Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment:A prospective study

Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various symptoms such as abnormal uterine bleeding,pelvic pain,infertility,and pregnancy complications.The treatment options for uterine fibroids include medical therapy,surgical intervention,and minimally invasive techniques.AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization(UAE).METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE,and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments.The two groups were matched for age,body mass index,parity,and baseline characteristics of uterine fibroids.The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Müllerian hormone(AMH),as well as ovarian reserve tests,such as antral follicle count(AFC)and ovarian volume(OV).The secondary outcome was fertility that was evaluated based on the menstrual cycle,ovulation,conception,pregnancy,and delivery.The participants were followed-up for 36 months and assessed at 1,3,6,12,24,and 36 months after treatment.RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women,resolving within a week.No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones(FSH,LH,E2,AMH)and ovarian reserve indicators(AFC,OV)at any point up to 36 months post-treatment.Additionally,there were no significant differences in conception,pregnancy,or delivery rates,with the average time to conception and gestational age at delivery being similar between the two groups.Birth weights were also comparable.Finally,there was no significant correlation between ovarian function,fertility indicators,and the type or amount of embolic agent used or the change in fibroids posttreatment.CONCLUSION UAE resulted in significantly positive pregnancy outcomes,no adverse events post-treatment,and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

Associated Factors and Consequences of Uterine Fibroids in Hospitals in the Borgou Department of Benin in 2022

Introduction: Uterine fibroids are the most common gynecological tumors in women of childbearing age and have multiple clinical manifestations. Objective: To determine factors associated with uterine fibroids in the Borgou department of Benin in 2022. Method: Descriptive, analytical cross-sectional study from August 22 to September 22, 2022. The sample consisted of women consulting for gynecological problems in 6 hospitals in the Borgou department in the North of Benin. Results: Of the 744 women surveyed, 10.1% were diagnosed with uterine fibroids. Women with uterine fibroids were often married, paucigesture, and nulliparous. Their main reasons for consultation were the desire for motherhood (50.7%), pelvic pain (46.7%), and genital hemorrhage (14.7%). Age, history of miscarriage, high blood pressure, and diabetes were significantly associated with the presence of uterine fibroids (Conclusion: Uterine fibroids are common in hospitals in northern Benin. There were factors associated with them that should be taken into account in management strategies.

Evaluation of the Efficacy and Effectiveness of Hysteroscopic Electroresection in the Treatment of Submucosal Uterine Fibroids

Objective:To evaluate the effect of hysteroscopic electroresection in treating submucosal uterine fibroids.Methods:Using the random number table method,70 patients with submucosal uterine fibroids were divided into two groups,35 cases/group.The control group underwent laparoscopic myomectomy,and the observation group underwent hysteroscopic electroresection.Surgical indicators,sex hormone indicators,inflammation indicators,and treatment effects were compared between the two groups.Results:The surgical indicators,sex hormone indicators,and inflammatory indicators three months after operation in the observation group were all more ideal than those of the control group.The total effective rate of the observation group(97.14%)was higher than that of the control group(P<0.05).Conclusion:Hysteroscopic electroresection for the treatment of submucosal uterine fibroids was less invasive,accelerates recovery,and is more effective.

Discussion on the Application of Operating Room Nursing in Patients with Uterine Fibroids and Diabetes

Objective: To analyze the application value of surgical nursing in patients with uterine fibroids and diabetes. Method: Sixty diabetic patients who agreed to undergo surgery for uterine fibroids at the Sun Yat-sen University Cancer Center from January 2021 to May 2022 were randomly selected as the study subjects. According to criteria such as number of patients, age, nursing methods, and treatment methods, the patients were evenly divided into an observation group and a control group. The control group received routine nursing measures, while the observation group received focused surgical nursing measures based on the routine ones. The blood glucose and blood lipid metabolism status, the incidence of adverse reactions, and nursing satisfaction were compared between the two groups. Results: The blood glucose and blood lipid metabolism status of the observation group were safer than those of the control group (P < 0.05). The observation group had advantages in terms of the incidence of adverse reactions and nursing satisfaction compared to the control group (P Conclusion: Systematic surgical nursing for patients with uterine fibroids and diabetes during surgery can help patients control their blood glucose and blood lipid metabolism status, reduce the incidence of adverse reactions, and improve the patient’s experience during the treatment stage.

Surgical Management of Uterine Fibroids: About 175 Cases

Background: Uterine fibroids are a common condition in Senegal and often symptomatic. Our study aims to determine the epidemiological profile, to clarify the diagnostic aspects and to evaluate the surgical management of patients with uterine fibroids. Patients and Method: We carried out a retrospective and descriptive study carried out over a period of 30 months, from August 1, 2017 to January 31, 2020, concerning all patients who underwent surgery for the treatment of uterine myomatosis in the department of Gynecology Obstetrics of the Hospital Principal of Dakar. The data was collected from the patients’ medical records and analyzed using Excel version 2016 and R version 4 software. Results: We collected 175 surgical interventions for uterine fibroids, representing 44.7% of gynecological interventions. Most of the patients were between 30 and 39 years old, with an average age of 39 years. The nulliparous were the majority with 64.6%. The clinical symptomatology was represented by genital bleeding (32.6%), pelvic pain (18.85%) and infertility (12.6%). The diagnosis was confirmed by pelvic ultrasound in all patients with variable myoma topography. A myomectomy was performed in 82.3% of cases and a total hysterectomy in 17.7%. The postoperative course was simple in 94.2% of cases, and the results of treatment revealed a disappearance of symptoms in 94.3% of cases. Conclusion: Surgery occupies a prominent place in the management of uterine fibroids.

Sigmoid Volvulus, Intestinal Obstruction and Bowel Perforation;an Unusual Presentation of Pedunculated Fibroid Torsion. Case Report

Pedunculated fibroid torsion presenting as a case of acute abdomen from sigmoid volvulus and large bowel perforation is rare. Without prompt diagnosis and intervention, this could lead to serious morbidity and mortality. Ms FM was a 52-year-old perimenopusal woman who was admitted to the Intensive Therapy Unit (ITU) with worsening symptoms of confirmed Covid-19 infection. On the 10th day of her admission, she developed abdominal distension and tenderness. A pelvic ultrasound scan showed a large pedunculated fibroid measuring 23 × 15 × 22 cm. The plan was for conservative management to use pain killers. Following deterioration of her clinical state, an abdominal CT scan was done which confirmed a large uterine fibroid, large bowel distention. CT findings also showed sigmoid volvulus and large bowel perforation. Following a multidisciplinary team assessment, she had an emergency exploratory laparotomy with findings of a large, torted, pedunculated fibroid with adherent sigmoid colon which had become twisted and obstructed. The large bowel segment above the Sigmoid volvulus was grossly distended and there was a gangrenous hepatic flexure with perforation. She had a right hemicolectomy, a de-functioning colostomy and subtotal hysterectomy. Postoperatively, she made very good clinical improvement. Fibroid histology report showed tissue infarction and necrosis which confirmed the torsion. She was discharged home after making good recovery.

Dynamic enhanced computed tomography imaging findings of an inflammatory fibroid polyp with massive fibrosis in the stomach

Inflammatory fibroid polyp(IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography(CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis. The authors suggest that when the submucosal layer of the gastric wall is markedly thickened with delayed enhancement and preservation of the mucosal layer, an IFP with massive fibrosis should be considered in the differential diagnosis.

Successful laparoscopic management of hemoperitoneum due to spontaneous venous rupture overlying a uterine fibroid

Spontaneous venous rupture overlying a uterine fibroid is a rare cause of hemoperitoneum. A 38-year-old woman presented to the emergency department with acute onset of abdominal pain. The ultrasound revealed multiple fibroids and free fluid in the peritoneum. There was a significant drop of the hemoglobin and hematocrit. The patient underwent emergent exploratory laparoscopy. A subserosal uterine leiomyoma was found, with a bleeding vein on its basis and massive hemoperitoneum. Laparoscopic myomectomy was successfully performed with local injection of vasopressin and intraoperative autologous blood transfusion. This case suggests that spontaneous intraperitoneal haemorrhage associated with uterine fibroids, although rare, should be considered in women with hypovolemic shock and a pelvic mass.

Inflammatory fibroid polyps in children:A new case report and a systematic review of the pediatric literature

AIM: To study that inflammatory fibroid polyps(IFPs) in children are extremely uncommon tumors that may occur throughout the gastrointestinal tract. METHODS: A systematic review of the pediatric literature and a report of a new case of IFP is also pres-ented. The Pub Med database was searched for original studies on pediatric IFPs since 1960, according to "Preferred reporting items for systematic reviews and meta-analyses" guidelines for systematic reviews. RESULTS: Five studies were finally enclosed, encompassing 6 children with IFPs(mean age 64 mo). Tumors were located in the stomach(2 patients), in the small bowel(2 patients), in the rectum(1 patient) and in the colon(1 patient). Open surgery was performed in all patients and complete excision of the mass was achieved in all cases. All patients are alive and free of symptom. Authors described a further case of a 3-year-old boy with a large duodenal IFP, in whom the tumor was removed by "en block resection". The presence of IFP throughout the gastrointestinal tract and its variable clinical appearances make it difficult to diagnose. An accurate pre-operative assessment is fundamental in order to differentiate IFP from other more aggressive gastrointestinal tumor, enabling unnecessary demolitive surgery. CONCLUSION: When complete resection of the IFP is achieved, the prognosis is excellent.

Tranexamic acid for the management of uterine fibroid tumors:A systematic review of the current evidence

AIM: To conduct a detailed systematic review of the current evidence on the administration and efficacy of tranexamic acid in patients with menorrhagia due to uterine fibroids. METHODS: We conducted an electronic search on the following databases Pub Med and Medline(1950-2013);(1980-2013); Cochrane library(1993-2013). RESULTS: A total of 36 articles were retrieved after the initial electronic search. Careful assessment of the retrieved studies led to the final selection of 5 articles for inclusion in the review. CONCLUSION: Tranexamic acid may reduce blood loss perioperatively in myomectomies. It may reduce the menorrhagia in patients with fibroids, however a stratification of fibroids by size and location is required to define the responses. It is safe in general, with mild adverse effects observed in some cases. More studies with a double-blind randomized design and larger numbers of participants are necessary to reach more precise and safe conclusions.

Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment:A case report

BACKGROUND High-intensity focused ultrasound(HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids.Although this procedure is safe and effective,adverse outcomes are becoming a major problem.CASE SUMMARY We present a case of ventral hernia that occurred as a rare and delayed complication of HIFU ablation for uterine fibroids treatment.The patient came to the hospital with abdominal bloating that occurred 6 mo after ultrasound-guided HIFU ablation for managing uterine fibroids.The ventral hernia,which occurred due to atrophied muscle layers following the procedure,was confirmed by imaging studies and intraoperative findings.She required a hernia repair with mesh and hysterectomy for definitive treatment of uterine fibroid.CONCLUSION High-intensity ultrasound ablation should be performed only on appropriate candidates.Patients should be educated about potential complications of the procedure and the possibility of subsequent treatment.Post-procedural long-term follow-up for detecting delayed adverse effects is important.

Broad Ligament Fibroid Mimicking as Ovarian Tumour

Background: Giant fibroids usually arise from the uterus, and very rarely can also arise from the broad ligament. Large fibroids can undergo hyaline, cystic degeneration and very rarely red degeneration. Case Report: In our case, ovarian neoplasm of the ovaries was suspected, as an adnexal mass with cystic degeneration and intervening septations were seen which were not separate from the lesion. The MRI findings were also characteristic of ovarian neoplasm. Giant fibroid with cystic degeneration was a rare differential diagnosis. Broad ligament fibroid excision, total abdominal hysterectomy, and bilateral salpingo-oophorectomy were performed on the patient. The diagnosis was confirmed on histopathological examination. Conclusion: Broad ligament leiomyoma should be kept as an important differential diagnosis for solid adnexal or ovarian masses.

Percutaneous Ultrasound-Guided Radiofrequency Thermal Ablation for Treatment of Uterine Fibroids

Purpose: To assess the safety, efficacy and effectiveness of percutaneous radiofrequency (RF) thermal ablation to reduce symptoms of uterine fibroids. Materials and Methods: 17 premenopausal women with symptomatic uterine fibroids despite conventional medical treatment were included. The assessment of symptoms and characteristics of fibroids by vaginal ultrasound, magnetic resonance imaging (MRI) and contrast enhanced ultrasound (CEUS) was performed before starting treatment and 6 months after the procedure. Successful treatment was clinically considered if patients reported a reduction in symptoms 6 months after RF myolysis. Successful treatment was also considered if the necrosis of the fibroid was greater than 50%, 6 months after treatment. Results: The baseline score on visual analogue scale (VAS) for dysmenorrhea and intermenstrual pain was 5.76 ± 3.31 and 3.0 ± 3.4, respectively. According to a score of 0 - 3, baseline bleeding during menstruation was 2.29 ± 0.92. Six months after RF myolysis, the VAS for dysmenorrhea was 2.75 ± 3.32 (p = 0.004), whereas for intermenstrual pain it was 1.38 ± 2.56 (p = 0.02). Menstrual bleeding was reduced to 1.13 ± 0.89 (p = 0.005). Clinical success of the treatment was evident in 11 (64.7%) of the 17 patients with a 95% CI [38.6%, 84.7%]. Fourteen patients underwent MRI monitoring 6 months post-myolysis. Compared to baseline fibroid volume, ultrasound and MRI volume were 57.38% and 79.66% six months after surgery, respectively. A total of 13 patients (92.86%) had radiological success from the treatment (95% CI [64.2%, 99.6%]). Conclusion: Since percutaneous RF myolysis reduces volume and symptoms of uterine fibroids, it may be considered as a valid treatment for symptomatic fibroids.

Ileo-Ileal Intussusception Caused by an Inflammatory Fibroid Polyp: A Case Report

Inflammatory fibroid polyps (IFP) are a rare benign entity that arises from the submucosa of the gastrointestinal tract and protrudes into the lumen. The clinical presentation depends on the size and localization. They are particularly found in the ileum, where they are frequently present as an ileal intussusception. We report the case of a 56-year-old female patient who presented with periumbilical pain along with multiple episodes of vomiting and chronic constipation. An abdominal CT scan revealed an ileo-ileal intussusception of an endoluminal hypodense lesion with mesenteric lymphadenopathy. Surgical treatment consisted of segmental ileal resection with primary anastomosis. The histopathological analysis revealed an inflammatory fibroid polyp in the ileum. Although these tumors have no malignant potential, surgery is always indicated in ileo-ileal intussusception to ascertain the histological nature of the lesion.

Laparoscopic myomectomy versus open myomectomy in uterine fibroid treatment: A meta-analysis

Objective:Uterine fibroids are the most commonly occurring benign solid tumors in women,and laparoscopic or open myomectomy constitutes the primary option for treatment.However,both methods are under debate currently in terms of efficacy and safety.In this meta-analysis we assessed the efficacy and safety of the two procedures.Methods:We conducted a comprehensive literature search of PubMed,ScienceDirect,and the Cochrane Library in December 2020.The search terms included“open myomectomy”,“myomectomies”,“laparoscopic”,and“uterine fibroids”.We then selected the randomized control trials published from 1996 to 2019 and compared laparoscopic and open myomectomies.Results:We included 10 studies of 449 patients who underwent laparoscopic myomectomy and 449 patients who underwent open myomectomy.The data revealed that laparoscopic myomectomy was associated with reduced blood loss(MD=-34.43;95%CI,-34.92 to-33.94;p<0.001),an attenuated decline in hemoglobin(MD=-1.04;95%CI,-1.14 to -0.93;p<0.001),less post-operative pain at 24 h(MD=-0.51;95%CI,-0.83 to -0.19;p=0.002),and fewer overall complications(OR=0.42;95%CI,0.24 to 0.71;p=0.001)relative to open myomectomy;but the former possessed a longer operative time(MD=12.96;95%CI,9.94 to 15.97;p<0.001).There were no significant differences in pregnancy rate(OR=1.39;95%CI,0.72 to 2.68;p=0.33)or recurrence rate of postoperative uterine fibroids(OR=1.15;95%CI,0.60 to 2.18;p=0.67)between the two groups.Conclusion:Laparoscopic myomectomy displayed superior results compared to open myomectomy,although the former involved a longer operating time.

MECHANISM IN PNEUMOTRANSPORT OF THE FIBROID SUBSTANCE

In this paper,the mechanism of pneumotransport of the fibroid material is discussed. It is thought that the motion of air relative to the material is the filtration of the air passing through the porous medium which is composed of the cluster of fibroid material. It is found that the deviations of the experimental data with the theoretical results are within experimental error.

INFLAMMATORY FIBROID POLYPS OF GASTRO-INTESTINAL TRACT

Objective: To review the diagnosis and differential diagnosis of inflammatory fibroid polyp (IFP) of gastrointestinal tract. Methods: The clinical symptoms, histopathologic features and immunohistochemical (ABC method) staining in 9 cases were observed. Results: IFP presented either as a solitary pedunculated or sessile lesion arising from the submucosa and protroding into the lumen; composed of a background of fibroblasts and blood vessels infiltrated by a variable number of inflammatory cells, often numerous eosinophilias leukocytes. Immunohistochemical staining: the spindle cells of all cases reacted with Vimentin. The partial cells of several cases react with Actin, NSE, a -AT. 7 cases were follow-up. No patients had a recurrence of the lesion. Conclusion: IFP are rare lesions, and may represent an exaggerated response to inflammatory or other injury process. The prognosis is good when treated by segmental resections of endoscopic removals.

A Rare Combination of Gastric Inflammatory Fibroid Polyp and Hiatal Hernia

Inflammatory fibroid polyp (IFP) is a rare solitary gastrointestinal lesion of unknown etiology. It generally presents as polypoid mass in the gastric antrum. Mostly affects adults at average age of 60 years. IFP can cause different symptoms such as abdominal pain, gastrointestinal bleeding, intestinal obstruction or intussusception. IFP is a bening lesion and it may rarely mimic the submucosal tumor. The diagnosis can be possible after removal of the detected lession either by laparoscopic or open approach. In the present paper, we report a patient with gastric IFP and hiatal hernia. IFP was excised throughout the gastrotomy and following hiatal hernia was repaired. According to our best knowledge, this may be the first case report of gastric IFP concomitance with a hiatal hernia.

Intra-ligamentous fibroid removed laparoscopically

In this paper, we report the case of a left round ligament fibroid in a 24 year-old, gravida 0, female that was successfully managed laparoscopically. Operative findings also included severe adnexal adhesions bilaterally, severe adhesions of the liver to the anterior abdominal wall (Fitz-Hugh-Curtis syndrome), pigmented areas on the left tube, uterus and posterior broad ligament (that proved to be endometriosis), and low capacity bladder (450 cc at 70 cm water pressure) with florid glomerulations and Hunner’s ulcers consistent with typical interstitial cystitis. Beside the feasibility of laparoscopic management of intra-ligamentous tumors this case highlights the common multifactorial nature of chronic pelvic pain and the frequent association of endometriosis and interstitial cystitis.

Huge Intravaginal Pedunculated Fibroid Embolization and Resectoscopy—A Case Report and Review of Literature

Background: Submucosal fibroids account for approximately 15 - 20 percent of total fibroids. Rarely, they prolapse. Common size is 2 - 6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibroids are associated with significant bleeding and pose a surgical challenge. Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter. She presented with metrorrhagia and an intense malodorous vaginal discharge, irresponsive to oral therapy. The patient had a history of resectoscopic fibroid enucleation, 7 months earlier, followed by insertion of an (intra-uterine device) IUD. There was no uterine prolapse. Management involved bilateral uterine artery embolization, followed by hysteroscopic excision with rigid resectoscope. The fibroid was “delivered” transvaginally intact. The uterus was preserved. The IUD was partly buried within the mass. Blood loss was negligible. Patient recovery was quick and uneventful. At 6-months follow up, pelvic anatomy has been restored. Conclusion: Large pedunculated fibroids are very rare. Embolization of uterine arteries has proven a valuable tool in challenging gynecologic operations. In our case, not only it prevented massive bleeding during excision, but also allowed a fertility-sparing minimally invasive management.