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Utility of Laparoscopic Uterine Myomectomy as a Treatment for Infertility with No Obvious Cause Except for UterineFibroidsUterinefibroids are capable of causing infertility, but there are no definite criteria for which laparoscopic uterine myomectomy (LM) is known to be beneficial. To investigate the usefulness of LM, we examined pregnancy rates in patients with infertility with no obvious cause except for the presence of uterine fibroids.We retrospectively reviewed the clinical records (...) ) in the non-LM group. There were no pregnancies in patients with >10 fibroids. The postoperative pregnancy rate in the LM group was comparable to previously reported pregnancy rates.Our criteria for performing LM in patients with no obvious cause for infertility except for uterinefibroids seem appropriate, especially when the fibroids are large and the number of fibroids is between 4 and 9. However, our results suggest that the effectiveness of LM is low in patients with 10 or more uterinefibroids.
Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with UterineFibroids Women with uterinefibroids (UF) may undergo less invasive procedures than hysterectomy, including myomectomy, endometrial ablation (EA), and uterine artery embolization (UAE); however, long-term need for reintervention is not well characterized. We estimated reintervention rates for 5 years and identified predictors of reintervention.A longitudinal retrospective
Application of a â€˜Baseballâ€™ Suture Technique in Uterine Myomectomy Following Laparoscopic Enucleation of Uterine Leiomyoma (Fibroid) BACKGROUND The aim of this study was to evaluate the safety and efficacy of a 'baseball' suture technique for uterine myomectomy incision closure in laparoscopic surgical enucleation of uterine leiomyoma (fibroid). MATERIAL AND METHODS The study included 20 patients who underwent laparoscopic myomectomy with a 'baseball' suture technique, compared with 20 (...) in pregnancy outcomes between the two groups. CONCLUSIONS The 'baseball' suture technique for closure of the uterine incision is a safe and effective method for use in laparoscopic myomectomy. However, the long-term recovery outcomes require further study.
Uterine Necrosis after Uterine Artery Embolization for Symptomatic FibroidsUterine artery embolization (UAE) is a minimally invasive intervention that is used in the treatment of fibroids. UAE can lead to complications including postembolization syndrome, postprocedure pain, infection, endometrial atrophy leading to secondary amenorrhea, and uterine necrosis. Uterine necrosis after UAE is very rare and hence poses a clinical dilemma for any clinician in its identification and management. We (...) document a case of uterine necrosis after UAE and conduct a literature review on its causation, clinical features, and management principles.A patient presented one month after UAE with abdominal pain and abdominal vaginal discharge. Her work-up revealed features of possible uterine necrosis with sepsis and she was scheduled for a laparotomy and a subtotal hysterectomy was performed. She was subsequently managed with broad spectrum antibiotic and recovered well.Uterine necrosis after UAE is a rare
Effects of TGF-Î² on uterinefibroids of women of childbearing age and uterine artery embolization. To evaluate the effects of transforming growth factor-β (TGF-β) on uterinefibroids of women of childbearing age and uterine artery embolization (UAE) using Embosphere microspheres.A total of 128 eligible women were randomly divided into an experimental group and a control group (n = 64) who received UAE using Embosphere microspheres and panhysterectomy, respectively. Another 128 healthy women (...) receiving physical examination in the same period were also enrolled. Serum TGF-β levels were detected by enzyme-linked immunosorbent assay (ELISA). Serum TGF-β level, size of uterinefibroid and prognosis were followed up.The serum TGF-β level of patients was significantly higher than that of healthy subjects. After treatment, the red blood cell counts and hemoglobin levels of the two patient groups significantly increased compared with those before (p < .05). After UAE, the diameter of uterine
A New Paradigm for UterineFibroid Treatment: Transcervical, Intrauterine Sonography-Guided Radiofrequency Ablation of UterineFibroids with the Sonata System This article provides the current evidence related to transcervical radiofrequency ablation of uterinefibroids under integrated intrauterine sonography guidance (the Sonata System).Published data on the treatment of fibroids with the Sonata System has demonstrated significant median reductions in total (73.3%) and perfused (73.3 (...) %) uterinefibroid volume, menstrual bleeding (72.3%), symptom severity (62.5%), and improvements in health-related quality of life (127%) at 12 months post-ablation. A clinical trial under an FDA Investigational Device Exemption is in progress.The Sonata System is a promising treatment modality for uterinefibroids. As an incisionless, minimally invasive treatment that does not require general anesthesia or hospitalization, it has the potential for redefining the current paradigm for management
Factors associated with uterinefibroid in Ghanaian women undergoing pelvic scans with suspected uterinefibroidUterinefibroids are the most common benign tumours affecting premenopausal women and are often associated with considerable hospitalization and morbidity. Literature shows virtually no study concerning the quantification of the main factors associated with uterinefibroids in Ghanaian women. The purpose of this study was to assess the main factors associated with uterinefibroid (...) between selected demographic and gynaecological characteristics and uterinefibroid appearance. All tests were two-tailed and p-value of less than 0.05 was interpreted as significant.The range, mean and standard deviation (SD) of the patients' age were 14-54 years, 31.89 years and ± 7.92 respectively. Factors that associated significantly with uterinefibroid in Ghanaian women included obesity (X2 = 17.3, p-value = 0.001), participant's age range (X2 = 47.4, p-value = 0.001), parity (X2 = -10.169, p
Magnetic resonance guided focused ultrasound surgery (MRgFUS) for uterinefibroids File Name: 20151202 AS MRgFUS fibroids v1.0.docx Version: 1.0 Date: 22 January 2016 Produced by: SHTG Page: 1 Review date: December 2017 Advice Statement 001/2015 December 2015 Is magnetic resonance guided focused ultrasound surgery (MRgFUS) for the treatment of uterinefibroids clinically effective, safe and cost effective compared with uterine artery embolisation (UAE), myomectomy and hysterectomy? This advice (...) has been produced following completion of evidence note 55 by Healthcare Improvement Scotland, in response to an enquiry from NHS National Services Scotland Background MRgFUS is a non-invasive treatment for symptomatic uterinefibroids typically performed on an outpatient basis by an interventional radiologist. Currently there are two CE marked MRgFUS systems, namely Insightec’s ExAblate 2000 system and upgraded ExAblate 2100 conformational system (Insightec) and Philips’ Sonalleve (Philips
Aromatase inhibitors for uterinefibroids. Uterinefibroids, also called uterine leiomyomas or myomas, are the most common benign tumours in women of reproductive age. Albeit generally benign, uterine ﬁ broids can have a major impact on women's health and quality of life by contributing to abnormal uterine bleeding and causing pelvic pressure symptoms (such as increased urinary frequency, pelvic pain and constipation). Traditional treatments for symptomatic ﬁ broids include a variety (...) trial did not report data on fibroid volume in a form that permitted calcuation of an odds ratio. Morevoer it was unblinded and included only 60/70 women in analysis.Evidence is insufficient to support the use of AI drugs in the treatment of women with uterinefibroids.
A comparative study on the effects of MRI- and CT-guided interventional therapies on uterinefibroids. To compare the effects of MRI- and CT-guided interventional therapies on uterine fibroids.A total of 280 patients with uterinefibroids who were treated in our hospital from August 2008 to February 2014 were selected and divided into a treatment group and a control group by random draw (n=140). The control group and the treatment group were subjected to CT- and MRI-guided interventional (...) therapies for uterine artery embolization.After three months of treatment, 94.3% and 92.9% of heavy menstrual bleeding and pelvic pressure of the treatment group were relieved respectively, which were similar to those of the control group (92.9% and 92.1% respectively) (P>0.05). The two groups had similar uterine and fibroid sizes before treatment, which were all significantly decreased after treatment (P<0.05) when the treatment group had significantly smaller uteri and fibroids than the control group
Safety and efficacy of the selective progesterone receptor modulator asoprisnil for heavy menstrual bleeding with uterinefibroids: pooled analysis of two 12-month, placebo-controlled, randomized trials. Can asoprisnil, a selective progesterone receptor modulator, provide clinically meaningful improvements in heavy menstrual bleeding (HMB) associated with uterinefibroids with an acceptable safety profile?Uninterrupted treatment with asoprisnil for 12 months effectively controlled HMB (...) and reduced fibroid and uterine volume with few adverse events.In a 3-month study, asoprisnil (5, 10 and 25 mg) suppressed uterine bleeding, reduced fibroid and uterine volume, and improved hematological parameters in a dose-dependent manner.In two Phase 3, double-blind, randomized, placebo-controlled, multicentre studies, women received oral asoprisnil 10 mg, asoprisnil 25 mg or placebo (2:2:1) once daily for up to 12 months.Premenopausal women ≥18 years of age in North America with HMB associated
Ultrasound-guided high-intensity focused ultrasound in the treatment of uterinefibroids. The aim of the present study was to investigate factors affecting ablation effect and safety of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterinefibroids (UFs).A retrospective analysis of 346 patients with symptomatic UFs who were treated with USgHIFU was performed. All UFs was grouped based on magnetic resonance imaging (MRI) characteristics before HIFU; all adverse events (...) , hypointense (T2WI), and mild enhancement (T1WI contrast enhancement) UFs had the highest ablation rate. The EEF of the anterior, intramural, hypointense (T2WI), mild enhancement (T1WI contrast enhancement), and >5 cm UFs had minimum value, with a statistically significant difference (P < .01). According to multiple linear regression model, the distance from the UFs ventral side to the skin, enhancement type on T1WI, size of UFs, signal intensity on T2WI, location of UFs, type and volume of fibroids all
Myometrial progesterone hyper-responsiveness associated with increased risk of human uterinefibroids. UterineFibroids (UFs) growth is ovarian steroid-dependent. Previous studies have shown that estrogen and progesterone play an important role in UF development. However, the mechanism underlying progesterone induced UF pathogenesis is largely unknown. In this study, we determined the expression of progesterone receptor and compared the expression level of progesterone-regulated genes (PRGs
Application of oxytocin in ultrasound-guided percutaneous microwave ablation for treatment of hypervascular uterinefibroids: a preliminary report. Objective: This study evaluated the effect of oxytocin administration prior to microwave ablation (MWA) of hypervascular uterinefibroids. Methods: Thirty-two patients with 38 hypervascular uterinefibroids (Adler blood flow grade 3) were equally apportioned to receive intravenous oxytocin infusion (0.32 U/min) 20 min before ultrasound-guided (...) was noted. Conclusion: Intravenous oxytocin administered before percutaneous MWA of hypervascular uterinefibroids can effectively block the blood supply vessels of the myoma, reduce the heat sink effect, and thereby increase the ablation volume and improve the local therapeutic effect.
Implementation of the uterinefibroids Option Grid patient decision aids across five organizational settings: a randomized stepped-wedge study protocol. Uterinefibroids are non-cancerous overgrowths of the smooth muscle in the uterus. As they grow, some cause problems such as heavy menstrual bleeding, pelvic pain, discomfort during sexual intercourse, and rarely pregnancy complications or difficulty becoming pregnant. Multiple treatment options are available. The lack of comparative evidence (...) demonstrating superiority of any one treatment means that choosing the best option is sensitive to individual preferences. Women with fibroids wish to consider treatment trade-offs. Tools known as patient decision aids (PDAs) are effective in increasing patient engagement in the decision-making process. However, the implementation of PDAs in routine care remains challenging. Our aim is to use a multi-component implementation strategy to implement the uterinefibroids Option Grid™ PDAs at five organizational
Randomised trial of two embolic agents for uterine artery embolisation for fibroids: Gelfoam versus Embospheres (RAGE trial). Uterine artery embolisation (UAE) is an established treatment option for women with symptomatic uterinefibroids who wish to avoid surgery. However the most efficacious embolic agent remains uncertain.We conducted a pilot double blind randomized controlled trial comparing Gelfoam with Embospheres in women undergoing UAE. Outcomes recorded at baseline, 24-h, 1 and 6 (...) ± 26 in the E and G groups respectively. UFS-Qol HRQL also improved in both groups at 6 months, mean 41 ± 28 to 79 ± 20 and 53 ± 19 to 78 ± 21 in the E and G groups respectively.Uterine volume at 6 months reduced from 1018 ± 666mls to 622 ± 436 (p = 0.001) and from 1026 ± 756 to 908 ± 720 (p = 0.15) in the E and G groups respectively. There was a significant difference between groups for this parameter p = 0.01. All uterine arteries were patent at 24-h and 6 months. Complete (100%) fibroid
Diagnostic ambiguity of aseptic necrobiosis of a uterinefibroid in a term pregnancy: a case report. Uterinefibroids are the most common uterine tumours in females of reproductive age. During pregnancy, uterinefibroids may be complicated by aseptic necrobiosis. We herein report an ambiguous clinical presentation of uterinefibroids in pregnancy and discuss the diagnostic challenges encountered in our resource-constraint setting.A term pregnant Cameroonian woman was admitted to our maternity (...) unit with clinical findings suggestive of a strangulated umbilical hernia. She underwent an emergency caesarean section which fortuitously revealed aseptic necrobiosis of a uterinefibroid, managed within the same surgical intervention by myomectomy. Her post-operative course was uneventful.The authors highlight the need for a high index of suspicion by healthcare providers, as well as the need for a multidisciplinary approach for a favourable maternal and foetal outcome.
Lower prevalence of non-cavity-distorting uterinefibroids in patients with polycystic ovary syndrome than in those with unexplained infertility. To study whether there is a difference in the prevalence of non-cavity-distorting uterinefibroids between infertile patients with polycystic ovary syndrome (PCOS) and those with unexplained infertility (UI).A secondary analysis of data from three randomized clinical trials.Academic health centers.A total of 2,249 patients with normal uterine (...) -distorting uterinefibroids was lower in women with PCOS than in those with UI (6.7% vs. 12.4%); this result held after patients were divided into Black and non-Black or into three different body mass index groups. After adjustment for all the other variables in the final model, patients with PCOS had a significantly lower prevalence of fibroids than those with UI (odds ratio 0.54). No differences in the prevalence of non-cavity-distorting fibroids with any dimensions ≥4 cm or the volume of the largest
Prescription of Chinese herbal products is associated with a decreased risk of uterinefibroids: A population-based cohort study. The finding of a decrease in subsequent fibroid-related operation following the use of Chinese herbal products (CHPs) has led to speculation that CHPs might play a role in uterinefibroids prevention.This study provides an overview of uterinefibroids incidence, comparing CHP users with those who do not use CHPs, referred to as non-CHP users. The results can provide (...) information to clinicians for counseling women about the preventive use of CHPs.A total of 52,151 women (20-45 years of age) were recruited from a nationwide 1-million-person representative sample of those covered by National Health Insurance in Taiwan and were followed from 2000 to 2013. Exact matching was performed for comparative analysis. The age-specific hazard ratios (HRs) of uterinefibroids in relation to either CHP or the phytoestrogen use were calculated with multivariate Cox proportional hazard