Management of Symptomatic Uterine Leiomyomas

doi:10.1097/aog.0000000000004401

Cited by 137 publications

(38 citation statements)

References 99 publications

(134 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The treatment goal is to improve fibroid-related symptoms, such as abnormal uterine bleeding, dysmenorrhea, and bulk symptoms, considering the patient’s health status and need for fertility preservation[ 5 ]. Management options include medical, interventional, and surgical therapies[ 5 - 6 ]. Traditionally, hysterectomy is an effective and definitive surgical treatment for uterine fibroid[ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment: A case report

Park¹,

Choi²

2022

World J Clin Cases

View full text Add to dashboard Cite

BACKGROUND High-intensity focused ultrasound (HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids. Although this procedure is safe and effective, adverse outcomes are becoming a major problem. CASE SUMMARY We present a case of ventral hernia that occurred as a rare and delayed complication of HIFU ablation for uterine fibroids treatment. The patient came to the hospital with abdominal bloating that occurred 6 mo after ultrasound-guided HIFU ablation for managing uterine fibroids. The ventral hernia, which occurred due to atrophied muscle layers following the procedure, was confirmed by imaging studies and intraoperative findings. She required a hernia repair with mesh and hysterectomy for definitive treatment of uterine fibroid. CONCLUSION High-intensity ultrasound ablation should be performed only on appropriate candidates. Patients should be educated about potential complications of the procedure and the possibility of subsequent treatment. Post-procedural long-term follow-up for detecting delayed adverse effects is important.

show abstract

Section: Discussionmentioning

confidence: 99%

Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment: A case report

Park¹,

Choi²

2022

World J Clin Cases

View full text Add to dashboard Cite

show abstract

“…Focused ultrasound procedures guided by diagnostic ultrasound (high intensity focused ultrasound, HIFU) or magnetic resonance imaging (Magnetic Resonance-guided Focused Ultrasound, MRgFUS), are non-invasive treatments using multiple high-intensity ultrasound waves to cause coagulative necrosis within fibroids ( 50 ). According to the limited published data, HIFU and MRgFUS reduce both fibroid and uterine volume ( 23 ) and improve the quality of life—but the evidence is of low quality ( 51 ).…”

Section: Radiological Managementmentioning

confidence: 99%

“…RFA improves UF associated symptoms and quality of life. Surgical reintervention rate at 3 years is 11.5% ( 50 ). While RFA thus seems to be a good management option for symptomatic fibroids, access to this procedure is currently very limited.…”

Section: Radiological Managementmentioning

confidence: 99%

“…Hysteroscopic myomectomy significantly improves fibroid-associated symptoms and quality of life, and the reintervention rate is as low as 7% at 5 years ( 19 ). Myomectomy via laparoscopy or laparotomy are a second-line treatment for FIGO type 3–8 fibroids if medication has failed ( 6 , 50 ). Improvements in the quality of life are similar regardless of surgery type, but laparosopic myomectomy is associated with faster recovery time ( 50 ).…”

Section: Surgical Managementmentioning

confidence: 99%

“…Myomectomy via laparoscopy or laparotomy are a second-line treatment for FIGO type 3–8 fibroids if medication has failed ( 6 , 50 ). Improvements in the quality of life are similar regardless of surgery type, but laparosopic myomectomy is associated with faster recovery time ( 50 ). The surgical reintervention rate for laparoscopic and laparotomy myomectomy is 12.2% ( 19 ).…”

Section: Surgical Managementmentioning

confidence: 99%

See 2 more Smart Citations

Uterine Fibroids (Leiomyomata) and Heavy Menstrual Bleeding

Uimari

Subramaniam

Vollenhoven

et al. 2022

Front. Reprod. Health

View full text Add to dashboard Cite

Uterine Fibroids, or leiomyomata, affect millions of women world-wide, with a high incidence of 75% within women of reproductive age. In ~30% of patients, uterine fibroids cause menorrhagia, or heavy menstrual bleeding, and more than half of the patients experience symptoms such as heavy menstrual bleeding, pelvic pain, or infertility. Treatment is symptomatic with limited options including hysterectomy as the most radical solution. The genetic foundations of uterine fibroid growth have been traced to somatic driver mutations (MED12, HMGA2, FH−/−, and COL4A5-A6). These also lead to downstream expression of angiogenic factors including IGF-1 and IGF-2, as opposed to the VEGF-driven mechanism found in the angiogenesis of hypoxic tumors. The resulting vasculature supplying the fibroid with nutrients and oxygen is highly irregular. Of particular interest is the formation of a pseudocapsule around intramural fibroids, a unique structure within tumor angiogenesis. These aberrations in vascular architecture and network could explain the heavy menstrual bleeding observed. However, other theories have been proposed such as venous trunks, or venous lakes caused by the blocking of normal blood flow by uterine fibroids, or the increased local action of vasoactive growth factors. Here, we review and discuss the evidence for the various hypotheses proposed.

show abstract

Impact of FIGO type 3 uterine fibroids on in vitro fertilization outcomes: A systematic review and meta‐analysis

Favilli

Etrusco

Chiàntera

et al. 2023

Intl J Gynecology & Obste

View full text Add to dashboard Cite

BackgroundThe effect of FIGO (the International Federation of Gynecology & Obstetrics) type 3 myomas on in vitro fertilization (IVF) is uncertain.ObjectivesTo evaluate whether FIGO type 3 myomas affect IVF outcomes, through a systematic review and meta‐analysis (CRD42022379700).Search strategyElectronic databases were searched until November 15, 2022.Selection criteriaStudies evaluating the effects of FIGO type 3 myomas on IVF outcome.Data collection and analysisPooled results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using Higgins I2. Sources of heterogeneity were explored with sensitivity and subgroup analyses.Main resultsIn total, 1020 patients were included: 324 with FIGO type 3 myomas and 696 controls (without myomas). A pooled data analysis showed a significantly lower live birth rate (OR 2.16, 95% CI 1.55–3.01, I2 = 0%, P < 0.00001), clinical pregnancy rate (OR 2.06, 95% CI 1.52–2.81, I2 = 0%, P < 0.00001), and implantation rate (OR 1.77, 95% CI 1.35–2.32, I2 = 0%, P < 0.00001) in women with untreated myomas compared with controls. The number and size of fibroids correlated with a worsening of IVF outcomes.ConclusionsFIGO type 3 myomas are significantly associated with a lower implantation rate, cumulative pregnancy rate, and live birth rate. Furthermore, their deleterious effect on the outcome of IVF increases further with increasing size and number. Nevertheless, no firm conclusions could be drawn about the potential benefits of surgery for FIGO type 3 uterine fibroids on IVF outcomes.

show abstract

Management of Symptomatic Uterine Leiomyomas

Cited by 137 publications

References 99 publications

Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment: A case report

Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment: A case report

Uterine Fibroids (Leiomyomata) and Heavy Menstrual Bleeding

Impact of FIGO type 3 uterine fibroids on in vitro fertilization outcomes: A systematic review and meta‐analysis

Contact Info

Product

Resources

About