Feasibility of a new system of classification of submucous myomas: a multicenter study

Lasmar, Ricardo Bassil; Zhang, Xinmei; Indman, Paul D.; Celeste, Roger Keller; Sardo, Attilio Di Spiezio

doi:10.1016/j.fertnstert.2011.01.147

Cited by 81 publications

(32 citation statements)

References 11 publications

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“…(7) The second was multicenter, prospective study conducted in four hysteroscopy centers in Brazil, China, Italy, and the United States (465 submucous myomas removed hysteroscopically) and also it concluded that the STEPW classification was helpful in predicting which submucous fibroids would be incompletely removed by hysteroscopic myomectomy. (8) In this study, correlation of the 2 system classification was done with complete or incomplete myomectomy, length of surgery, fluid balance and surgical complication in Egyptian women undergoing hysteroscopic myomectomy and it agreed with the results and conclusion of the previous 2 multicenter studies. To sum up, STEPW classification of submucous fibroids-considering size, topography, extension, penetration and wall affected-seems to be a more reliable predictor of myoma removal and other outcome measures of hystroscopic myomectomy than ESES classification which only considers the penetration of the fibroid into the myometrium.…”

Section: Disscusionsupporting

confidence: 86%

“…Since then, only few studies have been conducted comparing the 2 classification systems. One study included only Brazilian women (7) and the other was a multicenter study conducted in China, Italy and United States as well as Brazil (8) . Both studies reached the same conclusion that STEPW classification allows better prediction of myoma removal, fluid balance, surgical complications and operative time in hystroscopic myomectomy than ESES classification.…”

Section: Introductionmentioning

confidence: 99%

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Submucous Fibroid: Different Presurgical Classification Methods and Their Effect on Hysteroscopic Surgical Management

Amin

Ahmed

Seksaka

et al. 2013

Zagazig University Medical Journal

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Objective: To compare the degree of difficulty and outcome measures of hysteroscopic myomectomy of submucous fibroid according to 2 classification systems. Methods: This prospective study conducted in the Cytogenetic & Endoscopy unit, Zagazig University Hospitals during the period from July 2009 to July 2012, included 100 patients candidates for hysteroscopic resection of submucous fibroids. All fibroids were diagnosed and assessed by saline infusion sonohysterography and diagnostic hysteroscopy. Presurgical classification was performed according to the two classification systems; the European Society of Endoscopic Surgery (ESES)-considering only the penetration of the fibroid into the myometrium -and STEPW considering size, topography, extension, penetration and wall affected. Primary outcome measure was incomplete resection of the fibroid. Secondary outcome measures were operating time (in minutes), the fluid deficit (in milliliters) and any intraoperative complications. Sensitivity, specificity and kappa measure of agreement were calculated for each classification at their best cut off. P value less than 0.05 is considered significant. Results: Myomectomy was considered incomplete in 8 out of 104 fibroids (7.7%) According to ESES, 2 belonged to type 0 and 6 belonged to type 1.Risk ratio and 95% confidence interval (CI) was 0.56 (0.07-3.3) and the difference was not significant (p=0.7); whereas according to the STEPW classification, the incomplete myomectomies were one in group I (1/8, 12.5%) and seven in group II (7/8, 87.5%). The risk ratio (95% CI) was 0.02 (0.0-0.18) and the difference was significant (p= 0.000). Considering the area under the ROC curve, the dichotomized STEPW scores performed better than the dichotomized ESES scores (P<.001). Conclusion:The application of STEPW classification of submucous fibroid gives better prediction of myoma removal than ESES classification.

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Section: Disscusionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Submucous Fibroid: Different Presurgical Classification Methods and Their Effect on Hysteroscopic Surgical Management

Amin

Ahmed

Seksaka

et al. 2013

Zagazig University Medical Journal

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“…However studies showing HRSM has a success rate of 70-99% in controlling AUB is known. As the monitoring period lengthens, generally this success rate reduces due to recurrence of myoma and a range of dysfunctional factors [6,10] . Indman et al [7] performed hysteroscopic resection on 51 submucosal myoma cases with menorrhagia complaints and followed them for 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…After the procedure in the case of a wanted pregnancy it protects the woman's chances of giving birth vaginally. To date there have been many studies on morbidity, procedure management, pregnancy results, and control of bleeding in hysteroscopic approaches to submucosal myoma [5][6][7][8][9][10]. While this data is important to evaluate the success of the procedure for the surgeon, many women are more interested in a simple and basic sign of satisfaction, the number of pads used during the menstrual period.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Hysteroscopic Submucosal Myoma Resection on Number of Sanitary Pads

Mun¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Premenepozal dönemde submüköz myom nedeniyle menometrorajisi olan hastalarda, histereskopik submükoz myom rezeksiyonunun (HSMR), menstrual dönemde kullanılan ped sayısı üzerine etkisini araştırmak. Gereç ve Yöntem: Menoraji miktarları Pictorial Blood Assessment Chart (PBAC) yönte-mi kullanılarak değerlendirilen ve submüköz myomu olan 27 kadın prospektif olarak çalışmaya alındı. Hastalara HSMR yapıldıktan sonra 6. Ayda kanama değerlerinin kullandıkları ped sayısı üzerine olan etkisi kaydedildi. Bulgular: Çalışmaya dâhil edilen hasta gurubunun yaş ortalaması 41± 5.1 idi. 27 hastanın 20'sinde (%74) bir tane, 4'ünde (%14) iki ve 3'ünde (%12) üç veya daha fazla submükoz myom mevcuttu. Çıkarılan myomların 17'si (%63) 3 cm'nin altında, 6'sı (%22) 3-5 cm arasında ve 4'ü (%15) 3cm'nin üzerinde çapa sahipti. Hastaların postoperatif 6. ayda menstruel kanamanın en yoğun olduğu gün-lerdeki ortalama ped sayıları preoperatif döneme göre 9.1'den 3.8'e düştüğü (p<0.05) gözlendi. Tartışma: Premenopozal dönemde menometroraji nedeniyle yapılan HSMR kadınların kullandıkları ped sayısında ve kanama günü sayı-sında anlamlı derecede azalmaya neden olmuştur. Anahtar KelimelerSubmüköz Myom; Menoraji; Histeroskopi; Hijyenik Ped Abstract Aim: To research the effect of hysteroscopic resection of submucosal myoma (HRSM) on the amount of pads used during the menstrual period in a premenopausal patient with menometrorrhagia caused by submucosal fibroids. Material and Method: A total of 27 women with submucosal fibroids were included in this prospective study using the Pictorial Blood Assessment Chart (PBAC) to evaluate quantity of menorrhagia. Bleeding evaluation and number of pads used by patients in the 6th month after HRSM were recorded. Results: The average age of patients included in the study was 41±5.1. Of 27 patients 20 (74%) had one. 4 (14%) had two and 3 (12%) had three or more submucosal myomas. The diameter of removed fibroids were 17 (63%) less than 3 cm, 6 (22%) between 3 and 5 cm and 4 (15%) were above 5 cm. In the postoperative 6th month on the day of heaviest menstrual bleeding average number of pads used dropped to 3.8 compared to 9.1 in the preoperative period (p<0.05). Discussion: HRSM performed due to menometrorrhagia in the premenopausal period significantly reduces the number of pads used and the number of days of bleeding.

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“…If one or more fibroids are diagnosed, each lesions' size, grade (Fig. 10), and number should be documented accurately to allow estimation of the technical complexity of the resection procedure [18][19][20][21][22][23][24][25].…”

Section: Ultrasonography After Endometrial Samplingmentioning

confidence: 99%

Ultrasound examination before, during, and after office endometrial sampling

2013

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Office endometrial sampling is widely used as the first diagnostic test in women with abnormal uterine bleeding. Because office sampling is a blind procedure, the lesion causing the symptoms may be missed. The use of ultrasound before, during, and after office endometrial sampling improves relevant tissue yield. The measurement of the endometrial thickness informs if sampling is indicated. The evaluation of ultrasound features (without or with fluid instillation) may suggest a focal intracavitary lesion necessitating operative hysteroscopy. The knowledge of the uterine cavity length, shape, and flexion may avoid nonrepresentative sampling. The concordance between the tissue yield and the ultrasound findings reflects the reliability of the sampling. If not concordant, further diagnostic steps such as fluid instillation sonography or hysteroscopy are indicated. We conclude that integrating ultrasound in the diagnostic algorithm for uterine intracavitary pathology optimizes office endometrial sampling.

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Feasibility of a new system of classification of submucous myomas: a multicenter study

Cited by 81 publications

References 11 publications

Submucous Fibroid: Different Presurgical Classification Methods and Their Effect on Hysteroscopic Surgical Management

Submucous Fibroid: Different Presurgical Classification Methods and Their Effect on Hysteroscopic Surgical Management

The Effects of Hysteroscopic Submucosal Myoma Resection on Number of Sanitary Pads

Ultrasound examination before, during, and after office endometrial sampling

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