Hysteroscopic removal of submucous leiomyomas

Uterine leiomyomas are benign neoplasms that, when symptomatic, may require surgical treatment. The most symptomatic leiomyomas are of the submucous variety, causing persistent or recurrent uterine bleeding. Fifty-nine women experiencing abnormal uterine bleeding, dysmenorrhea, and/or infertility were diagnosed to have submucous leiomyomas, and of these, 52 were treated by hysteroscopic removal. In all women treated, the symptoms disappeared or markedly decreased. Of 16 patients with associated infertility, 10 conceived and 8 of these delivered a viable infant vaginally. Two women had a spontaneous abortion at 6 weeks and 11 weeks gestation, respectively. Although hysteroscopic removal of submucous leiomyomas is feasible in some patients, specific criteria for patient selection are needed that will allow the hysteroscopist to avoid failures and prevent complications. Hysteroscopy offers the best diagnostic method to detect or confirm submucous leiomyomas and, in selected cases, provides a good surgical alternative for treatment.