MRI Evaluation of the Uterine Structure after Myomectomy

Abstract

Myomectomy is a good indication for women with uterine leiomyoma who desire to preserve their child-bearing potential. However, there are still no reports about how long it takes the uterus to reach a stable state after myomectomy. We evaluated the changes in uterine structure during the recovery process after myomectomy by MR images. MR images were used to analyze the time-dependant changes in the length of the uterine cavity, the volume of the uterus, recovery of the junctional zone, prevalence of modification of the endometrium, and uterine structure in the region of the enucleated myoma. The cavity length and the volume of the uterus, and the myometrium were stabilized at six weeks after the myomectomy. With regard to the endometrium, 12 weeks were required for it to achieve a stable state after myomectomy. However, even at 12 weeks postoperatively, 14.2% of the cases showed an unusual view near the uterine incision on MR images. We concluded that the recovery process is complete at 12 weeks after the operation if there are no clear findings of hematoma or edema formation in the myometrium on MR images.

Surgical Management of Leiomyomas for Fertility or Uterine Preservation

“…Magnetic resonance imaging (MRI) after myomectomy suggests the uterine healing takes at least 12 weeks and even longer if there is hematoma formation in the myometrium. 16 This study included only patients in whom single intramural myomas were removed. It seems logical that, if multiple myomas are removed with a greater propensity to myometrial hematoma formation, more time will be required before attempting pregnancy.…”

Reproductive outcomes following robotic myomectomy

“…Findings from magnetic resonance imaging (MRI) studies after myomectomy suggests approximately 12 weeks preconception is required for uterine healing to occur and even longer if there is evidence of hematoma formation in the myometrium. 38 Hence, a 12-week waiting period is suggested before attempting pregnancy. If there a significant myometrial defect is created during the procedure, cesarean delivery is often recommended with a view to reduce the risk of uterine rupture during labor and delivery.…”

“…If there a significant myometrial defect is created during the procedure, cesarean delivery is often recommended with a view to reduce the risk of uterine rupture during labor and delivery. 38 Of the patients who became pregnancy and delivered, 46.1% underwent cesarean section, the majority of which were elective or recommended by their obstetrician given their history of myomectomy. Prior studies have reported a post-RALM cesarean section rate of 95.7% and a wide range of cesarean section rates after laparoscopic myomectomy (23.5% to 82.1%).…”

Evaluation of factors contributing to uterine scar formation after laparoscopic myomectomy

“…Several studies evaluating enucleated wounds after myomectomy have reported the utility of diagnostic imaging such as ultrasound and MRI for observing the temporal process of wound healing after myomectomy (14–17). As was done in the present study, these reports observed the myomectomy enucleation site at a second surgery.…”