COMMENTARY

Uterine Fibroids: A Short Review of Surgical Options

Peter Kovacs, MD, PhD

Disclosures

June 10, 2013

In This Article

The Study and Background

The Study

Falcone T, Parker WH. Surgical management of leiomyomas for fertility or uterine preservation. Obstet Gynecol. 2013;121:856-867.

Background

Uterine fibroids (leiomyomas) are the most common benign gynecologic tumors. Symptomatic fibroids occur in up 25% of women, but ultrasonography may detect them even more often.

Leiomyomas originate from uterine smooth muscle and can be either solitary or multiplex lesions. Various clinical symptoms may accompany them, depending on size, location, and number. Larger, multiplex intramural or subserosal fibroids typically result in pressure symptoms (urinary frequency, dyspareunia, and alterations in bowel function). Smaller tumors that grow toward the uterine cavity result in bleeding anomalies and may have an impact on reproduction.

Medical, surgical, and radiologic treatments are available for symptomatic patients. Medical treatment that induces hypoestrogenism and results in a decrease in myoma size might be beneficial. Radiologic treatments (uterine artery embolization or ultrasonography-guided radiofrequency myolysis) are effective but may have adverse reproductive effects, and therefore are not generally recommended when future fertility is desired.[1,2] Surgery may be definitive (hysterectomy) or conservative (myomectomy). The latter is recommended when the patient desires future fertility or wishes to retain the uterus.[3]

This review discusses the various conservative surgical options for fibroids and their indications, approaches, methods, and complications.

Comments

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