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Background: Fibroid of uterus are the most prevalent tumor affecting middle aged women, causing substantial morbidity and potentially impacting fertility. The precise an etiology of uterine fibroids is unknown. Fibroids may go in families and are regulated by hormone level. Abnormal bleeding, masses in pelvis discomfort in pelvis, infertility, bulk symptoms and obstetric problems are some of the clinical manifestations. Females with symptomatic fibroids who want to keep their fertility confront challenging treatment options. Surgical removal of fibroids may be indicated in patient if the symptoms are severe. Number, size and location of fibroid will decide the management of uterine fibroid. Materials and Methods:A retrospective analysis of 90 cases of uterine fibroids that were managed at Prathima Institute of Medical Sciences, Karimnagar, over a period of 1 year. The patients’ identification data were retrieved from the gynecological ward admission and theatre’s operation register. Their case notes were retrieved and analysed for incidence, age, parity, clinical presentation, presence of pelvic adhesions, type of surgical treatment, and postoperative complications. Result:Abdominal hysterectomy was performed in 58.9% of the cases, while 41.1% had abdominal myomectomy. There was no case of vaginal hysterectomy or endoscopic surgery, and all the hysterectomies were total abdominal hysterectomy. Pelvic adhesions were found in 67.6% of the cases, while 32.4% had clean pelvic cavity. All the surgeries were done with consultant gynecologists participating. The parity range was from 0 to 12, with a mean parity of 4.7±2.8. Among the patients, 6.7% were nulliparous, while 93.3% were of parous, with at least one living child. Among them, 33 women (31.4%) were grand multi-parae, which accounted for the highest frequency among the patients, while the least frequency was among the nulliparae. The use of hysterectomy was significantly higher among Para 4 and Para ≥5, while myomectomy was significantly higher among Para 0–2.Conclusion:Medical line of management is best for patients in younger age group, small size fibroid, and desire for future fertility. Uterus sparing option like myomectomy is done in patients not responding to medical line of management and desire for future fertility. Hysterectomy is definitive line of management for patients with fibroid uterus. |
Uterine fibroids are the most prevalent kind of tumor in women. Clinical manifestations include abnormal bleeding, mass in pelvis, pain in pelvic region, infertility, bulk symptoms and obstetric issues. [1] Fibroids can cause abnormal uterine bleeding, pelvic pressure, bowel dysfunction, urinary frequency and urgency, urinary retention, low back pain, constipation, and dyspareunia. Ultrasonography is the preferred initial imaging modality. Expectant management is recommended for asymptomatic patients because most fibroids decrease in size during menopause. [2]
The procedure used depends on the size, number, and location of the fibroids. For example, a hysterectomy can be performed using a spinal or epidural anesthetic, or sometimes a general anesthetic. Usually need to stay in hospital for a few days after having a hysterectomy, and it takes about 6 to 8 weeks to fully recover. [3]
Surgery can relieve symptoms like heavy menstrual bleeding, bleeding between periods, pain or pressure in your lower belly, frequent urination, and trouble emptying your bladder. However, surgery can also have risks, including: Excessive blood loss, Scar tissue, and Pregnancy or childbirth complications. [4]
Therapeutic options for long-term treatment of uterine fibroids have been very limited, with surgery being the main medical treatment for >100 years, with large recurrences of tumors. In accordance with a statistical analysis, 200,000 hysterectomies, 30,000 myomectomies, and thousands of selective uterine artery embolizations (UAEs) are performed annually in the USA to eliminate Uterine fibroids , with a psychological load and economic costs to the patient and the health care system. [5,6]
Nowadays, the development of several non-invasive surgical techniques and the recent clinical introduction of selective progesterone receptor modulators (sPRMs) like ulipristal acetate (UPA) have implicated that some of these patients, who initially had surgical indication, may have an alternative and conservative treatment. [7,8] As a consequence, the management of UF pathology is currently undergoing an important evolution, and after almost 2 decades without relevant updates, several scientific societies have found it necessary to actualize the protocols for the management of Uterine fibroids.
This study discusses the available surgical options for the treatment of uterine fibroids, such as hysterectomy, myomectomy and uterine artery embolization.
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