30905852 DOI: 10.1016/j.jogoh.2019.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/17/2019] [Accepted: 03/20/2019] [Indexed: 12/12/2022]
Abstract
Different types of urinary symptoms associated with myomas are reported, including urinary incontinence or dysuria. They are rarely investigated in patients and their prevalence is not well known. While myomas are the first reason to perform hysterectomy in France, few studies have evaluated the impact of surgical treatment in women with urinary symptoms. Our objective was to conduct a review of the literature regarding urinary symptoms associated with myomas and the impact of their treatment on these symptoms. We reviewed articles indexed in MEDLINE dealing with urinary symptoms and myomas, and published until September 2018. The prevalence of urinary symptoms in women with uterine myomas is highly variable depending on whether the authors are interested in symptoms or urodynamic results. The most frequently reported urinary symptoms are urgency (31-59%), dysuria (4-36%) and stress urinary incontinence (SUI, 20 80%). While some studies have found the anterior location of myomas and the size superior to 5 cm as a risk factor for UI, other studies have not found a correlation between myomas topography and symptom scores. The treatments of uterine myomas seem to have an impact on women's urinary symptoms. Although hysterectomy is considered as a risk factor for pelvic floor disorders, the removal of the uterus may sometimes improve or cure urinary symptoms. Most authors also found a significant improvement in urinary symptom scores after myomectomy and myomas embolization. More studies are needed to clarify the impact of myomas treatment on urinary symptoms.
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Affiliation(s)
- Julie Mourgues
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France
| | - Anne Villot
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France
| | - Thibault Thubert
- Department of Gynaecology and Obstetrics, University Hospital of Nantes, Nantes, France
| | - Raffaèle Fauvet
- Department of Gynaecology and Obstetrics, University Hospital of Caen, Caen, France; Normandie University, UNICAEN, Unité de recherche Inserm U1086 « ANTICIPE » - Axe 2 : Biologie et Thérapies Innovantes des Cancers Localement Agressifs (BioTICLA), Caen, France
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Gracia M, Nonell R, Ros C, Rius M, Quintas L, Martínez-Zamora MÁ, Carmona F. Sonographic and hysteroscopic endometrial examination in women treated with ulipristal acetate: Exploratory findings at a tertiary referral center. Eur J Obstet Gynecol Reprod Biol 2018; 232:40-45. [PMID: 30468982 DOI: 10.1016/j.ejogrb.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Ulipristal acetate (UPA) is a progesterone receptor modulator (PRM) agent that has shown benefits in women with symptomatic uterine fibroids. However, its effects on the endometrium are complex and not fully understood. We describe exploratory findings on macroscopic observation of the endometrium at transvaginal sonography (TVS) and hysteroscopy. The aim of the study is to characterize endometrial patterns commonly observed after UPA treatment. STUDY DESIGN We performed a prospective longitudinal study at a tertiary referral center with 100 women with symptomatic uterine fibroids who received a 12-week treatment with UPA (5 mg/day). Patients underwent TVS before and after the treatment, and also a hysteroscopy examination was performed. Main outcome was to compare sonographic and hysteroscopic findings to histology after UPA treatment. RESULTS Twenty one out of 100 (21%) women showed PAEC confirmed by histology after UPA treatment. Ultrasound findings were normal in most women after UPA treatment, but 18/100 (18%) showed an endometrial pattern suggestive of PRM effects (non-uniform, homogeneous endometrium with regular cystic areas). Endometrial thickness ≥16 mm was detected in 6/100 patients (6%), and all of them also presented sonographic PRM pattern. No patient presented malignancy according to histology in this subgroup, and 100% of them had PAEC pattern at histology. Among total patient population showing PAEC at histology, only 33% of these were identified by hysteroscopy, while 57% were identified by TVS with the PRM suggestive pattern. Of note, visibility of endometrium was improved at TVS after UPA. CONCLUSION Identification of increased endometrial thickness together with the categorized endometrial PRM pattern at TVS may be correlated to benign lesions and may not be a cause of concern. This study is exploratory and further research is necessary to support these conclusions. Nevertheless, TVS seems to be feasible to plan adequate follow-up protocols by avoiding unnecessary interventional procedures such as hysteroscopy.
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Affiliation(s)
- Meritxell Gracia
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Roser Nonell
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Cristina Ros
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Mariona Rius
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Lara Quintas
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Maria Ángeles Martínez-Zamora
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine-University of Barcelona, Barcelona, Spain.
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Varon S, Parvataneni R, Waetjen E, Dunn K, Jacoby VL. Misdiagnosis of Leiomyosarcoma after Radiofrequency Ablation of Uterine Myomas. J Minim Invasive Gynecol 2019; 26:564-6. [PMID: 30121386 DOI: 10.1016/j.jmig.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/01/2018] [Accepted: 08/05/2018] [Indexed: 11/22/2022]
Abstract
Minimally invasive therapies to treat symptoms of uterine myomas can be effective alternatives to major surgery. Such modalities include pharmacologic agents, uterine artery embolization, magnetic resonance-guided focused ultrasound, and laparoscopic radiofrequency ablation, known as the Acessa procedure. Acessa is used to treat women with symptomatic myomas and was approved by the US Food and Drug Administration in 2012. This case describes a patient who underwent Acessa and subsequently required hysterectomy for refractory symptoms. Pathology of her tumor was initially classified as epithelioid leiomyosarcoma but on subsequent review was classified as benign. This report highlights the challenges of accurate histologic diagnosis in the setting of using new therapeutic modalities. Clinicians should report such interventions to pathologists at the time of surgery to allow for accurate diagnosis.
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Alonso L, Nieto L, Carugno J. Hysteroscopic Management of Endometrial Smooth Muscle Metaplasia: A Rare Cause of Abnormal Uterine Bleeding. J Minim Invasive Gynecol 2018. [PMID: 29526666 DOI: 10.1016/j.jmig.2018.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Laura Nieto
- Hospital Universitario Reina Sofia, Cordoba, Spain
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13
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Shue S, Radeva M, Falcone T. Comparison of Long-Term Fertility Outcomes after Myomectomy: Relationship with Number of Myomas Removed. J Minim Invasive Gynecol 2018; 25:1002-1008. [PMID: 29371170 DOI: 10.1016/j.jmig.2018.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE To determine if the number of myomas removed during myomectomy for symptomatic relief affects long-term fertility outcomes in reproductive-aged women. DESIGN Retrospective cohort survey study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS One hundred forty-four patients who underwent myomectomy for symptomatic myomas and attempted to conceive afterward. INTERVENTION Questionnaire mailed to reproductive-aged women who received robotic, laparoscopic, or abdominal myomectomy. MEASUREMENTS AND MAIN RESULTS Patients with >6 myomas removed were less likely to achieve pregnancy after myomectomy than patients with ≤6 myomas removed (22.9% vs 70.8%, respectively; p < .001). To achieve pregnancy, 45% of those with >6 myomas removed (vs 17.6% of those with ≤6 myomas removed) relied on fertility treatment (clomiphene citrate, letrozole, intrauterine insemination, or in vitro fertilization). Of those with >6 myomas removed who became pregnant, 45.5% had a term birth, 45.5% miscarried, and 9.1% had an ectopic pregnancy. Of those with ≤6 myomas removed who became pregnant, 61.8% had a term birth, 23.5% had a preterm birth, and 13.2% miscarried. CONCLUSION The number of myomas removed during myomectomy significantly affects fertility. Women with >6 myomas removed were less likely to become pregnant, more likely to require fertility treatment, and less likely to have a term birth when compared with women with ≤6 myomas removed.
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Affiliation(s)
- Shirley Shue
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Milena Radeva
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Tommaso Falcone
- Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
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Fortin C, Flyckt R, Falcone T. Alternatives to hysterectomy: The burden of fibroids and the quality of life. Best Pract Res Clin Obstet Gynaecol 2017; 46:31-42. [PMID: 29157931 DOI: 10.1016/j.bpobgyn.2017.10.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 10/06/2017] [Indexed: 01/21/2023]
Abstract
Uterine fibroids are the most common benign tumor in reproductive-aged women. While the majority of women are asymptomatic, those with symptoms may suffer from abnormal uterine bleeding, infertility, pelvic pain or pressure, and urinary dysfunction. Fibroids represent a significant healthcare burden for women and society as a whole. Women with fibroids have compromised overall quality of life and impairment in many specific domains including work productivity, sexuality, self-image, relationships, and social emotional and physical well-being. Many women are reluctant to ask for help and delay seeking treatment. To date, myomectomy remains the gold standard for treating fibroid-related symptoms in reproductive-aged women. However, many less invasive uterine preserving approaches have been developed. Quality of life is improved in many women following treatment for fibroids. This article aims to provide an overview of the substantial impact of fibroids on health-related quality of life.
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Affiliation(s)
- Chelsea Fortin
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca Flyckt
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tommaso Falcone
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
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15
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Clark NV, Cohen SL. Tissue Extraction Techniques During Laparoscopic Uterine Surgery. J Minim Invasive Gynecol 2017; 25:251-256. [PMID: 28866098 DOI: 10.1016/j.jmig.2017.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Abstract
Morcellation allows minimally invasive approaches to surgery even in the presence of large uteri or myomas. Recent restrictions in the use of power morcellation, as well as concerns regarding the potential for morcellation to disseminate malignant tissue, have initiated investigation and innovation to find safer methods. This review examines current techniques for tissue extraction during uterine surgery, with a focus on contained power morcellation and contained manual morcellation via mini-laparotomy or colpotomy. Videos are included to demonstrate these methods.
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Affiliation(s)
- Nisse V Clark
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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Levast F, Legendre G, Bouet PE, Sentilhes L. [Management of uterine myomas during pregnancy]. ACTA ACUST UNITED AC 2016; 44:350-4. [PMID: 27216952 DOI: 10.1016/j.gyobfe.2016.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/14/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the impact of myomas on pregnancy and discuss the role of myomectomy during cesarean section. METHODS Databases PubMed, Medline and Cochrane were searched until 30 June 2015. RESULTS The most commonly reported obstetric complications relative to fibroids are: increased rate of spontaneous miscarriage in women with submucosal or intramural fibroids, pain, placentation disorders and malpresentation. A higher cesarean section rate is found among pregnant women with fibroids. The most common postpartum complication is postpartum haemorrhage. For years, risk of haemorrhage led caregivers not to practice myomectomy during cesarean section. Current data are rather reassuring. No study shows significant hemorrhage differences between myomectomy during cesarean section and cesarean section alone or myomectomy alone. The long-term morbidity of myomectomy during cesarean section is not enough studied but does not appear higher than expected for fertility and complications during pregnancy. Therefore, myomectomy during cesarean section is not currently recommended by learned societies. CONCLUSION Women with fibroids is a common obstetric situation. Complications are rare. Myomectomy during cesarean section seems to be not associated with higher short-term maternal morbidity. But studies with a longer-term follow-up of patients are necessary.
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Singh S, Jena SK, Naik M, Ray L, Behera S. Uterine Fibroid (Leiomyoma) with Acute Urinary Retention: A Case Series. J Clin Diagn Res 2016; 10:QR01-3. [PMID: 27190903 DOI: 10.7860/jcdr/2016/17028.7573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 01/31/2016] [Indexed: 11/24/2022]
Abstract
Uterine leiomyomas are an extremely rare cause of acute urinary retention in women. The delay in diagnosing uterine leiomyomas presenting with acute urinary retention further complicates the management. The rarity of the condition makes it difficult to plan either prospective or retrospective trials. Hence, most of the evidence comes from case reports or series. We report a case series of acute urinary retention in women with uterine leiomyomas and discuss the pathophysiology, diagnosis and management options.
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Affiliation(s)
- Sweta Singh
- Assistant Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences , Bhubaneswar, Odisha, India
| | - Saubhagya Kumar Jena
- Assistant Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences , Bhubaneswar, Odisha, India
| | - Monalisha Naik
- Senior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences , Bhubaneswar, Odisha, India
| | - Lipsa Ray
- Senior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences , Bhubaneswar, Odisha, India
| | - Satyanarayan Behera
- Senior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences , Bhubaneswar, Odisha, India
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David M, Pitz CM, Mihaylova A, Siedentopf F. Myoma-associated pain frequency and intensity: a retrospective evaluation of 1548 myoma patients. Eur J Obstet Gynecol Reprod Biol 2016; 199:137-40. [PMID: 26930041 DOI: 10.1016/j.ejogrb.2016.02.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the possible relation between symptoms (especially pain) reported by myoma patients and objective features of their myomas as determined by ultrasound. Specifically: (1) What is the frequency and intensity of myoma-related pain? (2) Does the pain intensity depend on the number, size, or location of the myomas? (3) Is there any correlation between premenstrual pain, menstrual pain, and pain during sexual intercourse? STUDY DESIGN A retrospective analysis of data from a patient questionnaire and ultrasound exams, collected from February 2009 until January 2013 at the myoma clinic of a university hospital in a large European city. The study analyzed data from 1548 myoma patients. Patients completed a 0-10 Likert scale questionnaire about their symptoms. The number, size, and location of myomas were determined from ultrasound exams. RESULTS The three most frequent symptoms reported were hypermenorrhea, dysmenorrhea, and premenstrual pain. There was no statistically significant relationship between premenstrual pain or pain during sexual intercourse on the one hand and the number, size, or location of myomas on the other hand. For women with severe dysmenorrhea (Likert-scale scores of 8-10), submucosal myomas were significantly more frequent than all other myoma locations (p=0.01). Severe dysmenorrhea (Likert-scale scores of 8-10) was reported by a significantly (p<0.001) greater portion of the women whose largest myoma had a largest diameter of <5cm than by the women whose largest myoma had a diameter ≥5cm. The number of myomas did not have a significant influence on the dysmenorrhea intensity. The three types of pain (premenstrual, menstrual, and/or during sexual intercourse) had moderate pairwise correlations (ρ values from 0.304 to 0.542) that were all statistically highly significant (p<0.001). CONCLUSION Myoma-associated pain is, alongside hypermenorrhea, the most frequent problem reported by the affected patients. Unlike premenstrual pain and pain during sexual intercourse, the intensity of menstrual pain is clearly dependent on the location and size of the largest myoma. Further research is needed to better understand the degree to which the pain reported by the patients is due to features of the myomas versus other possible factors.
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Affiliation(s)
- Matthias David
- Department of Gynecology, Virchow Campus, Charité University Hospital, Berlin, Germany.
| | - Clara Maria Pitz
- Department of Gynecology, Virchow Campus, Charité University Hospital, Berlin, Germany
| | - Adriana Mihaylova
- Department of Gynecology, Virchow Campus, Charité University Hospital, Berlin, Germany
| | - Friederike Siedentopf
- Breast Center, Department of Gynecology and Obstetrics, Martin Luther Hospital, Berlin, Germany
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Mazzon I, Favilli A, Grasso M, Horvath S, Bini V, Di Renzo GC, Gerli S. Predicting success of single step hysteroscopic myomectomy: A single centre large cohort study of single myomas. Int J Surg 2015; 22:10-4. [PMID: 26277533 DOI: 10.1016/j.ijsu.2015.07.714] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/18/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Submucous myomas represent one of the main indications of operative hysteroscopy. Hysteroscopic resection of submucous fibroids should be a simple, well-tolerated and effective procedure and ideally accomplished in in only one surgical step. METHODS Retrospective cohort single Centre study of 1244 women undergoing hysteroscopic myomectomy. Data analysis included patients' and the myomas characteristics. A multiple logistic regression was carried out in order to assess which variables were able to determine a multiple step procedure. RESULTS 1090 myomas (87.62%) were completely resected in a single-step procedure (SS group) whereas a multiple-step procedure (MS group) was needed for the removal of 154 fibroids (12.38%). The mean size of myomas resected in the SS group was 22.83 ± 9.36 mm whereas fibroids of the MS group measured 29.67 ± 10.76 mm. The overall feasibility of hysteroscopic myomectomy in one surgical procedure was 88.28%. All hysteroscopic myomectomies of G0 fibroids were completed in a single step. The chance of success to accomplish the treatment in a single-step for G1 and G2 myomas were 88.59% and 82.55%, respectively. The multivariate analysis revealed an inverse correlation between age and multiple step procedures and size of myomas were all directly correlated to multiple step procedures. CONCLUSION The grading, the size of the myomas and the age of patients play a crucial role in completing the hysteroscopic myomectomy in a single step. Only the diameter greater than 3 cm in G2 myomas is correlated to a higher risk of a multiple procedure.
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Affiliation(s)
- Ivan Mazzon
- "Arbor Vitae" Centre, Clinica Nuova Villa Claudia, 00191 Rome, Italy
| | - Alessandro Favilli
- Department of Obstetrics and Gynecology, University of Perugia, S.M. Della Misericordia Hospital, 06156 Perugia, Italy
| | - Mario Grasso
- "Arbor Vitae" Centre, Clinica Nuova Villa Claudia, 00191 Rome, Italy
| | - Stefano Horvath
- "Arbor Vitae" Centre, Clinica Nuova Villa Claudia, 00191 Rome, Italy
| | - Vittorio Bini
- Department of Obstetrics and Gynecology, University of Perugia, S.M. Della Misericordia Hospital, 06156 Perugia, Italy
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, University of Perugia, S.M. Della Misericordia Hospital, 06156 Perugia, Italy
| | - Sandro Gerli
- Department of Obstetrics and Gynecology, University of Perugia, S.M. Della Misericordia Hospital, 06156 Perugia, Italy.
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Aksoy Y, Sivri N, Karaoz B, Sayin C, Yetkin E. Carotid intima-media thickness: a new marker of patients with uterine leiomyoma. Eur J Obstet Gynecol Reprod Biol 2014; 175:54-7. [PMID: 24480112 DOI: 10.1016/j.ejogrb.2014.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/13/2013] [Accepted: 01/01/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether or not there are any significant differences in carotid intima-media thickness between patients with uterine leiomyoma and controls. STUDY DESIGN Patients whose ages were between 40 and 50 years, with body mass index <30kg/m(2), and with a pathological diagnosis of uterine leiomyoma constituted the study group. Control subjects had no uterine leiomyoma proven by sonography. Demographic, clinical, and drug history data were collected. Right, left and mean carotid intima-media thickness measurements were obtained by ultrasonography. RESULTS Carotid intima-media thickness and serum high-density lipoprotein (HDL) levels were significantly different between the groups (p=0.0001 and p=0.001 respectively), being respectively higher and lower in the leiomyoma group than in controls. Stepwise binary logistic regression analysis revealed that uterine leiomyoma development ratio was 159.32 times higher when carotid intima-media thickness was over 0.61mm (p=0.0001). In patients with uterine leiomyoma, carotid intima-media thickness was significantly less in patients taking statins compared to those not on these drugs (p=0.0001). CONCLUSION The present study demonstrated a positive association between carotid intima-media thickness and the presence of uterine leiomyoma. Conversely, an inverse association was suggested between HDL and uterine leiomyoma. These findings suggest that women with uterine leiomyoma might have an increased risk of subclinical atherosclerosis.
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Affiliation(s)
- Yuksel Aksoy
- Department of Cardiology, Trakya University Medical Faculty, Edirne, Turkey.
| | - Nasir Sivri
- Department of Cardiology, Trakya University Medical Faculty, Edirne, Turkey
| | - Banu Karaoz
- Department of Nursing, Trakya University Faculty of Health Sciences, Edirne, Turkey
| | - Cenk Sayin
- Department of Gynecology and Obstetrics, Trakya University Medical Faculty, Edirne, Turkey
| | - Ertan Yetkin
- Department of Cardiovascular Surgery, Mersin Ortadogu Hospital, Mersin, Turkey
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Ludwin A, Ludwin I, Pityński K, Basta P, Basta A, Banas T, Jach R, Wiecheć M, Grabowska R, Stangel-wójcikiewicz K, Milewicz T, Nocuń A. Transrectal Ultrasound-Guided Hysteroscopic Myomectomy of Submucosal Myomas With a Varying Degree of Myometrial Penetration. J Minim Invasive Gynecol 2013; 20:672-85. [DOI: 10.1016/j.jmig.2013.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 11/17/2022]
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