Management of Urinary Symptoms Associated with Fibroids

Abstract

Uterine fibroids are the most common benign tumours in women of reproductive age. Fibroids are linked with a variety of lower urinary tract symptoms (LUTS). Direct pressure on the bladder, but also vascular, neurogenic and hormonal changes have been proposed as underlying pathophysiological mechanisms. There is conflicting evidence in the literature regarding the association between LUTS and fibroid volume and position. Conservative management with bladder retraining, supervised pelvic floor muscle training with or without drug therapy might be used as first line. In the presence of persistent symptoms, conventional urodynamics or ideally videourodynamics might be considered before more invasive treatment. Counselling of patients prior to uterine artery embolisation, myomectomy or hysterectomy could be challenging, as it is difficult to estimate the effect of fibroid reduction or removal on LUTS.