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Myoma Uteri


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Published in: Health & Medicine

Myoma Uteri

  1. 1. Myoma Uteri
  2. 2. <ul><li>A benign tumors of the smooth muscle cells of the uterus </li></ul><ul><li>Synonyms : Fibroids, Leiomyomata. </li></ul>What is Myoma uteri
  3. 3. Epidemiology <ul><li>T he most common non-cancerous tumours in women </li></ul><ul><li>T he most common indication for hysterectomy </li></ul><ul><li>A pparent in up to 25% of women . </li></ul><ul><li>M ore common in a higher body mass index women </li></ul><ul><li>3 times more common in black American women than white women. </li></ul><ul><li>Asian women have a lower incidence </li></ul><ul><li>S ympt oms appear at age of 30 s or 40 s </li></ul><ul><li>The incidence increases with age up to the menopause. </li></ul>
  4. 4. Pathophysiology <ul><li>Exact etiology is unclear </li></ul><ul><li>Hormonally responsive to estrogen ; grow during pregnancy and regress with menopause </li></ul><ul><li>M ay outgrow blood supply and degenerate causing p ain </li></ul>
  5. 5. C lassifi cation <ul><li>A ccording to position </li></ul><ul><li>70 % Intramural </li></ul><ul><li>( in uterine wall ) </li></ul><ul><li>20% S ubserosal </li></ul><ul><li>( beneath serosa) </li></ul><ul><li>10 % S ubmucosal </li></ul><ul><li>( beneath endometrium ) pedunculated submucosal or pedunculated vaginal </li></ul>
  6. 6. Symptoms <ul><li>Half of women with fibroids have no symptoms </li></ul><ul><li>symptoms depends on their size, position and condition </li></ul><ul><ul><li>Hypermenorrhea (submucosal are more likely) . </li></ul></ul><ul><ul><li>Persistent intermenstrual bleeding (cause by pedunculated submucosal fibroid) </li></ul></ul><ul><ul><li>Dyspareunia (cause by torsion of a pedunculated fibroid) </li></ul></ul><ul><ul><li>abdominal cramps, discomfort, and heaviness( cause by large uterus) </li></ul></ul><ul><ul><li>Constipation and urinary frequency (cause by pressure) </li></ul></ul><ul><ul><li>Recurrent miscarriage or infertility </li></ul></ul>
  7. 7. Clinical Findings <ul><li>Palpable abdominal mass </li></ul><ul><li>PV examination </li></ul><ul><ul><li>irregularly enlarged and asymmetrical. </li></ul></ul><ul><ul><li>tender and large sizes u nlike the soft uterus containing a pregnancy </li></ul></ul><ul><li>Signs of anaemia due to menorrhagia </li></ul>
  8. 8. Differential diagnosis <ul><li>Chronic pelvic inflammatory disease </li></ul><ul><li>Tubo-ovarian abscess </li></ul><ul><li>Ovarian tumour </li></ul><ul><li>Uterine sarcoma </li></ul><ul><li>Endometrial polyps, endometrial carcinoma </li></ul><ul><li>Endometriosis </li></ul><ul><li>Dysfunctional uterine bleeding </li></ul><ul><li>O ther causes of a pelvic mass include tumour of large bowel, appendix abscess, diverticular abscess </li></ul><ul><li>Pregnancy </li></ul>
  9. 9. Investigation <ul><li>Pregnancy test may be indicated. </li></ul><ul><li>Full blood count </li></ul><ul><li>Pelvic ultrasound: </li></ul><ul><li>Transvaginal ultrasound is more accurate. </li></ul><ul><li>MRI: occasionally required if ultrasound not definitive in assessing depth </li></ul><ul><li>Endometrial sampling for histology in the assessment of abnormal uterine bleeding. </li></ul><ul><li>Hysteroscopy with biopsies. </li></ul>
  10. 10. Treatment <ul><li>Medical </li></ul><ul><li>Surgical </li></ul>
  11. 11. Medicine <ul><li>N SAID to reduce menstrual blood loss and dysmenorrhea </li></ul><ul><li>Antifibrinolytic agents , e.g. tranexamic acid to reduce menorrhagia </li></ul><ul><li>Combined oral contraceptive if women also requires effective contraception </li></ul><ul><li>Danazol reduces menorrhagia by suppressing gonadotropin secretion and abolishing cyclical ovarian function </li></ul><ul><li>GnRH agonists: </li></ul><ul><ul><li>R educ e size of fibroid 50% within 3 months but once discontinued, fibroids regrow to their former size within about 2 months; therefore mainly useful preoperatively. </li></ul></ul><ul><ul><li>Beware of side effects including amenorrhoea, menopausal symptoms and osteoporosis in long term use. </li></ul></ul>
  12. 12. Surg ery <ul><li>Indication </li></ul><ul><ul><li>excessively enlarged uterine size ( > 12 wks gestation ) </li></ul></ul><ul><ul><li>pressure symptoms ( urinary frequency or retentio n etc.) </li></ul></ul><ul><ul><li>abnormal uterine bleeding causing anemia </li></ul></ul><ul><ul><li>severe pelvic pain secondary to amenorrhea </li></ul></ul><ul><ul><li>growth after menopause </li></ul></ul><ul><ul><li>infertility </li></ul></ul><ul><ul><li>rapid increase in size (r/o leiomyosarcoma) </li></ul></ul><ul><li>O ophorectomy if ovaries are damaged or age > 45 </li></ul>
  13. 13. Surgical option <ul><li>Myomectomy </li></ul><ul><ul><li>for patients who want to preserve their fertility </li></ul></ul><ul><ul><li>Laparoscopic myomectomy for subserous fibroids </li></ul></ul><ul><ul><li>Hysteroscopic myomectomy for submucosal fibroids </li></ul></ul><ul><ul><li>Vaginal myomectomy for Pedunculated vaginal </li></ul></ul><ul><ul><li>recur in 50% of patients </li></ul></ul><ul><li>Hysteroscopic endometrial ablation for menorrhagia. </li></ul>
  14. 14. Total hysterectomy technique <ul><li>Abdominal hysterectomy </li></ul><ul><li>Vaginal hysterectomy most often used in cases of uterine prolapsed </li></ul><ul><li>L aparoscope-assisted vaginal hysterectomy Vaginal hysterectomy performed with laparoscope , th e uterus is removed in sections through the laparoscope tube or through the vagina. </li></ul>
  15. 15. COMPARISON Laparoscopic Hysterectomy with Vaginal and Abdominal No scar 3 ½ cm scars  Large scar COSMETIC RESULTS 3-5 weeks 2 weeks 4-6 weeks RETURN TO WORK Minimal Negligent Significant POSTOPERATIVE PAIN 3-4 days 1-3 days 5-6 days STAY IN HOSPITAL Not possible Possible Possible REMOVE OVARIES Small uterus Prolapse  All indications Large fibroids Endometriosis Ovarian masses Poor access Adhesions INDICATIONS VAGINAL LAPAROSCOPIC ABDOMINAL  
  16. 16. Abdominal hysterectomy
  17. 17. Vaginal hysterectomy <ul><li>1. cervix prolapsing through vaginal introitus grasped by tenaculi </li></ul>2. cervix being bivalved with scalpel
  18. 18. 3. uterine corpus being bivalved after separation of cervix has been completed 4. uterus halved after bivalving procedure to facilitate its removal
  19. 19. <ul><li>5. after half of uterus is removed. cervix is grasped with uterine corpus below </li></ul>6. bladder is drained with foley catheter revealing non-bloody urine
  20. 20. LAVH ( laparoscopically assisted vaginal hysterectomy ) <ul><li>S urgical procedure using a laparoscope to remove the uterus and/or f allopian tubes and ovaries through the vagina </li></ul><ul><li>Not all hysterectomies can or should be done by LAVH. </li></ul>
  21. 21. LAVH
  22. 23. Uterine artery embolisation <ul><li>Is both effective and relatively safe for women who no longer wish to have children </li></ul><ul><li>Ensuring the tumour is a benign </li></ul><ul><li>Compared with uterine artery embolisation (UAE), hysterectomy is associated with better improvement in pelvic pain </li></ul>
  23. 24. Uterine artery emobilization
  24. 25. Myoma uteri & Complication in pregnancy
  25. 26. Complication in pregnancy <ul><ul><li>Recurrent miscarriage </li></ul></ul><ul><ul><li>Fetal malpresentation </li></ul></ul><ul><ul><li>Red degeneration: presents with fever, pain and vomiting </li></ul></ul><ul><ul><li>Intrauterine growth retardation </li></ul></ul><ul><ul><li>Premature labour </li></ul></ul><ul><ul><li>Postpartum haemorrhage </li></ul></ul>
  26. 27. <ul><li>Smooth muscle tumors of the uterus are often multiple. Seen here are submucosal, intramural, and subserosal leiomyomata of the uterus </li></ul>
  27. 28. <ul><li>a very large leiomyoma of the uterus </li></ul>
  28. 29. <ul><li>leiomyosarcoma protruding from myometrium into the endometrial cavity </li></ul>