uterine fibroids (leiomyomas), we will use indifferently the two terms, are the more common benign tumors of gynecological. The word cancer can; to think of a dangerous condition, but the degeneration of the fibroids is a problem very rare, and in most cases are a find random, which does not influence the welfare of women. Fibroids symptomatic, presenting an increase of 25% in women, but the ultrasound canò note the più often.
The symptoms can be menstruation abundant, bleeding abnormal and symptoms of compression of abdominal structures.
leiomyomas originate from smooth muscle of the uterus and can be either solitary lesions which multiple. Depending on the size, location and number, various clinical symptoms can accompany them. Fibroids large, multiple, intramural or sottosierosi cause typical symptoms of increased pressure (urinary frequency, dyspareunia, and changes in bowel function).
Fibroids smaller, which grow in the direction of cavità uterine can give bleeding is abnormal and can have a negative impact on reproduction.
For the symptomatic treatments are available medical, surgical, and radiological. The medical treatment that you do through medications that cancel out the hormones of the woman induces hypoestrogenism (reduction of the female hormones) and results in a decrease in the size of the myoma.
it is a temporary reduction, and is used only for the preparation for surgery or for women, close to the menopause, a condition that naturally reduces the size of the myomas.
you Should remember that you can; anticipate menopause forò, and then the women who wish to prolong their hormonal condition, are also taking estrogen after the disappearance of menstruation are not suitable subjects for this therapy. In fact, the myoma will grow back when the stimulation estrogen begins again.
radiation Treatments (uterine artery embolization or myolysis through the rf scan wizard) are effective but may have adverse effects on reproduction, and therefore are not generally recommended when you want a future fertilityà.
The surgery può be definitive (hysterectomy) or conservative (myomectomy). This last intervention is recommended when the patient wishes to keep the uterus, or want to have a pregnancy in the future.
The fibroids that are causing symptoms that interfere with normal qualityà of life should be treated. The patients with recurrent spontaneous abortions or in which the second or third trimester of pregnancy is difficult, and some infertility patients with myomas may benefit from surgical intervention.
The hypovlenogonia fibroids that, regardless of their size, interfere with the plant’s normal product of conception, should be removed.
The fibroids sottosierosi instead do not seem to affect pregnancy rates, né result.
The fibroids intramural lowers the probability; of pregnancy, but not è been consistently demonstrated that their removal will improve the result of the treatment of steriltà.
The pre-operative evaluation and screening
The preoperative evaluation può be performed with a examination, a ultrasound, a hysterosalpingogram, a sonoisterografia saline, or MRI . Screening for anemia is recommended if the indication for the intervention is a menorrhagia.
The injury endocavity and submucosal can be removed in hysteroscopy. It is scarcely invasive, is performed under general anesthesia.
how to può require several steps.
When you suspect a uterine perforation as a complication of this surgery, you should control the bladder, or the presence of a trauma of the intestine. The infection is a rare complication. Intrauterine adhesions may develop after the procedure. In general, women who want to conceive have to wait 2-3 months after the procedure.
Laparotomy, Laparoscopy, a Robotic Surgery
The multiple fibroids and those of larger size, especially when they are in a position intramural or subserosa, it must be removed via laparotomy or laparoscopy. It is important to evaluate the size, number and exact location of the fibroids, as well asé the their position in relation to the endometrium.
During the procedure, the tourniquets or vasopressin can be used to reduce the loss of blood. Once the myoma has been removed, the electrocoagulation should be used with caution, and you should make a quick attempt to close the uterus to prevent bleeding and formation of hematomas. The blood loss is typically less with the laparoscopic approach.
fever is common and usually resolves by itself. Bowel, bladder, and vascular damage are potential complications of laparoscopy, and are usually associated with the positioning of the trocar (the device that guide the surgical equipment that enters the abdomen). Clinically, both approaches are equally effective but the laparoscopic approach is associated with lower morbilità and a recovery più fast.
The robotic assistance può be used for laparoscopic surgery than for the classic one. This approach requires more time and is, currently, the più expensive.
Point of view
fibroids are symptomatic are the indication of the più common gynaecological surgery. When is must a treatment that does not leave the possibilityà of recurrence of the fibroid, it is recommended to have a hysterectomy, which is associated with a lower morbilità compared to the approaches of conservation.
In some cases, however, the uterus must be maintained and only the tumor needs to be removed.
Multiple modeà are now available for the treatment of fibroids. Medical therapy può be considered for patients who are at high surgical risk or for those who are expected to enter the menopause early. The medical options usually offer temporary relief of symptoms, but can be sufficient to allow appropriate preparations preoperative radiation.
uterine artery Embolization
The best candidates for uterine artery embolization are in patients with a higher than average risk for surgical complications due to obesityà, multiple abdominal procedures before, or health problems. The procedure, however, può be associated with adverse outcomes for fertilityà and therefore it can notò be considered as the first choice for those who wish to maintain fertilityà.
Summary of surgical options
When is required the surgery, you can; choose between different approaches. The decision should be based on the characteristics of the patient, size of the fibroids and location, body mass index, and history of surgical previous) and the abilityà of the surgeon. In general, the approaches to minimally-invasive procedures are preferred:
- hysteroscopy is the preferred route for myomas intracavitary or submucosal;
- laparoscopy, and laparotomy is reserved for cases of intramural and sottosieroso.
preoperative evaluation and accurate preparation of prepared intra-operative (hemostasis) is able to reduce the morbilità perioperative.
The use of barriers to accession può to reduce to a minimum their training and prevent the morbilità long-term from adhesions.
The laparoscopic approach should be reserved for experienced surgeons and for fibroids up to medium-sized (about 5 cm).
With fibroids più great, complication rates increase in women who wish to conceive, some of the menstrual cycles should pass (about 3 months) before trying to get pregnant, to avoid a scar deiscente during pregnancy.
by Lisa Canitano, gynecologist
Fibroids in the uterus
Correlation between fibroids and dysplasia
Fibroids, options, non surgical treatment
Fibroids and the uterus to be removed
1 July 2013