Effect of dienogest treatment on uterine fibroid volume in patients with endometriosis or adenomyosis complicated by uterine fibroids

BACKGROUND Currently,the use of dienogest in clinical practice has increased significantly,and many studies have focused on its effectiveness and safety in the treatment of endometriosis and adenomyosis;however,the effects of treatment with dienogest on uterine fibroid size in patients with endometriosis or adenomyosis have not been investigated.AIM To explore changes in fibroid size in patients with concomitant uterine fibroids undergoing dienogest treatment for endometriosis or adenomyosis and to evaluate the effectiveness and safety of the drug.METHODS The clinical data of patients with uterine fibroids treated with dienogest for endometriosis or adenomyosis at Peking University First Hospital from January 2021 to January 2023 were retrospectively analyzed.RESULTS The maximum uterine fibroid diameter and volume increased after 3 months,6 months and 1 year of dienogest treatment compared with those before treatment(P<0.01).The maximum diameter and volume of the uterine adenomyoma increased after 3 months of dienogest treatment but decreased after 6 months and 1 year of treatment compared with those before treatment,but the difference was not significant(P>0.05).Endometrial thickness and antigen 125 levels were significantly thinner and decreased,respectively,after dienogest treatment(P<0.01).Pearson's correlation analysis revealed that the increase in uterine fibroid volume after 3 months of dienogest treatment was positively correlated with the basic uterine fibroid volume(r=0.792,P<0.01).Among 64 patients with dysmenorrhea,63 experienced significant relief of dysmenorrhea after 6 months of treatment with dienogest,and all patients experienced significant relief of dysmenorrhea after 12 months.Patients were able to tolerate the drugs,with an average drug tolerance score of 8.73.CONCLUSION The use of dienogest in patients with endometriosis or adenomyosis combined with uterine fibroids can effectively relieve the patient's pain symptoms and significantly reduce the sizes of ovarian endometriotic cysts,but it cannot inhibit uterine fibroid growth.

Uterine rupture due to adenomyosis in an adolescent:A case report and review of literature

BACKGROUND Uterine rupture is a fatal medical complication with a high mortality rate.Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures.Adenomyosis is a possible risk factor for uterine rupture.However,spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.CASE SUMMARY A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg.Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung,suggesting lung metastasis.The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules.Histologically,the uterus showed diffuse adenomyosis with glandular and stromal dissociation.Lung nodules were endometrioma with massive hemorrhage.Immunohistochemistry demonstrated that the tumor cells were positive for PAX8,ER,and PR expression,leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis.Following surgery,the patient remains in good condition without recurrence.CONCLUSION This is the first case of spontaneous uterine rupture due to adenomyosis in a nongravida adolescent.

Adenomyosis uterine innervation in mice correlates to nerve growth factor expression,inflammation,and vascularization

BACKGROUND： Studies have shown that abnormal innervation is an important factor impacting occurrence and development of pathological pain in endometriosis. OBJECTIVE： To observe uterine innervation of adenomyosis mice and to analyze the cause of innervation changes due to nerve growth factor （NGF） expression, inflammation, and vascularization. DESIGN, TIME AND SETTING： This randomized, controlled, animal experiment was performed at the Research Institute of Obstetrics and Gynecology Hospital, and Central Laboratory of Zhongshan Hospital, Fudan University from March to December 2008. MATERIALS： Tamoxifen was provided by Fudan Forward, China. Rabbit anti-mouse NGF was purchased from Santa Cruz Corporation, USA; rabbit anti-protein gene product 9.5 （PGP9.5） and rabbit anti-substance P （SP） were purchased from Chemicon, USA. METHODS： A total of 40 newborn ICR mice were randomly assigned to adenomyosis model and control groups, with 20 animals in each group. Mice in the adenomyosis model group were orally administrated 2.7 μmol/kg tamoxifen on days 2-5 after birth, while the controls were not treated. MAIN OUTCOME MEASURES： Both uteri from all mice were harvested at days 135-145 after birth Expressions of polyclonal PGP9.5 and SP were immunohistochemically detected to demonstrate pan- and sensory nerve fibers. Microvessel density was quantified in the endometrium and myometrium using immunochemical staining for polyclonal rabbit anti-CD31, which stained vessels. Gene expression for NGF, high-affinity tyrosine kinase receptor （trkA）, p75 neuretrophin receptor （p75NTR）, bradykinin receptor-1 （BKR-1）, and 2 （BKR-2）, as well as substance P receptor （neurokininl receptor, NK1-R）, were detected by reverse transcription-polymerase chain reaction. NGF-13 protein expression was detected by Western blot analysis. RESULTS： More nerve fibers were stained with PGP9.5 in the endometrium and myometrium, and with SP in the endometrium, in adenomyosis mice compared with controls （P 〈 0.01 and P 〈 0.05）. Microvessel density in the myometrium of adenomyosis mice was significantly greater than the controls （P 〈 0.01）. In the uterus of adenomyosis mice, mRNA expression of NGF and its two receptors （trkA and p75 NTR）, BKR-1, and NK1-R, as well as protein expression of NGF-β, were greater than the control mice （P 〈 0.01 or P 〈 0.05）. CONCLUSION： Uterine innervation in the adenomyosis mice was increased compared with the controls. Moreover, NGF expression, inflammation, and vascularization, which have been shown to be impact factors of innervation, were abnormal in the uteri of adenomyosis mice.

Intrauterine cystic adenomyosis:Report of two cases

BACKGROUND Cystic adenomyosis is a special type of adenomyosis. Its clinical manifestations lack specificity. Pelvic ultrasound and nuclear magnetic resonance imaging can help clarify the diagnosis. Because cystic uterine adenomyosis is rare in clinical work, it can be easily misdiagnosed or its diagnosis can be missed. Early surgical treatment and postoperative drug treatment can alleviate dysmenorrhea,menorrhagia, anemia, and other symptoms.CASE SUMMARY Two cases complained about abnormal vaginal bleeding and were diagnosed with intrauterine cystic adenomyosis by gynecological ultrasound and pathological examination. The clinical manifestations included dysmenorrhea,hypermenorrhea, and a history of cesarean section. Both cases underwent a surgery, and chocolate-like liquid was released from the cystic mass in the uterus and the manifestations were relieved.CONCLUSION Intrauterine cystic adenomyosis could be diagnosed by pathological examination and treated by hysterectomy or hystscopy to release the liquid inside.

Acute recurrent cerebral infarction caused by moyamoya disease complicated with adenomyosis:A case report

BACKGROUND Moyamoya disease is essentially an ischemic cerebrovascular disease.Here,we describe a case of acute recurrent cerebral infarction caused by moyamoya disease with concurrent adenomyosis which,to our knowledge,is the first in the literature.A literature review is also presented.CASE SUMMARY A 38-year-old female presented to the Research and Treatment Center of Moyamoya Disease in our hospital with"left limb weakness"as the main symptom.She was diagnosed with acute cerebral infarction and moyamoya disease through magnetic resonance imaging and digital subtraction angiography.Prior to this,she had experienced a prolonged menstrual period of one-month duration.This was investigated and adenomyosis was diagnosed.After passing the acute cerebral infarction phase,the patient underwent surgery for adenomyosis followed by combined cerebral revascularization.During the postoperative follow-up,improvements of the perfusion imaging stage and modified Rankin Scale were observed.A review of the literature showed only 16 reported cases of gynecological diseases complicated with stroke.The clinical characteristics,pathogenesis,therapeutic effects,and long-term prognosis of these cases have been studied and discussed.CONCLUSION In patients with moyamoya disease,early management of gynecological-related bleeding disorders is essential to prevent the complications of cerebral events.

Giant exophytic cystic adenomyosis with a levonorgestrel containing intrauterine device out of the uterine cavity after uterine myomectomy: A case report

BACKGROUND A cystic lesion arising from the myometrium of the uterus, termed as cystic adenomyosis, has chocolate-like, thick viscous contents and contains various amounts of endometrial stroma below the glandular epithelium. It is an extremely rare type of adenomyosis.CASE SUMMARY Herein, we report an unusual case of a giant cystic mass in the pelvic cavity after uterine myomectomy. The patient complained of abnormal uterine bleeding and severe dysmenorrhea. After a levonorgestrel-containing intrauterine device(LNG-IUD) was inserted, her symptoms were greatly alleviated. However, the LNG-IUD was detected in the cystic cavity during the follow-up. For fear of the intrauterine device migrating into and damaging the surrounding viscera,surgical treatment was proposed. Therefore, laparoscopic resection of the lesion and removal of the LNG-IUD were performed and cystic adenomyosis with an LNG-IUD out of the uterine cavity was diagnosed.CONCLUSION We believe that myomectomy breaking through the endometrial cavity may have been a predisposing factor for the development of cystic adenomyosis in this case.

Ultrasound-guided microwave ablation for symptomatic adenomyosis:More areas of concern for more uniform and promising outcomes

Adenomyosis is a common gynecological disease in reproductive women,which causes serious dysmenorrhea,menorrhagia,anemia,and infertility,and has a serious impact on the physical and mental health of women.Considering that the efficacy of the traditional medication and surgical treatment is not ideal,an increasing number of patients are searching for more effective and less invasive therapies.Ultrasound(US)-guided microwave ablation(MWA)has emerged as a new effective and minimally invasive alternative treatment for symptomatic adenomyosis,and it is widely being used in clinical settings.Several studies have proven that it is an efficient and safe treatment modality for symptomatic adenomyosis,but a significant variance in clinical outcomes reported in previous studies was also observed.Herein,we have analyzed the potential causes of this problem from the aspects of the diagnosis of adenomyosis,symptom evaluation before ablation,steps of USguided ablation treatment,and outcome evaluation after ablation.Simultaneously,the clinical problems existing in the ablation treatment of adenomyosis are discussed,and the directions of future research are pointed out.

Preoperative MRI Classification May Not Predict Symptom Relief after Uterine Artery Embolization in Patients with Adenomyosis

Objective:To investigate the association between magnetic resonance imaging(MRI)classification and symptom relief after uterine artery embolization(UAE)in patients with adenomyosis.Methods:Totally,73 patients with symptomatic adenomyosis who underwent UAE were retrospectively analyzed.Preoperative MRI classification was defined as:type Ⅰ,high signal on both T2-weighted images(T2WI)and T1-weighted images(T1WI);type Ⅱ,high signal only on T2WI,and type Ⅲ,high signal on neither T1WI nor T2WI.Dysmenorrhea was measured with the visual-analog scales and the degree of menorrhagia was measured according to the number of sanitary pads used in one menstrual cycle.Dysmenorrhea and menorrhagia were measured before UAE and 12 months after UAE.Results:The number of the type Ⅰ,Ⅱ,Ⅲ cases was 23,37,and 13,respectively.The baseline characteristics of the three groups exhibited no significant difference.The alleviation rates of dysmenorrhea among type Ⅰ,Ⅱ,Ⅲ cases were 73.9%,89.2%,and 84.6%,respectively(P=0.455).The alleviation rates of menorrhagia for type Ⅰ,Ⅱ,Ⅲ were 69.6%,78.4%,and 92.3%,respectively(P=0.714).Conclusion:Pre-procedure MRI classification and symptom relief after UAE exhibited no significant association.UAE has a favorable mid-term control on dysmenorrhea and menorrhagia among patients with adenomyosis.Preoperative MRI classification might not indicate symptom relief.More research is needed before changing clinical practice.

Evaluating the clinical efficacy of Thunder-Fire moxibustion combined with ovulation monitoring in the treatment of adenomyosis combined with infertility

This study evaluated the clinical efficacy of Thunder-Fire moxibustion combined with ovulation monitoring for the treatment of adenomyosis-associated infertility.A series of 120 patients diagnosed with uterine adenomyosis and infertility and cold coagulation blood stasis syndrome in traditional Chinese medicine(with the clinical manifestations of premenstrual or menstrual lower abdomen cold pain,pain reduction with heat application,and cold extremities)were randomized equally to treatment group with Thunder-Fire moxibustion and ovulation monitoring as well as control group with ovulation monitoring only.Treatment continued for six menstrual cycles.The pregnancy rate of the treatment group was significantly increased with the control group(50.0%vs.23.3%,P=0.021).Dysmenorrhea and the traditional Chinese medicine syndrome in the treatment group improved significantly compared with the control group(3.87±2.03 vs.5.70±1.01,P=0.002 and 7.33±4.11 vs.10.52±2.33,P=0.006,respectively),and there was also significant between-group differences in serum cancer antigen 125(55.45±14.65 vs.63.34±11.41,P=0.031).However,the average uterus diameters in the treatment and control groups were not significantly different(67.13±7.59 vs.69.89±5.30,P=0.137).Thunder-Fire moxibustion with ovulation monitoring improved the pregnancy rate of patients diagnosed with adenomyosis-associated infertility.

Association between etiopathogenesis of morbidly adherent placenta and adenomyosis

The association between etio-pathogenesis of morbidly adherent placenta (MAP) or placenta cretas and adenomyosis has never been described in medical literature. Contrary to the believe that MAP is due to direct invasion of trophoblastic tissues into the adjacent normal myometrium due to prior uterine surgeries, this article describes how pre-existence of adenomyosis acts as a precursor for the development of placenta cretas. It elucidates how prior uterine traumas such as surgeries, repeated childbirths and endometritis cause endometrial tissues to invade the myometrium as a result of disruption of decidua basalis. The invaded endometrial tissues cause hyper-plasia and hypertrophy of surrounding myometrium to form the clinical entity called adenomyosis. The over-expression of bcl-2 oncogene in the endometrium causes inhibition of apoptosis of endometrial cells removing the barrier of trophoblastic tissues to invade the myometrium to form MAP. This hypothesis is based on the similarity of their clinical perspectives, similar pathological description of the two disease entities and their common molecular components. Both diseases increase with age;more in women older than 35 years and also in those with history of previous endometrial traumas such as surgeries, childbirth and endometritis. Both diseases also share common pathological factors and molecular components due to absence of deciduas basalis and over-expression of bcl-2 oncoprotein gene, inhibition of cell apoptosis and failure to find genetic abnormalities such as mutations of K-ras, P53 or LOH. An ongoing study looking at uterine specimens from cesarean hysterectomies and pelvic MRI evaluation of patients with retained placentas to prove that pre-existing adenomyosis may be a precursor to the development of morbidly adherent placenta is near to conclusion.

Pathogenesis and treatment status of adenomyosis complicated with infertility

Adenomyosis (AD) refers to the endometrium (including glands and stroma) into myometrium gr owth of pathological changes, with the delay of women's childbea ring age, the pa ti ents with AD-associated infertility increased significantly. Although scholars disagreed about the effect of AD on infertility, more and more evidence showed that AD was closely related to the str uct ural and func ti onal defects of the eutopic endomet rium and myomet rial junc tional zone (MJZ), which may lead to embryo implantation failure and infertility. With the rapid development of imaging technology, the accuracy of diagnose AD has been enhanced, more and more infertility patients were diagnosed with AD. At the same time, a series of pathogenic hypothesis have been proposed to explain the relationship between AD. In addition, AD may influence the patient's reproductive function by affecting sperm transport, embryo implantation, altering uterine peristalsis, influencing the structure and function of endometrium, and changing the intrauterine environment. At present, the treatment of AD-associated infertility is similar to the treatment of AD. The commonly used treatment methods include drug therapy, conservative operative treatment, drug combination surgery, and Chinese medicine treatment and so on. The clinical and experimental studies of AD complicated with infertility and its possible pathogenesis and treatment in recent years are reviewed in this article.

Evaluation of the Impact of Laparoscopic Supracervical Hysterectomy for the Treatment of Adenomyosis on Pain Intensity and Patient Satisfaction

Objectives. Common symptoms of adenomyosis include pain and bleeding disorders and can severely impact a patient’s quality of life. Few studies report on the impact of hysteroscopy procedures on improving these symptoms. This study evaluates the effect of laparoscopic supracervical hysterectomy (LASH) in adenomyosis patients on pain in general, pain during intercourse, bleeding disorders and general satisfactoriness of the procedure. Methods. This prospective observational single-arm, single-center study included 256 patients treated with LASH and whose histological analysis revealed adenomyosis. Other inclusion criteria were completed family planning and no more symptom relief with conservative therapy. They completed questionnaires before and after the procedure which evaluated pain in general, pain during intercourse, bleeding disorders and general satisfactoriness of the procedure. Results. Our results showed a significant (p Conclusion. As a minimal invasive procedure associated with low major complication rates, LASH is a qualified therapeutic choice to treat pain and bleeding disorders in adenomyosis patients with completed family planning and in where conservative therapy failed.

Transcervical Interstitial Microwave Ablation Therapy for the Treatment of Adenomyosis: A Novel Alternative to Hysterectomy

Objectives: To investigate the clinical effects of transcervical interstitial microwave irradiation of adenomyotic tissues as an alternative to hysterectomy. Methods: Thirty-three patients who were candidates for hysterectomy for the treatment of adenomyosis associated with menorrhagia were treated by interstitial microwave irradiation using a specifically developed transabdominal ultrasound probe attachment for transcervical puncture along with microwave endometrial ablation, as an alternative to hysterectomy. Primary outcomes were changes in the venous hemoglobin level and the volume of the uterine body before and after treatment. Secondary outcomes were the visual-analogue scale (VAS) score for menorrhagia and dysmenorrhea after treatment. Results: At 3 months after surgery, the average hemoglobin level significantly increased by 4.6 g/dL. The volume of the uterine body significantly decreased to 53% and 52% of the volume before treatment at 3 and 12 months, respectively. VAS scores indicated an improvement in menorrhagia and dysmenorrhea. Conclusions: Transcervical interstitial microwave ablation therapy combined with microwave endometrial ablation reduced the uterine body volume and relieved menorrhagia and dysmenorrheal caused by adenomyosis. This strategy is a promising alternative to hysterectomy for the treatment of symptomatic adenomyosis.

Effects of LNG-IUS combined with TCRE on ovarian function, MMP and related factors in patients with adenomyosis

Objective: To observe the effect of combined therapy regimen on ovarian function, MMP and related factors in patients with adenomyosis under the condition of LNG-IUS drug therapy. Methods: A total of 110 patients with adenomyosis from October 2015 to October 2017 were retrospectively analyzed and divided into control group and observation group. The control group of 54 patients, observation group of 56 patients. All patients were treated with LNG-IUS system in the 4th to 7th day of the menstrual cycle. The patients in the observation group were treated with TCRE on the basis of LNG-IUS. The fasting venous blood was taken from the third day of menstruation and the luteinizing hormone (LH (MMP-2, MMP-3, MMP-9) were detected by enzyme-linked immunosorbent assay (ELISA). The levels of VEGF, CA125 and IGF-1 were detected by enzyme-linked immunosorbent assay (ELISA) Ang-2, PGE2 levels were compared. Results: There was no significant difference in LH, FSH and E2 levels between the two groups before treatment. After treatment, the levels of LH, FSH and E2 were significantly higher in the two groups compared with those before treatment. (2) Before treatment, the levels of serum MMP-2, MMP-3, MMP-2 and MMP-2 in the two groups were significantly higher than those in the control group. The levels of MMP-2, MMP-3 and MMP-9 in the serum of the two groups were significantly lower than those before treatment, and there was no significant difference between the two groups. (3) Before treatment, serum levels of VEGF, CA125, IGF-1, Ang-2 and PGE2 in the two groups were significantly lower than those in the control group. The levels of serum VEGF, CA125, IGF-1, Ang-2 and PGE2 in the two groups were significantly lower than those before treatment. The patients in the observation group were significantly lower than the control group, there was significant difference between the two groups. Conclusion The levels of serum MMP-2, MMP-3, MMP-9 and VEGF, CA125, IGF-1, Ang-2 and MMP-2 in patients with adenomyosis were treated with TCRE on the basis of LNG-IUS drug therapy. PGE2 level, indicating that TCRE combined with LNG-IUS drug therapy can not only improve the efficacy, improve the patient's menstrual flow, dysmenorrhea and other symptoms, control the progression of the disease, but also by regulating the expression of certain factors play a role in improving ovarian function, worthy of clinical On the promotion and application.

Clinical Efficacy of Dienogest and Levonorgestrel-Releasing Intrauterine System in the Treatment of Adenomyosis

Objective:To compare the clinical efficacy and adverse reactions of dienogest and levonorgestrel-releasing intrauterine system in the treatment of adenomyosis.Methods:A total of 60 cases of adenomyosis admitted to Dezhou Women and Children’s Hospital from January 2020 to October 2021 were selected and randomly divided into two groups(Group A and Group B),which were initiated on dienogest and levonorgestrel-releasing intrauterine system,respectively.The therapeutic effects and adverse reactions of the two groups were analyzed.Results:After 6 months of treatment,the uterine volume in the LNG-IUS group reduced slightly compared with that before treatment,with no statistical significance(p>0.05),while that in the DNG group increased slightly compared with that before treatment,with no statistical significance(p>0.05).After 6 months of treatment,the hemoglobin of patients in both groups increased compared with that before treatment;there was no significant difference in the DNG group(p>0.05),but there was significant difference in the LNG-IUS group(p<0.01).After 6 months of treatment,the VAS scores of the two groups were significantly lower than those before treatment(p<0.01);the serum CA125 level in both groups decreased significantly compared with that before treatment(p<0.01).Conclusion:Mirena(levonorgestrel-releasing intrauterine system)has better therapeutic effect on adenomyosis and fewer adverse reactions than deinogest.

Comprehensive transcriptional atlas of human adenomyosis deciphered by the integration of single-cell RNA-sequencing and spatial transcriptomics

Adenomyosis is a poorly understood gynecological disorder lacking effective treatments.Controversy persists regarding“invagination”and“metaplasia”theories.The endometrial-myometrial junction(EMJ)connects the endometrium and myometrium and is important for diagnosing and classifying adenomyosis,but its in-depth study is just beginning.Using single-cell RNA sequencing and spatial profiling,we mapped transcriptional alterations across eutopic endometrium,lesions,and EMJ.Within lesions,we identified unique epithelial(LGR5+)and invasive stromal(PKIB+)subpopulations,along with WFDC1+progenitor cells,supporting a complex interplay between“invagination”and“metaplasia”theories of pathogenesis.Further,we observed endothelial cell heterogeneity and abnormal angiogenic signaling involving vascular endothelial growth factor and angiopoietin pathways.Cell-cell communication differed markedly between ectopic and eutopic endometrium,with aberrant signaling in lesions involving pleiotrophin,TWEAK,and WNT cascades.This study reveals unique stem cell-like and invasive cell subpopulations within adenomyosis lesions identified,dysfunctional signaling,and EMJ abnormalities critical to developing precise diagnostic and therapeutic strategies.

Influence of assisted reproductive technology and uterine leiomyoma on pregnancy outcomes in women with adenomyosis

Aim To assess whether adverse pregnancy outcomes in women with adenomyosis are different according to the method of conception and the concurrent of uterine leiomyoma(UL).Methods We performed a retrospective study.Fifty-three singleton pregnancy cases complicated with adenomyosis were included in this study.In the study group,15 women became pregnant with assisted reproductive technology(ART)and 21 women combined with UL.Pregnancy outcomes were compared between ART and non-ART,UL and non-UL groups.Results The prevalence for such complications as hypertensive disorder complicating pregnancy(HDCP)and postpartum hemorrhage(PPH)were significantly higher in the women conceived by ART(33.3%vs.5.3%,P​=​0.023)and(53.3%vs.23.7%,P​=​0.037),respectively.And women concurrent with UL of which the diameter≥4​cm were more likely to have severe PPH(44.4%vs.0%,P​=​0.021).Conclusion ART may increase the risk of adverse pregnancy outcomes such as HDCP and PPH in women with adenomyosis and UL of which the diameter≥4​cm may further increase the risk of severe PPH.

Twenty-three cases of adenomyosis treated by acupuncture

Objective To explore the efficacy of adenomyosis treated by acupuncture.Methods Acupuncture combined with TDP was applied to the adenomyosis patients.Taichong（太冲 LR 3）,Taixi（太溪 Kl 3）,Sanyinjiao（三阴交 SP 6） and Hegu（全谷 LI 4） were selected and TDP was applied to the patients with waist and abdominal chill.The efficacy was evaluated.Results Twenty-three cases were treated,16 cases were cured,7 cases were improved and 0 cases were ineffective,the total effective rate was 100%.Conclusion Acupuncture combined with TDP has sound effect in the treatment of adenomyosis.

Pyomyoma as a Complication of Uterine Artery Embolization (A Case Report)

Pyomoyoma is a rare complication of Uterine Artery Embolization (UAE). This case report reflects on this condition. A 45-year-old female, a known case of adenomyosis, presented with intermittent fever and foul vaginal discharge. These symptoms occurred shortly after the patient underwent UAE for menorrhagia secondary to adenomyosis. Computed tomography scan of the abdomen and pelvis aided in the diagnosis of Pyomyoma secondary to UAE. After a trial of broad spectrum antibiotics and Suction and Evacuation of the uterus had little to no help in the patient’s condition, she underwent Total Abdominal Hysterectomy in which a big, organized pus collection was removed from the uterus. Conclusion: Pyomyoma should be considered in the differentials for patients presenting with fever and vaginal discharge post UAE.

Menorrhagia and Uterine Volume Associated with Lower Urinary Tract Symptoms in Patients with Adenomyosis

Background： Adenomyosis is a gynecological disorder with symptoms most presenting as dysmenorrhea and heavy menstrual bleeding. However, the presence of lower urinary tract symptoms （LUTS） among women with adenomyosis remains unclear. This study was designed to determine the prevalence of LUTS and factors related to the severity of these symptoms in this population. Methods： From July 2016 to November 2016, a total of 298 untreated symptomatic adenomyosis patients and 280 age-matched controls were enrolled. Demographics, LUTS, pain symptoms, ultrasouographic uterine size, and serum CA125 level were recorded. LUTS were evaluated using the International Prostate Symptom Score （IPSS） questionnaire. Factors related to the severity of LUTS were detected using the logistic regression analysis presented as odds ratio （OR） and 95% confidence interval （CI）. Results： Compared with the control group, patients with adenomyosis had a greater IPSS total （4 [2-8] vs. 2 [0-3], Z = -8.159, P 〈 0.001 ）, IPSS storage （2 [1-4] vs. [[0 2], Z = -7.361 [P 〈 0.001）, and I PSS voiding （2 [0-4] vs. 0 [0-1], Z = -7.[94, P 〈 0.001）. Of the patients with adenomyosis, 30.2% had moderate-to-severe lower urinary tract symptoms （IPSS 〉8）. The most prevalent LUTS were daytime frequency （40.9%）, lbllowed by nocturia （24.8%）, weak stream （24.2%）, and incomplete emptying （23.5%）. In study group, patients with an IPSS total score ≥8 had higher proportion of menorrhagia （51.1% vs. 30.8%, χ2 = 11. 162 P = 0.025） and larger uterine volumes （183.3 [109.8-273.8] cm3 vs. 148.5 [96.4-262.7] cm3, Z=- 1.441, P = 0.150） compared to patients with an IPSS total score 〈8. On multivariate logistic regression analysis, patients with menorrhagia were associated with an increased risk of an IPSS total score 〉8 （OR： 2.309, 95% CI： 1.310-4.070, P= 0.004）, an IPSS storage subscore 〉4 （OR： 2.422, 95% CI： 1.395-4.206, P= 0.002）, and an IPSS voiding subscore 〉5 （OR： 1.971, 95% （CI： 1.176-3.302, p= 0.010）. However, patients with uterine volume more than 180 cm3 had more than 2-fold risk of bearing IPSS total score ≥8 （OR： 2.437, 95% CI： 1.381-4.300, P = 0.002）, 1PSS storage subscore 〉4 （OR： 2.486, 95% CI： 1.433-4.314, P =0.001）, and IPSS voiding subscore ≥5 （OR： 2.700, 95% （CI： 1.485-4.908, P=0.001）. Conclusions： Lower urinary tract synaptoms are prevalent in patients with symptomatic adenomyosis and greatly affect patients＇ quality of life. Menorrhagia and large uterine volume could be potential risk factors that increase the occurrence of moderate-to-severe LUTS.