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Multidisciplinary Approach in Large-sized Submucosal Myoma: Hysteroscopic Myomectomy after Uterine Artery
Jeong Namkung1, So Yeun Kang2, Youn Jee Chung3
1From the Department of Obstetrics and Gynecology, St. Paul's Hospital (Dr. Namkung).
Study Objective:
To evaluate the safety and effectiveness of hysteroscopic myomectomy after uterine artery embolization (UAE) for the treatment of large-sized submucosal myomas with deep intramural invasion that are difficult to treat with 1-step hysteroscopy.
Design:
A retrospective cohort study (Canadian Task Force classification II-2).
Setting:
An academic university hospital.
Patients:
Eight premenopausal patients with symptomatic submucosal myomas with intramural invasion.
Interventions:
All of the patients after bilateral UAE underwent subsequent hysteroscopic operation 3 to 15 months after UAE.
Measurements And Main Results:
A total of 8 patients who had a large-sized submucosal myoma with deep myometrial invasion were included. The average volume of the submucosal myomas was 87.7±39.9 cm3 as confirmed by magnetic resonance imaging, and the average patient age was 37.6 years. The mean volume reduction of the submucosal myomas was 83.3±16.4% after UAE, and no immediate complications were observed. One-step hysteroscopic myomectomy after UAE was successfully performed in all patients. Leiomyomas with hyaline degeneration were pathologically confirmed. All women showed improved symptoms, and there was no evidence of recurrence 1 year later. One patient conceived naturally and delivered a full-term baby.
Conclusion:
In premenopausal women with large-sized symptomatic submucosal myomas with deep myometrial invasion, hysteroscopic myomectomy after UAE is very effective and safe.
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