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Myoma: A benign tumor of smooth muscle in the wall of the uterus. A myoma of the uterus is commonly called a fibroid.
Uterine fibroids are the single most common indication for hysterectomy. Fibroids can be present and be in apparent. However, they are clinically apparent in up to 25% of women and cause significant morbidity including prolonged or heavy menstrual bleeding, pelvic pressure or pain, and, in rare cases, reproductive dysfunction. Both the economics cost and the effect of fibroids on quality of life substantial.
Fibroids are not cancerous. Drugs that manipulate the levels of steroid hormones are effective in treating fibroids but side effect limit their long term use. Fibroids may be removed if they cause discomfort or if they are associated with uterine bleeding. Surgery is the mainstay of fibroid treatment. In addition to hysterectomy and abdominal myomectomy, various minimally invasive procedures have been developed to remove fibroids.
Fibroids: Uterine fibroids (also referred to as myoma, leiomyoma, leiomyomata, and fibromyoma). Fibroids range in size from very small (coin sized) to larger than a melon. A very large uterine fibroid can cause the uterus to expand to the size of a six or seven-month pregnancy. There can either be one dominant fibroid or a cluster of many small fibroids.
There are three primary types of uterine fibroids, classified primarily according to location in the uterus:
- Subserosal uterine fibroids : These fibroids develop in the outer portion of the uterus and continue to grow outward.
- Intramural uterine fibroids : The most common type of fibroids . These develop within the uterine wall and expand making the uterus feel larger than normal(which may cause “bulk symptoms”.
- Submucosal uterine fibroids: These fibroids develop just under the lining of the uterine cavity. These are the fibroids that have the most effect on heavy menstrual bleeding and the one’s that can cause problems with infertility and miscarriage.
- Pedunculated: Fibroids that grow on a small stalk that connects them to the inner or outer wall of the uterus.
Symptoms of uterine fibroids:
- Very heavy and prolonged menstrual periods.
- Pain in the back of the legs.
- Pelvic pain or pressure.
- Pain during sexual intercourse.
- Pressure on the bladder which leads to a constant need to urinate, incontinence, or the inability to empty the bladder.
- Pressure on the bowel which can lead to constipation and / or bloating.
- An enlarged abdomen which may be mistaken for weight gain or pregnancy.
Treatment:
Hysterectomy : Surgical removal of the uterus. Expect a hospital stay and a recovery period.
There are 3 Types of Hysterectomy:
- Total Hysterectomy- The surgeon will remove the whole of the uterus, including the cervix.
- Subtotal Hysterectomy- The surgeon will remove the top part of the uterus, leaving the cervix behind.
- Radical HysterectomyThis is a more extensive hysterectomy performed for cancer of the uterus or cerVIX.
With any type of hysterectomy, the ovaries and fallopian tubes may be removed as well (Salpingooophorectomy). This is more commonly done in women over the age of 45. Please feel free to discuss your preferences with your doctor.
There are four ways to perform a hysterectomy:
- Abdominal Hysterectomy- The operation is performed through a 15-20cm incision in the abdomen. The incision may be horizontal and quite low (Bikini line) or vertical from the umbilicus down to the pubic bone. This is the traditional way of performing a hysterectomy and is still required in some difficult cases. It usually requires a longer hospital stay and longer recovery period than the other methods of performing a hysterectomy.
- Vaginal Hysterectomy - The uterus is removed via incisions in the vagina. This is the safest way to perform a hysterectomy. Its main disadvantages are that it may not be technically possible to perform (eg large uterus), and that the surgeon may not be able to see or treat other problems inside the abdomen.
- Laparoscopic Hysterectomy - Through 4 small incisions in the abdomen, and by using "keyhole surgery" techniques, the uterus and/or ovaries can be cut free and removed via the vagina. This is the newest form of hysterectomy. It is only performed by a small number of surgeons. Initially there was a slightly higher incidence of complications as surgeons were learning the procedure. It is now felt that the risks are comparable to abdominal hysterectomy, but the recovery time is shorter.
- Laparoscopically Assisted Vaginal Hysterectomy -"Keyhole surgery" is used to help the surgeon perform a vaginal hysterectomy in situations where the only other option would be abdominal hysterectomy. Performed by many gynaecologists, it is useful for removing the ovaries or when other pathology is present, such as fibroids or endometriosis.
| Removal of Uetrus with Ovarioncyst |
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| Removal of large size Uetrus |
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General risks of surgery:
- Wound, chest or urinary tract infection: 3-5%
- Major haemorrhage requiring blood transfusion: 2-4%
- Blood clots in the legs or lungs: <1 %
- Risks of the anaesthetic including heart attacks or strokes: <1 %
- Abnormal scar tissue formation (keloid): variable
Risks specific to hysterectomy:
- Injury to adjacent organs including, bowel, bladder or ureter: <1 %.
- Pelvic haematoma (blood clot): 3-5%.
- Temporary alteration in bladder and bowel habit is quite common after a hysterectomy.
- The menopause may start one or two years earlier.
- Prolapsed of the vagina may be more common following hysterectomy secondary to disruption of the supports of the upper vagina. This may require corrective surgery.
- During a vaginal or laparoscopic hysterectomy there is a small chance that the surgeon may need to convert to an abdominal hysterectomy to safely complete the procedure.
COMMON ISSUES :
Vaginal Bleeding and Discharge - A small amount of vaginal bleeding is common after this surgery and it may persist for 6 weeks. Have some ultra thin sanitary pads on hand - best to avoid tampons. Please report any discharge that is offensive or becomes heavier than a period.
Return to normal activity
- Activities should be limited for 4-6 weeks after surgery (including most housework).
- It is important that you do not do any heavy work for 6 weeks or heavy lifting for 8 weeks after surgery.
- As a general rule, if it hurts do not do it!
- Intercourse should not be resumed until six weeks after surgery and one week after the bleeding stops.
- It is advisable not to drive a car until completely comfortable and feeling well. This may be anywhere between 2-6 weeks. Do not plan a long trip even as a passenger for at least a couple of weeks after your discharge from hospital.
- Gentle swimming is fine once all vaginal discharge has settled.
- Avoid constipation.If this is a problem increase your fibre and fluid intake (have at least 1-1 Y2 litres of water per day). Coloxyl tablets (1-2 tablets once or twice a day) may also be useful.
Abdominal Myomectomy: Removal of one or more of the fibroids with open abdominal surgery.
Laparoscopic or hysteroscopic myomectomy: One or more of the fibroids are removed using laparoscopic or endoscopic techniques.
Harmone Therapy: GnRH drug treatment causes fibroids shrinkage.
Uterine Artery Embolization : The uterine artery is injected with polyvinyl alcohol beads, with catheter, which block the flow of blood to the fibroids and cause necrosis.
Watchful Waiting: No treatment.Monitoring for any progression of symptoms.
Treatment by Single Hole Surgery read more >>> |
