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PubMed2003

Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment--a prospective, randomized, and controlled clinical trial.

PURPOSE: To evaluate the effectiveness of uterine artery embolization (UAE) in the management of bleeding in patients with uterine fibroids and to compare UAE with hysterectomy, particularly with regard to length of hospital stay and associated complications (ie, safety). MATERIALS AND METHODS: A prospective clinical trial was performed with patients who were randomly assigned to one of two groups: patients who were offered the option of undergoing either UAE or hysterectomy (group 1) and patients who were not informed of the alternative treatment-that is, UAE (group 2). The primary variables that were considered for evaluation of the effectiveness, efficiency, and safety of the two procedures were, respectively, bleeding cessation, total length of hospital stay, and resulting complications. The lengths of hospital stay in the two study arms were compared on an intent-to-treat basis. Owing to crossover between the treatment arms, however, effectiveness and safety were evaluated on the basis of the actual treatment received. RESULTS: The clinical success rate for the patients who underwent UAE, which was based on the cessation of bleeding, was 86% (31 of 36 patients). The mean hospital stay for group 1 was 4.14 days shorter than that for group 2 (P <.001). Ten (25%) of the 40 patients who underwent UAE experienced minor complications, in contrast to four (20%) of the 20 who underwent hysterectomy and experienced major complications. CONCLUSION: Compared with hysterectomy, UAE is safe and effective for treatment of bleeding fibroids, necessitates a shorter hospital stay, and results in fewer major complications.

Adult↗
PubMed2004

Cost-effectiveness of uterine artery embolization and hysterectomy for uterine fibroids.

PURPOSE: To compare the cost-effectiveness of uterine artery embolization (UAE) with that of hysterectomy for women with symptomatic uterine fibroids. MATERIALS AND METHODS: The authors developed a decision model to compare the costs and effectiveness of UAE and hysterectomy. In the model, a cohort of women aged 40 years with a diagnosis of uterine fibroids and no desire for future pregnancy was followed up until menopause. The analysis was performed from a societal perspective, including all costs and effects, regardless of who incurs them. Transition probability and quality-of-life estimates were obtained from the literature and a gynecologist, whereas costs (in 1999 U.S. dollars) were estimated by using rates of Medicare reimbursement for hospital costs and physician fees. Sensitivity analyses of key estimates were performed. Results were expressed in costs per quality-adjusted life-year (QALY). RESULTS: UAE was more effective (8.29 vs 8.18 QALYs) and less expensive (US dollars 6916 vs US dollars 7847) than hysterectomy. Cost-effectiveness results, with the exception of quality-of-life data, were robust to changes in most model assumptions. When the quality-of-life adjustment was eliminated, the two procedures were equally effective. CONCLUSION: UAE is a cost-effective alternative to hysterectomy across a wide range of assumptions about the costs and effectiveness of the two procedures. However, the study results were sensitive to changes in quality-of-life values.

Cost-Benefit Analysis↗
PubMed2005

Effect of fibroids on fertility in patients undergoing assisted reproduction. A structured literature review.

OBJECTIVE: The aim of this study is to evaluate the current data to understand the impact of intramural leiomyomata on pregnancy outcome in assisted reproduction. PATIENTS AND METHODS: In this review, articles were found by means of computerized Medline and Cochrane Library search using the key words uterine myomata, leiomyomata, fibroids, implantation, pregnancy, infertility and in vitro fertilization. Limitations were English, human, 1990-2002. Inclusion criteria were pregnancy data on in vitro fertilization, intramural myomata with no cavitary distortion and control groups without myomas for each patient with a myoma. RESULTS: There was a significant negative impact on implantation rate in the intramural myomata groups versus the control groups, 16.4 vs. 27.7% OR 0.62 (0.48-0.8). The delivery rate per transfer cycle was also significantly lower (myomata vs. control), 31.2 vs. 40.9% OR 0.69 (0.50-0.95). CONCLUSION: Our study supports the notion that patients with intramural fibroids have a lower implantation rate per cycle. The studies did not shed new light on the size of intramural myomata that could affect the outcome. In previous failed in vitro fertilization cycles, microsurgical removal of myomata must be considered.

Adult↗
PubMed1989

Mechanism of LHRH analogue action in uterine fibroids.

Luteinising hormone-releasing hormone analogues have been found to reduce the size of uterine fibroids. Further studies are required to determine their exact mechanism of action. However, they are known to induce hypo-oestrogenism, which leads to reduction in uterine arterial blood flow, one mechanism by which reduction of fibroid size is thought to occur.

Buserelin↗
PubMed1996

The place of Zoladex in deferred surgery for uterine fibroids. Zoladex Myoma Study Group.

Two hundred and forty-seven patients with uterine fibroids were randomized to surgery alone or 3 months' Zoladex (Zeneca, Macclesfield, Ches., UK) followed by surgery. Zoladex significantly reduced uterine and fibroid volumes (p = 0.0001). There was a significantly (p = 0.002) greater mean rise in haemoglobin from entry to preoperation in the Zoladex group (1 g/dl) compared with the surgery-alone group (0.3 g/dl) as well as a tendency towards easier surgery, and reduced operative blood loss. Zoladex-treated patients had a significantly (p = 0.016) shorter hospital stay and pelvic pain and abdominal pressure symptoms were significantly (p < 0.0001) reduced in this group. Zoladex was well tolerated.

Adult↗
PubMed2004

Small bowel obstruction in a twin pregnancy due to fibroid degeneration.

Small bowel obstruction in pregnancy is unusual. It is a difficult diagnosis to make, as vomiting and abdominal distension are commonly associated with pregnancy, and x-rays are avoided if possible. We present a case of small bowel obstruction caused by uterine fibroid degeneration in a 37 year old with a twin pregnancy. Following a period of observation an x-ray was performed which prompted surgical exploration, relief of the obstruction and myomectomy. This case highlights that x-ray is essential if there is a clinical suspicion of small bowel obstruction in pregnancy as delay in diagnosis can be catastrophic. As childbearing is increasingly delayed into later life it is possible that pregnancy complicated by fibroids will be seen more frequently.

Adult↗
PubMed1984

Management of uterine fibroids at the University of Benin Teaching Hospital.

One hundred and eighty cases of uterine fibroids out of the two hundred treated in a gynaecological unit in a 7-year period are reviewed. The incidence of uterine fibroids among gynaecological conditions was 3.2% and it accounted for 3.6% of the operations. The peak age incidence was at 31-40 years (46%). Twenty per cent of those affected were grand multiparae. The commonest clinical features were abdominal swelling, infertility, abdominal pain, menorrhagia and dysmenorrhoea. Most of the patients were treated surgically with myomectomy (68%), mainly on account of the low parity and age. There was increased morbidity among those who had hysterectomy; 2 deaths occurred in this group. We have advocated liberal use of myomectomy , with its preservation of menstrual and reproductive function.

Adult↗
PubMed2005

Inflammatory fibroid polyp of the oesophagus.

BACKGROUND: Inflammatory fibroid polyp of the oesophagus is an uncommon lesion and very rarely it grows rapidly. CASE PRESENTATION: We present the case of a patient with a rapidly growing inflammatory fibroid polyp (IFP) of the oesophagus, which showed up within five months after a normal endoscopy. CONCLUSION: The treatment of IFP is by surgical excision, either open or endoscopic. Laser or other form of ablative treatment like thermo cautery can also be tried.

Journal Article↗
PubMed1999

Embolization of uterine fibroids.

14 patients have undergone uterine artery embolization of uterine fibroids. No complications related to the procedure have occurred. In all six of the cases with available data, there has been a reduction in fibroid volume as measured with MRI at 2 months post procedure (average reduction 43%). Technical aspects of this promising procedure are described.

Adult↗
PubMed2004

Inflammatory fibroid polyp: an immunohistochemical study.

BACKGROUND: Inflammatory fibroid polyp is a localized lesion, which arises in the submucosa of the gastrointestinal tract, most often in the stomach. Although it is generally believed to represent a reactive, nonneoplastic condition, its histogenesis remains controversial. AIM: To study inflammatory fibroid polyp by immunohistochemistry in an attempt to further clarify their histogenesis. MATERIAL AND METHODS: Nine cases were studied by immunohistochemistry using a panel of antibodies against smooth-muscle actin, vimentin, S-100 protein, factor VIII- R.Ag and macrophage (HAM-56). RESULTS: There was a strong diffuse positive staining pattern in the spindle cells with vimentin antibody. A patchy staining for smooth-muscle actin was observed in these cells. Immunophenotyping revealed a heterogeneous reaction with HAM-56. In edematous areas, HAM-56-positive cells show voluminous cytoplasm and reniform nuclei. In cell-rich areas, the HAM-56-positive cells had fusiform cytoplasm. Stains for S-100 and factor VIII RAg were negative in the proliferating elements. CONCLUSIONS: The present immunohistochemical study refutes the suggested neural or vascular nature of the lesion. The strong positivity for vimentin in all cases suggests a major component of spindle cells best recognizable as fibroblasts. These results would favor the existence of a span of morphological and immunohistochemical patterns possibly indicating evolutive phases of an inflammatory reaction.

Adult↗
PubMed1991

Transcervical resection of endometrium and fibroids. Initial complications.

Transcervical resection of endometrium--and of submucous fibroids when present--seems to represent a new alternative to hysterectomy for patients with uncontrolled bleeding disorders. In the present study, we report our initial experience with the first 20 patients treated with a standard, rigid urological resectoscope. Resection of endometrium--and of fibroids when present--was carried out under general anesthesia. The uterine cavity was distended and irrigated with glycine 1.5%. Two perforations occurred, but damage to neighboring organs was not seen. In one patient, copious bleeding was encountered and hysterectomy became necessary the following day. Clinical signs of postoperative infection occurred in 3 patients. Otherwise, no major morbidity was seen during or after the procedure. In 2 patients with persistent metrorrhagia, re-resection was performed after 2-3 months and satisfactory bleeding control achieved. At the 3-month follow-up, 2 further patients complained of persistent bleeding and had an abdominal hysterectomy performed. In the remaining patients, satisfactory bleeding control was reported at the 6-month follow-up. Although large series are needed to assess the complications associated transcervical resection of the endometrium, the technique may be applied in departments with experience in routine hysteroscopy, and the approach seems to represent an attractive alternative to hysterectomy.

Adult↗
PubMed1996

Transcervical resection of endometrium and fibroids: the outcome of 412 operations performed over 5 years.

OBJECTIVE: To evaluate the value of transcervical resection of endometrium and fibroids in clinical practice. STUDY DESIGN: A retrospective review of operative details of 412 transcervical resections of endometrium and fibroids and clinical outcome from 387 procedures performed over five years is reported. MATERIAL AND METHODS: Patients referred due to bleeding disturbance, treated with a standard urological resectoscopes, controlled after 6 and 12 months. Subsequent follow up was performed by questionnaire and patient bleeding diary. RESULTS: Operative complications (perforation, hemorrhage, absorption and more than 1500 ml glycine irrigating fluid) arose in 72 patients (18%). In 52 (14.4%) of 366 patients the outcome was not considered acceptable by either ourselves or the patients. This led to a repeat resection procedure being performed in 31 cases (9.0%) with favorable result in 21 (68%) of these cases. Twenty-one patients (6.1%) underwent a hysterectomy because of a persistently poor outcome. A favorable outcome was then reported in subsequent follow up of 335 patients (91%). In addition, pain associated with menstruation was reduced after the procedure and correlates with achieved result on bleeding intensity. CONCLUSION: Endometrial resection is safe and acceptable treatment option for both menorrhagia and metrorrhagia associated with dysmenorrhoea.

Adult↗
PubMed1992

Symptom-free interval after triptorelin treatment of uterine fibroids: long-term results.

An increasing number of publications document regression of fibroids under treatment with gonadotropin releasing hormone (GnRH) agonists. However, recurrence after stopping treatment regularly counterbalances its benefit. We now report on 28 patients with intramural myomas, treated with triptorelin for 4-6 months and followed for 42-56 months. During or shortly after treatment, six patients entered menopause. In this group, a volume reduction of 71% was achieved and no surgery was needed thereafter. In 22 premenopausal women, a 64% decrease of uterine volumes was obtained at the end of treatment; the long-term reductive effect was 31%. When compared with initial values, a significant decrease was observed at the end of treatment (p = 0.0001) and of follow-up (p < 0.0005). In 13 (of 22) premenopausal patients, surgery was needed after triptorelin treatment for permanent control of fibroids. The remaining nine patients were free of symptoms after 42-56 months, having uteri in situ. These two groups differ significantly in pretreatment uterine volume (p < 0.001) and in reduction rate after therapy (p < 0.01), both parameters being higher in patients who finally needed surgery. In conclusion, triptorelin treatment is definitely beneficial in perimenopausal women and in nearly half of premenopausal women, in whom hysterectomy can be prevented. In the other half, surgery is necessary, despite significant volume reduction. These results need to be corroborated on larger groups of patients. More research is needed to explain different responses to treatment in premenopausal patients.

Adult↗
PubMed2004

Recurrent inflammatory fibroid polyp of cardia: a case report.

Inflammatory fibroid polyp is one of the chronic inflammatory diseases in the digestive tract, which often mimics the submucosal tumor. Precise diagnosis is possible after removal of the detected lesion. Endoscopic removal is recommended as a safe and efficient method of the treatment. In this report the authors present a case of inflammatory fibroid polyp located in the cardia, which has been removed endoscopically. Twelve months later, recurrence of the lesion was noted and the patient was referred to surgical resection.

Cardia↗
PubMed2000

Uterine artery embolisation for symptomatic fibroids.

Traditional operative treatments for symptomatic fibroids--hysterectomy and myomectomy--involve considerable morbidity. Although morbidity is reduced with endoscopic surgery, this technique is not widely available, and has limitations. Embolisation of the pelvic vasculature is not a new procedure, having been used to treat postpartum and postsurgical bleeding for 20 years. It has only recently been used to treat symptomatic fibroids. Uterine artery embolisation can produce a mean reduction of 29%-51% in uterine volume at the time of the three-month review, with longer follow-up showing continued shrinkage and no regrowth. The range of shrinkage is highly variable, which needs to be explained to all potential candidates. Symptomatic relief is a more certain outcome, with relief of pelvic pressure symptoms in 91%-96% of women. There is a small risk of complications requiring hysterectomy, and the long-term effect on ovarian function is unknown.

Arteries↗
PubMed2001

Translabial sonography of vaginal fibroids: report of 2 cases and review of the literature.

OBJECTIVE: To determine the role of translabial sonography in the diagnosis of vaginal fibroids. METHODS: Two women with vaginal masses of undetermined origin were examined by various imaging procedures, including translabial sonography. RESULTS: Initial examinations, which included transabdominal sonography, cystoscopy, and cystourethrography, yielded inconclusive findings. Translabial sonography, however, suggested isolated vaginal leiomyomas in both patients, and in both the diagnosis was confirmed histologically after surgery. CONCLUSIONS: Translabial sonography should be considered as an adjunct to transabdominal and transvaginal sonography for patients with suspected vaginal fibroids.

Adult↗
PubMedDate not supplied

Myomectomy in pregnancy: incarcerated pedunculated fibroid in an umbilical hernia sac.

We describe a rare case of a 31-year-old woman at 28 weeks of pregnancy presenting with an incarcerated pedunculated fibroid in an umbilical hernia sac. She had a successful myomectomy and hernia repair and proceeded to have spontaneous vaginal delivery at term. Incarceration of a pedunculated fibroid presents a diagnostic puzzle which can be successfully treated by myomectomy.

Adult↗