Uterus myomatosus (German Edition)
In none of the cases a perioperative blood transfusion was necessary. One patient underwent hysterectomy in another hospital after primary successful resection, one patient received transfusion of 2 bags of red blood cell concentrate during her stay in hospital. Uterus-preserving myomectomy can be used in cases of large uteri or with multiple fibroids with low amount of blood loss.
The combination of preoperative embolization and subsequent myomectomy may be a therapeutic option in cases of infertility due to a fibroid-induced uterine deformation. Good interdisciplinary cooperation is essential for sustainable results in this complex group of patients. Uterine fibroids are the most common benign tumors of the female genital tract [ 1 ]. Their size and number can vary greatly.
Gennaro Della Rossa et al. The quality of life can be severely impacted by fibroid-related symptoms [ 4 ] [ 5 ], although such symptoms do not necessarily correlate with the size of the myoma. Only symptomatic myomas or those affecting fertility should be treated.
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When pursuing uterus-preserving treatment measures, however, the preservation or improvement of fertility must always be included in the therapy decision. In , Klatsky et al. Surgical removal and hysterectomy are still the most widely used methods of treating myomas.
Because of the size of the uterus, laparoscopic access is not useful in this case. In addition, there is a risk of heavy bleeding from the myoma wound bed and the risk that the uterus can no longer be preserved or reconstructed [ 3 ] [ 8 ]. Since the initial report of successful treatment of uterine myomas via embolization of uterine arteries [ 9 ], uterine artery embolization UAE has established itself, especially in developed industrialized countries, as part of the spectrum of modern uterus-preserving therapies for myoma-associated disorders.
In recent years, a few working groups have reported on planned preoperative uterine artery embolization PUAE , particularly with regard to large uterine myomas, to improve the surgical outcome of subsequent myoma enucleation and to reduce intraoperative blood loss [ 8 ] [ 10 ]. After an interval of hours or a few days, uterine artery embolization is followed by operative myoma enucleation by laparoscopy or by a transverse or longitudinal incision.
In the following, we present peri- and post-procedural experiences from our own case series 21 patients and provide an overview of the current international literature on preoperative embolization of patients with myomas.
uterus myomatosus | Latin to English | Medical (general)
A retrospective analysis reviewed the data pertaining to 21 consecutive patients who, between January and March , underwent preoperative uterine artery embolization PUAE followed by an open abdominal myoma enucleation. After presenting in a university gynecological outpatient clinic, all patients were informed in detail regarding the various treatment options for large uterus myomatosus. Since the surgeon considered surgery alone without prior embolization to be too risky, all patients with a uterus myomatosus that could be detected at navel height or higher were offered the option of combined treatment using UAE and surgery.
The patients were hospitalized and initially received bilateral embolization of the uterine artery UAE after probing with a microcatheter. The type of particle used was up to the examining physician: Three patients expressed the desire that resorbable gelatin sponge particles should be used instead of non-degradable embolization particles for their embolization.
They felt that the safety, effectiveness, and temporary character of this embolizate were proven and they would not accept nonabsorbable particles [ 11 ]. The radiation exposure during the procedure was determined based on the fluoroscopy time and the dose area product using Dose Watch GE Health Care, Chalfont St.
All patients received adequate opioid-based pain medication [ 12 ]. After 24 to 48 hours post-embolization, the patients underwent a longitudinal incision with the goal of preserving the uterus [ Fig. Between June and August , all 21 patients were surveyed using a mailed questionnaire we developed regarding post-surgical progression, complications, scar length, satisfaction and improvement in symptoms. Those articles providing at least an English or German abstract were considered. The removed fibroids were primarily situated intramurally; some exhibited a broad submucosal component.
The median fluoroscopy time was The mean dose area product was Primary uterus preservation was achieved in all 21 fibroid patients. All interventions were performed by the same surgeon MD.
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One patient underwent hysterectomy 14 days postoperatively in another hospital due to heavy vaginal bleeding that could not be otherwise controlled. None of the 21 planned myoma enucleations required the administration of erythrocyte concentrates EC immediately after UAE. One patient received a postoperative transfusion of two ECs after hemoglobin declined from Mean diameter of the largest myoma was In none of the cases a perioperative blood transfusion was necessary. One patient underwent hysterectomy in another hospital after primary successful resection, one patient received transfusion of 2 bags of red blood cell concentrate during her stay in hospital.
Uterus-preserving myomectomy can be used in cases of large uteri or with multiple fibroids with low amount of blood loss. The combination of preoperative embolization and subsequent myomectomy may be a therapeutic option in cases of infertility due to a fibroid-induced uterine deformation. Good interdisciplinary cooperation is essential for sustainable results in this complex group of patients.