Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know?

Abstract

Introduction. Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment. Materials and Methods. A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term “non-puerperal uterine inversion,” and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment. Results. Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm. Conclusions. Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.

Characteristics and Outcome in Non-Puerperal Uterine Inversion

“…There was no evidence of abnormalities in 9.9% of all cases [ 6 ]. A recent literature review concluded that malignancy was present in one-third of the reported cases [ 7 ]. This should be discussed with patients when choosing the type of surgical management.…”

An Unusual Presentation of a Huge Nabothian Cyst of Cervix With Manifestation of Uterine Prolapse: A Case Report

“…Herath et al 15 had reviewed the literature on nonpuerperal uterine inversion (NPUI) by collecting the data of published case reports from 1911 to September 2018. NPUI is a rare gynecological condition with diagnostic and surgical challenges.…”

Management of Nonpuerperal Uterine Inversion Using a Combined Vaginal and Abdominal Approach

“…Treatment of nonpuerperal uterine inversion depends on the patient's desire for future fertility and the nature of the intrauterine prolapsed mass (benign or malignant). If future fertility is desired and malignancy is excluded, surgical procedures to reposition and preserve the uterus should be attempted [ 5 , 10 ]. Thus, there is a need for histologic diagnosis prior to definitive surgery.…”

“…The repositioning of the uterus to the exact anatomy is vital before proceeding to hysterectomy. It is assumed that hysterectomy would be technically easier on a normally positioned uterus as repositioning would restore normal anatomy most surgeons are familiar with [ 10 , 14 ].…”