INTRODUCTION: The aim was to compare the surgical experience and the clinical results of laparoscopic myomectomy (LM) with or without pre-treatment with ulipristal acetate (UPA). MATERIAL AND METHODS: Fifty-four women who underwent LM for intramural myomas and were pre-treated with three months of UPA were matched with 54 patients with the same procedure but no hormonal pre-treatment. All operations were performed by one team. The technical features of the procedures were reviewed and evaluated by two other laparoscopists, unaware of the eventual use of UPA. The clinical, histological, and reproductive outcomes of each patient were assessed and the results of both groups were compared. RESULTS: The groups did not significantly differ in operation time, intra-operative blood loss, drop in hemoglobin concentration, number of complications, pregnancy rate, and delivery rate. Women pre-treated with UPA had significantly longer hospital stays, higher numbers of histologically abnormal leiomyomas, and higher rates of fibroids peri-procedurally assessed as soft and disintegrating. The other four technical parameters of LM were comparable in both groups. CONCLUSIONS: The surgeons performing LM in women pre-treated with UPA should be aware of the abnormal texture of enucleated myomas. Nevertheless, this does not negatively affect the other surgical and clinical outcomes of these patients.
- MeSH
- laparoskopie * MeSH
- lidé MeSH
- myomektomie * MeSH
- nádory dělohy * farmakoterapie chirurgie MeSH
- norpregnadieny * MeSH
- těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- adenomyóza * chirurgie diagnostické zobrazování krev MeSH
- antigen CA-125 analýza MeSH
- hysteroskopie metody MeSH
- lidé MeSH
- ženská infertilita etiologie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- hysteroskopie * metody škodlivé účinky MeSH
- lidé MeSH
- myom * diagnóza patologie terapie MeSH
- myomektomie metody MeSH
- pooperační komplikace MeSH
- předoperační vyšetření metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Uterine artery embolization (UAE) is a minimally invasive procedure with large symptomatic potential in treatment of women with uterine leiomyomas. Due to specificities of this method and possible complications the appropriate indication is crucial. Patient' symptoms, age, plans for pregnancy, and surgical and reproductive history play a major role in decision-making regarding appropriate subjects for UAE. Close cooperation between the gynecologist and the interventional radiologist is necessary. UAE is usually offered as an alternative to surgical treatment. In patients with no fertility plans, it is a less invasive option than abdominal hysterectomy, with a comparable effect on fibroid-related symptoms and quality of life. The need for reintervention is markedly greater in patients after UAE (up to 35% within 5 years) than after hysterectomy. Women with large symptomatic fibroids wishing to retain the uterus and ineligible for minimally invasive (laparoscopic or vaginal) hysterectomy are good candidates for UAE. However, studies comparing UAE with minimally invasive hysterectomy are lacking. Use of UAE in younger women desiring pregnancy is more controversial, mainly because of the significant risk of miscarriage (as high as 64% in some studies) as well as the increased risk of other complications of pregnancy, such as preterm delivery, abnormal placentation, and post-partum hemorrhage. The risk of infertility or subfertility following UAE is unknown. Even poor candidates for myomectomy should be carefully selected for UAE after counseling about all possible adverse effects on fertility. Good prospective studies focused on fertility comparing UAE with no treatment or with myomectomy are needed but would be ethically questionable. This review summarizes the current knowledge regarding the benefits and potential risks of UAE from the point of view of the gynecologist, who should be responsible for proper indication of this treatment.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Aeskulap
1. vyd. 173 s. : il. ; 20 cm
Výběr kazuistik z této oblasti medicíny by čtenářům měl přinést nejen pohled na zajímavé, komplikované či velmi neobvyklé situace řešené endoskopicky, ale i návod, jak v těchto situacích postupovat nebo nad jakými jinými postupy uvažovat. Autoři se pokusili vybrat několik zajímavých případů ze své praxe, popsat je textem, doplnit obrázky a konfrontovat s literaturou. Gynekologická endoskopie a minimálně invazivní operace jsou dnes již běžnou součástí dovedností i mladých gynekologů a snad kromě onkologie představují dominantní přístup v celé gynekologické operativě. Proto má tato knížka ambici oslovit co nejširší spektrum gynekologů, ale též lékaře z jiných invazivních oborů, např. chirurgy, urology a anesteziology.
- MeSH
- endoskopie metody MeSH
- gynekologická onemocnění chirurgie terapie MeSH
- gynekologické chirurgické výkony MeSH
- laparoskopie metody MeSH
- miniinvazivní chirurgické výkony metody MeSH
- Publikační typ
- kazuistiky MeSH
- Konspekt
- Gynekologie. Porodnictví
- NLK Obory
- gynekologie a porodnictví
- NLK Publikační typ
- kolektivní monografie
