-
The Pan African Medical Journal 2022Uterine artery embolization (UAE) is a very efficient treatment modality for myoma. A rare complication of this procedure is vaginal expulsion of the uterine myoma... (Review)
Review
Uterine artery embolization (UAE) is a very efficient treatment modality for myoma. A rare complication of this procedure is vaginal expulsion of the uterine myoma (expelled myoma) which may occur in 3 to 5% of cases during a period of 3 to 48 months. We report a case of myoma expulsion after embolization, discussing diagnosis and treatment. A literature review was also conducted. A 40-year-old patient sought medical care on 5/2/2021 with intermittent pelvic pain and hypermenorrhagia. Vaginal ultrasound revealed an enlarged uterus (253 cm) with myomas. The largest intramural myoma measured 7 cm. Uterine artery embolization was performed on 11/11/2021, without any complications. On 12/7/2021, during clinical examination an expelled myoma was observed entirely inside the vaginal canal. A vaginal myomectomy was performed, without any complications. At 15 months after the initial follow-up, the patient is doing well.
Topics: Female; Humans; Adult; Uterine Neoplasms; Embolization, Therapeutic; Leiomyoma; Myoma; Uterus; Uterine Artery Embolization
PubMed: 36942141
DOI: 10.11604/pamj.2022.43.210.38030 -
Gynecological Endocrinology : the... Oct 2009The myoma pseudocapsule is a structure formed surrounding the uterine fibroid, that in the uterus separates the myoma from normal tissue; because literature is lack of... (Review)
Review
BACKGROUND
The myoma pseudocapsule is a structure formed surrounding the uterine fibroid, that in the uterus separates the myoma from normal tissue; because literature is lack of detailed information concerning myoma pseudocapsule, the author reviewed this important topic.
METHODS
An extensive literature review from 1980 to 2008 was performed on the myoma pseudocapsule, using: fibroid, myoma, myomectomy and reproductive outcome, as keywords.
RESULTS
The fibroid removal should always be performed inside its pseudocapsule and with a careful stretching, to extract fibroid from the surrounding fibromuscular skeleton, breaking up the fibrous bridges; because the vascular network generally surrounds the myoma, detachment of the myoma occurring inside the pseudocapsule should cause less bleeding. The maintenance of myometrial integrity during myomectomy allows the facilitation of uterine healing and is of benefit for future reproductive outcome.
CONCLUSION
The benefits of intracapsular myomectomy are evident, because it preserves myometrial integrity and allows for restoration of the uterine musculature. This correct myomectomy, if done by laparoscopy, confers significant advantages in less intraoperative blood loss, short duration of hospital stay, few therapeutic antibiotic administration and better future fertility.
Topics: Female; Gynecologic Surgical Procedures; Humans; Leiomyoma; Myoma; Myometrium; Uterine Neoplasms
PubMed: 19526398
DOI: 10.1080/09513590903015502 -
PloS One 2017The published data about alcohol consumption and uterine myoma are scanty and controversial: some studies found positive association whereas other studies showed no... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The published data about alcohol consumption and uterine myoma are scanty and controversial: some studies found positive association whereas other studies showed no association.
OBJECTIVES
To conduct a systematic review and meta-analysis to determine whether alcohol is a risk factor for myoma.
SEARCH STRATEGY
A MEDLINE/EMBASE search was carried out, supplemented by manual searches of bibliographies of the selected studies.
SELECTION CRITERIA
Articles published as full-length papers in English. In the review we included all identified studies. Otherwise, the inclusion criteria for studies included in the meta-analysis were: a) case-control or cohort studies, reporting original data; b) studies reporting original data on the association between alcohol consumption and myoma; c) diagnosis of myoma was ultrasound or histological confirmed and/or clinically based.
DATA COLLECTION AND ANALYSIS
A total of 6 studies were identified for the review and 5 studies were included in the meta-analysis. The primary outcome was the incidence of uterine myoma in ever versus never alcohol drinkers and when data were available, we also analyzed categories of alcohol intake. We assessed the outcomes in the overall population and then we performed a subgroup analysis according to study design. Pooled estimates of the odds ratios (OR) with 95% confidence interval (CI) were calculated using random effects models.
MAIN RESULTS
The summary OR (95%CI) of myoma forever versus never alcohol intake was 1.12 (0.94-1.34) with significant heterogeneity. The summary OR for current versus never drinking was 1.33 (1.01-1.76) with no heterogeneity.
CONCLUSIONS
Ever alcohol consumption is not associated with myoma risk. Based on the data of two studies, current alcohol drinkers had a slightly borderline increased risk of diagnosis of myoma. In consideration of the very limited number of studies and the suggestion of a potential increased risk among current drinkers, further studies are required.
Topics: Adult; Alcohol Drinking; Female; Humans; Middle Aged; Myoma; Odds Ratio; Risk Factors; Uterine Neoplasms; Young Adult
PubMed: 29176884
DOI: 10.1371/journal.pone.0188355 -
Expert Opinion on Emerging Drugs Mar 2008Uterine myomas are the most common benign tumors of the female reproductive tract. Of the different treatment methods available, medical therapy may be a less invasive... (Review)
Review
BACKGROUND
Uterine myomas are the most common benign tumors of the female reproductive tract. Of the different treatment methods available, medical therapy may be a less invasive choice.
OBJECTIVE
To review the literature on medical treatments that are available or being developed for women with uterine myomas.
METHODS
Literature review of articles pertaining to medical therapeutic strategies of uterine myomas. (Articles were searched by means of a computerized PubMed and Cochrane Library search with the following keywords: uterine myomas, leiomyomata, fibroids, and medical treatment.)
RESULTS/CONCLUSION
At present, many drugs are available in routine clinical practice, some of which are under investigation. This review will explore the recent advances in medical treatment for the management of uterine myomas.
Topics: Animals; Antineoplastic Agents; Female; Hormone Replacement Therapy; Humans; Leiomyoma; Myoma; Uterine Neoplasms
PubMed: 18321152
DOI: 10.1517/14728214.13.1.119 -
BMC Women's Health Jun 2023Parasitic myomas typically occur after a pedunculated subserosal fibroid loses its uterine blood supply and parasitizes other organs or after a surgery involving...
BACKGROUND
Parasitic myomas typically occur after a pedunculated subserosal fibroid loses its uterine blood supply and parasitizes other organs or after a surgery involving morcellation techniques. Parasitic myomas that occur after transabdominal surgery are extremely rare and may not be sufficiently documented. Here, we present a case of parasitic myoma in the anterior abdominal wall following a transabdominal hysterectomy for fibroids.
CASE PRESENTATION
The patient was a 46-year-old Chinese woman who had undergone surgery for uterine myomas at our hospital 1 year prior. The patient later revisited our department with a palpable mass in her abdomen, and imaging revealed a mass in the iliac fossa. The possibility of a broad ligament myoma or solid ovarian tumor was considered before surgery, and laparoscopic exploration was performed under general anesthesia. A tumor measuring approximately 4.5 × 4.0 cm was found in the right anterior abdominal wall, and a parasitic myoma was considered. The tumor was completely resected. Pathological analysis of the surgical specimens suggested leiomyoma. The patient recovered well and was discharged on postoperative day 3.
CONCLUSION
This case suggests that parasitic myoma should be considered in the differential diagnosis of patients presenting with abdominal or pelvic solid tumors with a history of surgery for uterine leiomyomas, even without a history of laparoscopic surgery using a power morcellator. Thorough inspection and washing of the abdominopelvic cavity at the end of surgery is vital.
Topics: Female; Humans; Middle Aged; Hysterectomy; Laparoscopy; Leiomyoma; Myoma; Pelvic Neoplasms; Uterine Myomectomy; Uterine Neoplasms
PubMed: 37328846
DOI: 10.1186/s12905-023-02410-3 -
Ceska Gynekologie 2023We present the case of a 47-year-old woman with a bulky, nascent necrotic myoma, which at first glance appeared to be a malignant process in the cervix. It caused...
We present the case of a 47-year-old woman with a bulky, nascent necrotic myoma, which at first glance appeared to be a malignant process in the cervix. It caused significant retention of urine due to compression of the bladder and ureters, hydronephrosis and deterioration of renal function. A fully developed picture of the "bulge syndrome" dominated - lymphedema of the lower limbs and lower abdomen, pain in the lower abdomen, constipation, secondary secondary urinary infection, and paradoxical ischuria. During a gynecological examination in a specula, a strong-smelling, necrotic tumour was visualized reaching half of the vagina, which was causing a bloody discharge, which brought the patient to the examination. A biopsy was taken from the tumour. A permanent urinary catheter was inserted into the urinary bladder with gradual adjustment of renal functions. Due to the difficulties and the benign histological findings from the biopsy, a simple abdominal hysterectomy with bilateral salpingectomy from a lower midline incision was indicated. The operation was complicated by an extensive adhesive process and blood loss of 1,200 mL, with a decrease in hemoglobin in the blood count from 128 g/L to 79 g/L and the need for three blood transfusions. In the postoperative period, there is a prompt recovery of spontaneous micturition with normalization of bladder function, subsidence of lymphedema and subjective complaints of the patient.
Topics: Female; Humans; Middle Aged; Hysterectomy; Lymphedema; Myoma; Urinary Bladder; Urinary Retention
PubMed: 37932054
DOI: 10.48095/cccg2023372 -
JBRA Assisted Reproduction Oct 2021Submucous myomas have negative effects on fertility. To maintain fertility, conservative treatment should be suggested to women who wish to become pregnant, especially...
Submucous myomas have negative effects on fertility. To maintain fertility, conservative treatment should be suggested to women who wish to become pregnant, especially young patients. The patient was a 33-year-old woman, who had had secondary infertility for 3 years. Upon vaginal ultrasound, we noticed a submucous myoma measuring 26 mm x 31 mm with a compressive effect on the anterior surface of the endometrium. Ovarian reserve was low. The gold standard of myoma treatment is surgical intervention. But, for the following reasons: the adverse effects of surgery on the endometrium (intrauterine adhesion), the patient's refusal to undergo a myomectomy and her request for pregnancy, our strategy for treating was to reduce volume of submucous myoma and start the assisted reproductive techniques (ART) cycle, simultaneously. We administered three courses of Gonadotropin-releasing hormone analogues (GnRHa) and then induced controlled ovarian hyperstimulation. Ovum pick up was done. Finally, we transferred two embryos (4 and 6 cells). In subsequent patient visits, βhCG was positive after 14 days. At the last patient visit, the heart of the embryo was formed. From this finding, it may be concluded that combined GnRHa and ART is the treatment of choice for infertile women with uterine submucous myoma, considering the reduced ovarian reserve and response.
Topics: Adult; Female; Humans; Infertility, Female; Leiomyoma; Myoma; Pregnancy; Reproductive Techniques, Assisted; Uterine Neoplasms
PubMed: 34415133
DOI: 10.5935/1518-0557.20210042 -
Presse Medicale (Paris, France : 1983) 2013
Topics: Female; Humans; Myoma; Practice Guidelines as Topic; Uterine Neoplasms
PubMed: 23588191
DOI: 10.1016/j.lpm.2013.02.324 -
Journal of Minimally Invasive Gynecology Jun 2022To provide a systematic review of pregnancy outcomes after radiofrequency ablation (RFA) of uterine myomas. (Review)
Review
OBJECTIVE
To provide a systematic review of pregnancy outcomes after radiofrequency ablation (RFA) of uterine myomas.
DATA SOURCES
A literature search was conducted using PubMed, Cochrane Library, Scopus, Web of Science, and Embase, from database inception to October 2021.
METHODS OF STUDY SELECTION
Two reviewers conducted independent literature searches. Studies that met the criteria based on title and abstract underwent full-text review. Publications were included if they reported pregnancies and obstetric outcomes after laparoscopic or transcervical RFA of myomas.
TABULATION, INTEGRATION, AND RESULTS
A total of 405 publications were initially identified and screened, 39 underwent full-text review, and 10 publications were ultimately included. There were 50 pregnancies reported among 923 RFA patients: 40 pregnancies after 559 laparoscopic RFAs and 10 pregnancies after 364 transcervical RFAs. The number of patients from these studies actively trying to conceive after RFA is unknown. Among the RFA patients who conceived, the average age at ablation was 37 years old (range, 27-46 years). Most patients had between 1 and 3 myomas ablated, and myomas size ranged from <2 cm to 12.5 cm. There were 6 spontaneous abortions (12%) and 44 full-term pregnancies (88%), of which 24 were vaginal deliveries and 20 were cesarean deliveries. There were only 2 complications among 44 deliveries: one placenta previa that underwent an uncomplicated cesarean delivery and 1 delayed postpartum hemorrhage with expulsion of a degenerated myoma, with no long-term sequelae. There were no cases of uterine rupture, uterine window, or invasive placentation and no fetal complications. The spontaneous abortion rate was comparable with the general obstetric population.
CONCLUSION
Almost all pregnancies after RFA of myomas were full-term deliveries with no maternal or neonatal complications. These findings add to the literature that radiofrequency myoma ablation may offer a safe and effective alternative to existing treatments for women who desire future fertility.
Topics: Abortion, Spontaneous; Adult; Catheter Ablation; Female; Humans; Infant, Newborn; Leiomyoma; Myoma; Pregnancy; Pregnancy Outcome; Uterine Neoplasms
PubMed: 35123041
DOI: 10.1016/j.jmig.2022.01.015 -
European Journal of Obstetrics,... Jan 2021To evaluate the feasibility and safety of leaving the submucous myoma (SM) in the uterine cavity after office hysteroscopic enucleation.
OBJECTIVE
To evaluate the feasibility and safety of leaving the submucous myoma (SM) in the uterine cavity after office hysteroscopic enucleation.
STUDY DESIGN
Prospective multicenter study including patients who had a single SM diagnosed by transvaginal ultrasounds with surgical indication. Office hysteroscopic enucleation of the SM was performed using a 5 mm continuous flow office hysteroscope with a 2.9 mm rod lens optical system and a 5 Fr operative channel. After the SM was released preserving the pseudo capsule using cold instruments, it was left into the uterine cavity. The primary endpoint was the proportion of patients without evidence of the myoma at the transvaginal ultrasound performed after 90 days from surgery.
RESULTS
Between January 1st, 2018, and March 31st, 2020, a total of 204 patients were enrolled. Most patients were nulliparous and reported abnormal uterine bleeding as the leading symptom. 76.5 % of enucleated myomas had a diameter ranging between 1.5 and 2.5 cm, and 81.4 % of SMs were of G0 or G1. Hysteroscopic procedures had a mean duration of 23.2 ± 10.5 min. The operative time was associated with the SM grade and size. All hysteroscopic procedures were completed. A vasovagal reaction was observed in 3 women (1.5 %), and minimal post-operative bleeding was reported after 7 procedures (3.4 %). None reported pelvic pain or vaginal discharges/bleeding during follow-up. The average patient satisfaction from surgery was 4.59 (5-points Likert scale). The level of patient satisfaction was not associated with the grade and the size of the myoma. In 192 (94.12 %; 98 %CI: 89.03-96.93 %) out of 204 patients, the SM was absent at the transvaginal ultrasound performed at the follow-up end. A higher prevalence of G2 SMs and lower prevalence of G1 SMs were observed among patients with evidence of the myoma after 90 days from the surgery.
CONCLUSION
Office hysteroscopic myomectomy with SM enucleation without mass extraction appears safe, well-tolerated, and effective in at least 89 % of patients. G2 SMs may be the factor associated with the procedure's failure.
Topics: Female; Humans; Hysteroscopy; Leiomyoma; Myoma; Pregnancy; Prospective Studies; Uterine Myomectomy; Uterine Neoplasms
PubMed: 33276281
DOI: 10.1016/j.ejogrb.2020.11.048