Surgical treatment of fibroids for subfertility

Metwally, Mostafa; Cheong, Ying; Horne, Andrew W

doi:10.1002/14651858.cd003857.pub3

Cited by 97 publications

(80 citation statements)

References 35 publications

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“…A systematic review of two randomized control trials evaluating a total of 293 patients allocated to either open or laparoscopic myomectomy reported no significant effect on the live birth rate (OR 0.80, 95% CI 0.42 to 1.50), clinical pregnancy rate (OR 0.96, 95% CI 0.52 to 1.78), ongoing pregnancy rate (OR 1.61, 95% CI 0.26 to 10.04), miscarriage rate (OR 1.31, 95% CI 0.40 to 4.27), or preterm labor rate (OR 0.68, 95% CI 0.11 to 4.43). 30 Recurrence of fibroids post-myomectomy has been associated with adverse obstetrical outcome. Sudik et al performed a comparative, retrospective non-randomized clinical study including 67 patients undergoing myomectomy for fertility and reported a higher rate of preterm delivery (38.5% vs. 0%) and cesarean section (84.6% vs. 38.8%) in patients with recurrent fibroids (N=31) compared with the recurrence-free control group (N=36).…”

Section: Discussionmentioning

confidence: 99%

Reproductive outcomes following robotic myomectomy

Shaia

Sekhon

Rosen

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: To assess pregnancy outcomes of patients following robotic myomectomy.Methods: Retrospective chart review was performed of 336 patients following robotic myomectomy at a university hospital from June 2006 to May 2013. Patients were called to obtain delivery outcomes.Results: Three hundred and thirty-six women had the following: mean age of 41.97 +/- 12.3 years (range 24-55), mean BMI of 24.6 +/- 4.96, mean of 3.37 +/- 3.1 fibroids removed (range 1-21), and mean weight of 352.28 +/- 339.56 grams of fibroids removed. Approximately 66.9% (N=250) provided pregnancy outcome data with 119 (47.6%) attempting pregnancy after surgery. Eighty-three (69.7%) achieved a total of 91 pregnancies. Less than half of these patients underwent cesarean section, and no cases of uterine rupture. Eighty-seven patients had known infertility pre-surgery; 22 underwent intrauterine insemination resulting in 12 pregnancies, and 34 underwent in vitro fertilization resulting in 25 pregnancies. A total of 53 (60.9%) of patients with infertility achieved 60 total pregnancies.Conclusions: The fertility rate after robotic myomectomy for patients attempting to conceive (69.7%) and for those with known infertility who continued to attempt pregnancy postoperatively (60.9%) were similar. There was a low incidence of complications associated with pregnancies conceived after robotic myomectomy.

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Section: Discussionmentioning

confidence: 99%

Reproductive outcomes following robotic myomectomy

Shaia

Sekhon

Rosen

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…This patient group has a rate of abnormal uterine bleeding of 70-80% and it constitutes an indication for hysteroscopic myomectomy [3,4,7,12]. Since Neuwith and Amin [5] technological hardware has developed making hysteroscopic resection a minimally invasive and standard treatment modality for submucosal myoma.…”

Section: Discussionmentioning

confidence: 99%

“…Since Neuwith and Amin [5] technological hardware has developed making hysteroscopic resection a minimally invasive and standard treatment modality for submucosal myoma. Especially with fertility and protecting the organ the current ideal in choosing a surgical treatment, this brings hysteroscopic resection to the fore compared with other choices for submucosal myoma treatment [9,12]. There is no meta-analysis in the literature of HRSM done due to AUB.…”

Section: Discussionmentioning

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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“…Metaanalízis során a myomák fertilitásra gyakorolt hatásáról egyértelmű, erős evidenciákat azonban nem sikerült felállítani [18].…”

Section: öSszefoglaló Közleményunclassified

A myoma uteri diagnosztikája és kezelése

Török

Póka

2016

Orvosi Hetilap

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A myoma a leggyakoribb nőgyógyászati jóindulatú daganat. Előfordulása rasszonként változó, általánosságban a reproduktív korú nők negyedét érinti. Rosszindulatú elfajulása az esetek kis részében észlelhető. Elhelyezkedésüktől, méretüktől függően diverz panaszokat okoznak, a meddőségtől az életminőséget komolyan befolyásoló vérzészava-rokig. A myoma felismerése, diagnosztikája a képalkotó módszerek és az endoszkópos beavatkozások egyre szélesebb körben való elterjedésének köszönhetően korai stádiumban lehetséges és igen nagy pontosságú. Kezelésük az általuk okozott panaszok súlyosságától függően szükséges. A terápiában gyógyszeres, radiológiai és sebészi módszerek is szerepet kapnak. A kezeléssel kapcsolatos kérdések az elmúlt évben igen nagy publicitást kaptak, az egyesült államok-beli "myomabotrány" miatt az eddiginél is szélesebb érdeklődés középpontjába kerültek. Orv. Hetil., 2016, 157(21), 813-819. Kulcsszavak: myoma, vérzészavar, meddőség, endoszkópia Diagnosis and treatment of fibroidsUterine fibroid is the most common tumor in women of reproductive age. Depending on the size and location they can cause variety of symptoms. The clinical presentation may include bleeding disorders, infertility, pelvic pain and dysmenorrhea as well. Detection and precise evaluation of the number, size and location of myomas is possible due to advances in imaging and endoscopic methods. Treatment of fibroids depends on the severity and type of symptoms. There are medical, radiological and surgical options for treatment. Debates on fibroid management are widely published and are in focus recently, related to the "fibroid-scandal" occurred in the United States. Rövidítések FDA = Food and Drug Administration; FIGO = International Federation of Gynecology and Obstetrics; GnRH = gonadotrop releasing hormon; HSC = hiszteroszkópia; HSG = hiszteroszalpingográfia; JZ = junctionalis zóna; MRI = mágneses rezonanciavizsgálat; PAECs = progesterone receptor modulators-associated endometrial changes; SIS = szalinainfúziós ultrahangvizsgálat; SPRM = szelektív progeszteronreceptor-mó-dosító; UPA = ulipristal acetát A myoma uteri a méhfal simaizomzatának monoklonális jóindulatú daganata. Általában az ép myometriumtól jól elhatárolt, azonban önálló tokja nincsen. A kóreredet epigenetikai hátterének tisztázása még nem végleges, számos géneltérés vizsgálata folyamatban van [1]. Növe-kedésében a genetikai faktorokon túl biokémiai és hormonális faktorok is szerepet játszanak. A hosszú távú emelkedett ösztrogénexpozíció (elhízás, korai menarche) emeli, a csökkent expozíció (multiparitás) csökkenti a myoma előfordulását, amiből az ösztrogén befolyáso-lóhatására következtethetünk. A myoma magasabb progeszteron-A-és -B-receptor-koncentrációja és az, hogy a mitotikus aktivitás a szekréciós fázisban, a progeszterontermelés csúcsán figyelhető meg, a progeszteron szerepét igazolja. A myomák előfordulása pubertás előtt igen ritka, a fertilis korban emelkedett, menopausa után pedig ÖSSZEFOGLALÓ KÖZLEMÉNY Keywords

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Surgical treatment of fibroids for subfertility

Cited by 97 publications

References 35 publications

Reproductive outcomes following robotic myomectomy

Reproductive outcomes following robotic myomectomy

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

A myoma uteri diagnosztikája és kezelése

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