Operations to remove fibroids. How is the removal of uterine fibroids, the rehabilitation period and possible consequences If you do not remove the fibroids, what will happen

Uterine fibroids are one of the most common diseases. It is characterized by the growth of the muscle tissue of this organ in the form of nodes, eighty percent of which are multiple. This is a benign tumor. Every third woman over thirty is a “carrier” of fibroids of larger or smaller sizes. But especially often, fibroids appear, and most importantly, suddenly begin to grow after forty years during the period of hormonal adjustment associated with the approach of menopause. In many countries, the main treatment for fibroids is hysterectomy, the removal of the uterus.

CAUSES OF UTERINE MYOMA

Doctors have long believed that uterine fibroids - estrogen - dependent tumor, and this is true. However, recent studies by American, Japanese, Russian scientists prove that the common cause of fibroids is different. This is the reaction of the uterus to various injuries. First of all, these are difficult childbirth, abortion, illiterate introduction of an intrauterine device, non-professional hysteroscopy (optical examination of the uterine cavity).

Russian doctors were among the first to discover various infections in myomatous nodes - chlamydia, ureaplasma, pathogenic viruses. And they, too, can become a trigger for the appearance of fibroids. So promiscuous sex life, especially without the use of a condom and other means of protection, also leads to the appearance of a tumor.

The cause of its occurrence can also be, on the contrary, an irregular sexual life, as well as anorgasmia during intercourse, when blood vessels are filled without sexual discharge.

One of the arguments in favor of hysterectomy is often the opinion that the tumor can become malignant. However, it is not. Myoma consists of muscle tissue, and cancer, according to experts, usually arises from epithelial tissue.

Russian doctors have proven that the possibility of malignancy (malignancy) of the myomatous node is practically zero. Uterine sarcoma is thirty times less common than any other cancerous tumor and usually has nothing to do with fibroids.

IS IT POSSIBLE TO LIVE WITH UTERINE MYOMA

If a fibroid never degenerates into a cancerous tumor, should it be treated at all? Definitely needed. A tumor is an abnormal condition of the uterus and can cause major problems. In particular, severe bleeding during menstruation - when a growing node deforms the uterine cavity, or severe pain - if the node grows on a "leg" that is twisted. Having reached a large size, the tumor can disrupt the functions of adjacent organs. For example, put pressure on the bladder, causing frequent, painful urination, "lean" on the rectum, causing constipation.

WHAT TO DO?

Today, as we have said, there is an alternative to hysterectomy. This is a complex conservative (preserving) treatment. For example, the operation is a conservative myomectomy, when only myomatous nodes are removed. Another promising way is drug therapy.

Not so long ago it became known that the growth of fibroids is affected not only by the hormone estrogen and progesterone. If you choose drugs containing progestins (the so-called fake progesterone is found in birth control pills), you can slow down the growth of fibroids and even completely get rid of them if they are less than three centimeters.

Small myoma nodes during pregnancy usually regress on their own, although doctors do not recommend giving birth with large ones. And for women over 40, who have fibroids of even large sizes, if, of course, it does not bother them, experienced doctors are advised to hold out until menopause. Then the body will stop producing sex hormones, and the fibroid regresses by itself.

Indications for hysterectomy - the size of fibroids 14-16 weeks, rapid growth, dysfunction of neighboring organs. The operation is done under general anesthesia, it is better if by laparoscopy.

FORECAST FOR THE FUTURE

We have a new word in the treatment of fibroids - the method of embolization of the uterine arteries. This is a blockage of the arteries that feed uterine fibroids. Under the control of X-ray television, a catheter with a diameter of 1.5 mm is inserted through a puncture in the femoral artery and passed into the uterine artery. Embolization particles of a special polymer are injected through the catheter. It completely blocks the vessels that surround and feed the myoma. After that, the tumor disappears.

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Myoma: to remove or not?

Having heard the diagnosis of "uterine fibroids", you should not panic - this diagnosis is more than common and certainly not fatal. According to statistics, fibroids are found in every fifth woman in the world, and after 30 years the risk of developing the disease increases. Today we’ll talk about when this benign formation should still be removed, and whether it’s worth it at all.

Treatment options for fibroids today are much more diverse than before. If a couple of decades ago, a woman with uterine fibroids would have been categorically offered a radical removal of the entire uterus, now doctors have become more careful and offer patients more gentle treatment methods in order to preserve the organ and reproductive function of the woman. Moreover, it is not at all necessary to remove the fibroids surgically.

Depending on the size of the neoplasm, the degree of discomfort and the number of nodes, the doctor will prescribe hormone therapy to the patient, which will help the fibroid resolve on its own or at least stop its growth. This option is possible if you are not planning a pregnancy in the near future.

The most advanced treatment for fibroids today is UAE - uterine artery embolization. Through a small puncture in the thigh, the doctor inserts a special catheter, contrasts the pelvic arteries and passes a substance through it that blocks the blood flow into the fibroids. Thus, the blood flow in the myoma stops, and it seems to die off naturally. UAE is done quite quickly and can be performed under local anesthesia, so it is extremely comfortable for the patient.

The third treatment option for fibroids is the surgical route, myomectomy. Today, they have learned to do such procedures as carefully as possible, preserving the organ, so now the removal of fibroids rarely affects the functioning of the uterus and the woman's further reproductive plans.

“There can be no exact, suitable for everyone recommendation about the removal or not removal of fibroids,” says an obstetrician-gynecologist, doctor of the II category of the Center for Surgery “SM-Clinic” Tatyana Aleksandrovna Yudina. - In each individual case, the doctor should assess the size and location of the fibroids and tell the patient about the possible treatment options. As a rule, we are talking about surgical treatment if the fibroid causes discomfort or pain to the patient, causes bleeding, interferes with pregnancy, or in some other way disrupts the normal functioning of the female body. Also, doctors begin to talk about removal when the fibroid reaches a rather large size, corresponding to a pregnancy of 12-14 weeks. In other cases, as a rule, non-surgical methods of treating fibroids are chosen. The only thing I would like to warn patients against is the unfounded advice of doctors to treat fibroids only by removing the uterus. Today in medicine there are much more humane methods of treatment, and removal of the uterus is prescribed only in exceptional cases. Therefore, if a doctor recommends removal of the uterus, it is better to get an alternative opinion from another specialist.”

If you have decided that it is necessary to remove the fibroids, then you should remember that after myomectomy, a certain rehabilitation period must pass, during which it is better to refrain from pregnancy. Usually this period is from six months to a year, after which a woman can plan to become pregnant without harm to her health and the health of the fetus. Otherwise, the operation to remove fibroids is less traumatic, it is done both laparoscopically and in some cases by laparotomic access, and allows the uterus to recover after the intervention rather quickly.

If the fibroid does not interfere with life and does not grow, then the doctor may recommend observing it - in some cases, the nodes pass on their own, especially with the onset of menopause.

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Should myoma be removed?

Myoma is a benign tumor that develops from the muscular tissue of the uterus, and consists of a number of connective tissue elements. This disease is most typical for women over 35 years of age, but recently, due to serious environmental pollution, the category of women who are prone to this disease is becoming younger and younger.

To date, doctors have identified three types of fibroids, each of which can form in certain areas of the uterus. Interstitial fibroids are located in the thickness of the walls of the uterus. Submucosal fibroids grow in such a way that part of the tumor protrudes into the uterus and deforms it. Subserous fibroids form under the peritoneum.

The most effective treatment for fibroids and whether fibroids need to be removed.

Despite all the achievements of modern pharmacology, treatment with tablets and various drugs is not always effective. That is why, when asked whether fibroids should be removed, patients are increasingly hearing an affirmative answer. Surgery is especially necessary to remove fibroids in the event that there is a rapid growth of the tumor, the fibroid is combined with an ovarian tumor, as well as infertility, or miscarriage.

Today, depending on the age of the patient and the location of the fibroids, a choice is made towards one of the methods of surgical treatment. In the event that exfoliation of myomatous nodes is observed, a conservative myomectomy is prescribed. This method of surgical intervention is abdominal, or laparoscopic. Such operations are performed mainly on women who are interested in becoming pregnant in the future.

How can you effectively get rid of fibroids?

You can also remove fibroids by hysterorectoscopy, which removes fibroids from the upper surface of the uterus. This type of operation is indicated primarily for women who have been diagnosed with a submycotic arrangement of nodes.

A hysterectomy is the removal of the uterus. This method is used primarily when the fibroids can no longer be removed by other available methods. Such operations are performed by the abdominal, vaginal or laparoscopic method.

Embolization of the uterine arteries is a minimally invasive operation that began to be introduced into surgical practice no more than ten years ago. This type of operation consists in introducing emboluses into the vessels, which block the arteries that supply blood to the myoma. Without a blood supply, fibroids die. Such an operation is quite complicated, but, despite this, after it the chances of getting pregnant are as high as possible.

Despite all the pros and cons of the above types of surgery, the most effective for removing fibroids is the combined method. The fact is that according to this method, all available methods of treating fibroids are used, and a number of measures are taken that prevent the recurrence of problems with tumors.

In addition, before removing the fibroids along with the uterus, it is necessary to conduct a complete examination in order to understand whether it is possible to leave the ovaries. The decision largely depends on the age of the patient, as well as the health of the ovaries.

As you know, the disease is much easier to prevent than to treat, and uterine fibroids are no exception. Therefore, in order to avoid such problems, it is imperative to regularly undergo an examination by a gynecologist, and, if necessary, follow all the recommendations and requirements of the doctor.

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November 21, 2014 Posted in case history, Notes, about the most important 2014, About the most important notes

Uterine fibroids is a problem that worries many women. Often women's doctors are asked questions about whether fibroids should be removed, they want to know if fibroids develop into cancer, if fibroids occur if a woman does not enjoy sex.

A specialist gynecologist will visit the program, he will help Dr. Myasnikov. By itself, fibroids are not an indication for treatment or removal. If a woman feels well, if she does not have pain and bleeding, anemia, then you should not treat or remove fibroids.

It happens that a woman is not bothered by a fibroid, it is discovered by chance during examination. But there are special nuances. The gynecologist should do an ultrasound. Myoma needs to be observed. If the fibroid is growing rapidly, then you need to take action and treat the fibroid.

Myoma does not develop into cancer, you need to know about it and not worry about it. Rapid growth is not a sign of something bad. If a woman is going to give birth in the near future, then the tactics of managing fibroids will be different. With fibroids, there may be pressure on the bladder or rectum.

With fibroids, there may be heavy periods, which lead to anemia. Myoma grows as long as there is menstruation. It depends on hormones. Myoma may be large. There can be many nodes in the uterus, but there are nodes that can deform the walls of the uterus and give symptoms.

A spectator came to the program, she is interested in this topic. A woman has fibroids, but she wants to give birth. One pregnancy with fibroids went well. But today the woman has concerns. She wants to give birth again. The doctor at the studio said that there were no fibroids, they were tiny and would not affect the pregnancy in any way.

Part of the fibroid may die when there is a pregnancy. But the woman did not have fibroids at all. An 8 mm knot is not a fibroid. This may be an error. If there was a fibroid, but the patient would have planned a pregnancy, then the doctors look at the nodes, there are nodes that do not interfere with giving birth.

If they can be removed without injuring the uterus, then they are recommended to be removed, and then become pregnant. But in case these nodes can interfere with gestation. There is a medical way to treat fibroids. Hormones are prescribed. But medicines temporarily shrink fibroids.

There is a minimally invasive operation, but it is shown to a woman if she wants to give birth. There is embolization of the uterine arteries. The method has proven to be excellent. The nodes lose power. The knot dies, it does not interfere with the woman. Evaporation was invented.

But there are many contraindications, this is an old method. In extreme cases, the entire uterus is removed. This may be when a woman is not going to give birth. But we must try to save the uterus. Removing the uterus is not healthy. The absence of a uterus increases the risk of cardiovascular disease.

We remind you that the synopsis is only a brief summary of information on this topic from a specific program, the full video release can be viewed here About the most important issue 1131 of November 21, 2014

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2018 Women's Health Blog.

Content

Myoma is a benign neoplasm of a hormone-dependent nature, localized in the muscular layer of the uterus. Pathology is typical for women from 30 to 45 years old, but can also develop at a younger age. If you start when the formation is small, you can avoid surgery, as well as more serious indications in the form of removal of the organ.

The feasibility of surgical treatment

Uterine fibroids form and develop in a muscular layer called the myometrium. Upon reaching a significant size, the formation can migrate and be diagnosed:

• in the body of a muscular organ;
• in the neck part.

Specialists distinguish the following options for fibroids regarding its localization in the uterus:

• subserous, located under the serous membrane;
• submucosal or submucosal, is located under the mucous membrane;
• intramural or interstitial, grows in the thickness of the myometrium;
• intraligamentary, progresses between the leaves of the broad ligament;
• retroperitoneal, grows from the cervical part.

Uterine fibroids usually have the form of nodes, which are characterized by a different number and size:

• multiple and single tumor;
• neoplasm of small, medium or large sizes.

Large nodules are often an indication for surgery or removal of the uterus. Myomatous nodes are attached to the tissue of the uterine wall through a wide base or thin stem. The growth rate of neoplasms depends on the structure.

1. Simple fibroids grow slowly and reach significant volumes within five years.
2. Proliferating tumor characterized by rapid progression.
3. Presarcoma contains altered cells, characterized by the presence of several large nuclei.

Histological composition may differ. If the formation contains predominantly smooth muscle cells in the structure, leiomyoma is diagnosed. Fibrous tissue in the composition of the tumor characterizes fibromyoma.

Myoma has a hormone-dependent etiology and pathogenesis. Congenital disorders that occur in the muscular tissue of the uterus under the influence of internal and external adverse factors are also considered as the cause of the formation of a neoplasm.

Before treating the disease, it is necessary, if possible, to eliminate the factors that provoke the progression of the nodes. Otherwise, the treatment may be useless, which will lead to tumor growth and an indication for its surgical removal.

The severity of the clinical picture is essential when choosing treatment tactics. Often, the disease proceeds latently, which contributes to its rapid progression and detection at an advanced stage. This explains why doctors often have to remove nodes surgically.

Features of the clinical picture are often an indication for surgery.

There are certain indications for both the removal of fibroids and the body of the uterus.

Doctors distinguish the following indications for the removal of fibroids:

• leiomyoma size at least 12 weeks;
• combination of fibroids with endometriosis or cancer;
• torsion of the legs of fibromyoma, its necrosis;
• violations of the functioning of internal organs;
• severe pain;
• oncological alertness;
• reproductive disorders;
• lack of effect from the use of drugs that stop acyclic.

The following sizes of nodes are called, which correspond to the weeks of pregnancy:

• a small fibroid corresponds to five weeks of pregnancy and two centimeters;
• secondary education, equivalent to a pregnancy for a period of eleven weeks and having a size of up to six centimeters;
• a large tumor looks like a 15-week pregnancy with nodes that have a volume of more than six centimeters;
• with a giant neoplasm an increase in the uterine cavity reaches 16 weeks or more.

A large or giant fibroid is an indication for removal. Sometimes doctors have to remove small fibromyomas, in particular, with torsion of the leg, necrosis of the formation, infertility. A few decades ago, gynecologists believed that with fibroids, the uterus should be removed.

In recent years, indications for hysterectomy have been reduced to a minimum. In modern gynecology, large fibroids and the onset of menopause are no longer indications for removal of fibroids.

It is necessary to remove the uterus with myoma in the following cases:

• suspicion of oncology;
• concomitant prolapse of the uterine body and cervix;
• active progression of endometriosis.

When a woman's uterus is removed, she not only loses her reproductive function. Removal of the uterus will necessarily entail serious consequences for health. In this connection, organ-preserving operations are carried out in modern gynecology. Removal of the uterus is necessary only for certain indications.

Operation methods

If indicated, uterine fibroids should be removed. Before removing the neoplasm, the doctor must conduct an examination to determine the exact location and type of leiomyoma.

When indications for surgical treatment of fibromyomas are carried out using:

• organ-preserving treatment;
• radical operations.

For small fibroids, the indication is treatment with sparing tactics, for example, uterine artery embolization, myomectomy, FUS ablation. During such operations, the myomatous node is removed, and the reproductive function is preserved.

Embolization of the uterine arteries consists in removing the node by blocking the vessels that feed it. Such removal of fibroids refers to an effective technique with a relatively low percentage of relapses.

Organ-preserving removal is carried out by several techniques.

1. Laparoscopic and laparotomic myomectomy. Indications for removal are single and multiple tumors of the interstitial or subserous variety. Laparotomy removal is used quite rarely due to trauma and the risk of surgical complications. Among the indications for the isolation of large leiomyomas, uterine deformities.
2. . Removal must be carried out using a hysteroscope with a submucosal location of the tumor. During this manipulation, gynecologists have to both diagnose and remove leiomyomas. The operation is also performed at the birth of the submucosal node. Removal must be performed in the first days of the cycle during a planned operation. You can remove fibroids in a hospital and outpatient setting.

When using surgical methods of treatment, it is necessary to take into account that the removal of uterine fibroids is often accompanied by a risk of complications and relapses.

In gynecological practice, sometimes doctors have to remove uterine fibroids using a radical method. Radical surgery requires removal of the uterus. Radical surgeries include:

• hysterectomy;
• extirpation.

After the surgical treatment The patient is undergoing medical examination. As a rule, a woman also has to take hormonal drugs to prevent relapse.

Hysterectomy

A uterus with fibroids can be removed with an operation called a hysterectomy. This intervention ranks second in frequency in women. Experts note that this is one of the most common ways to remove fibroids.

Absolute indications, in which it is necessary to remove the uterus in case of myoma, are the processes of its prolapse or prolapse, as well as the suspicion of cancer. Hysterectomy is often necessary for women to remove a uterus with advanced tumor after menopause.

With fibroids, the removal of the uterus can be carried out in different ways. There are several types of hysterectomy, with which you can remove the body:

• subtotal, consisting in the removal of the uterus while preserving its cervical part;
• total, meaning the removal of both the uterus and its cervix;
• hysterosalpingo-oophorectomy, implying the removal of the uterine body, ovaries, and tubes.

Before removing the affected organ, the doctor must warn about the complications that may arise during and after the hysterectomy. Complications after a hysterectomy include:

• allergic reactions to anesthesia, leading to death;
• damage to organs located in the pelvis, as well as nerve bundles;
• postoperative bleeding;
• intestinal obstruction;
• development of the adhesive process;
• peritonitis.

After removal, the patient needs to carefully monitor her well-being. In the absence of complications, recovery after a hysterectomy will take about two months.

Hysterectomy has a number of distant ones that adversely affect a woman's life. The long-term consequences after removal by the hysterectomy method include:

• posthysterectomy syndrome;
• exacerbation of diseases of the cardiovascular system;
• the risk of developing a tumor in the mammary glands;
• the development of manifestations of menopause, for example, depression and sweating, hot flashes, osteoporosis;
• problems in intimate life due to the occurrence of vaginal dryness, decreased libido;
• prolapse of the vaginal walls;
• urinary incontinence;
• bacterial vaginosis;
• hypertension;
• obesity.

The patient after the removal of the uterus, which implies a hysterectomy, must take hormonal drugs. After a hysterectomy, a woman loses her reproductive function, which is especially important for women of childbearing age.

Many modern gynecologists say that it is not always worth removing an organ through a hysterectomy. In some cases, an organ-preserving intervention is required. Before deciding on a hysterectomy and removing an organ, one must think about the consequences that may appear in the long term.

Uterine fibroids is one of the most common gynecological pathologies, and you will not surprise anyone with such a diagnosis. According to statistics, the disease is detected in 35% of women over the age of 35 years. In modern gynecology, practitioners often have to deal with formations of small and medium sizes.

Large-sized fibroids are somewhat less common due to the developed system of diagnostics and the timely passage of regular medical examinations by women. It is noted that huge nodes are detected mainly after 40 years in patients who have refused treatment for a long time.

The largest fibroid in the world, according to medical literature, weighed 63 kilograms, and so far this sad record has not been broken. This fact makes it clear: a uterine tumor can grow almost indefinitely, reaching gigantic proportions. There is no need to wait until the weight of the fibroids is equal to the weight of an adult. Timely therapy avoids such a development of events and prevents the rapid growth of the myomatous node.

What fibroid is considered large

On numerous forums on the Internet, you can find entries in the style of “I have been living with a large fibroid for many years, I don’t know what to do.” At the sight of such messages, women involuntarily ask themselves the question: which fibroids should be considered large and are there clear criteria for this condition (for example,)? Gynecologists adhere to the generally accepted classification, according to which a large fibroid is considered a node with a size of 6 cm (60 mm).

A large tumor is considered to be more than 6 centimeters in size (the photo shows a fibroid removed along with the uterus more than 15 cm in diameter).

The size of the uterus in this case corresponds to a 12-week pregnancy. But here are some important points to note:

• In the medical literature, you can find a mention that a large fibroid is a node with a diameter of 5-6 cm. In this situation, it is not entirely clear which category a tumor with a size of 5 or 5.5 cm belongs to - medium or large nodes? If we analyze the case histories of patients, we can see that fibroids of such borderline sizes are classified as both large and medium tumors. Practitioners in this situation are advised to look not only at the size of the formation, but also at the size of the uterus, and if it exceeds 12 weeks, classify the tumor as large;

A photo of a large fibromyoma can be seen below:

• With the leading value is the size of the dominant node - they are guided by it when drawing up a treatment protocol;
• Giant fibroids deserve special attention among large formations. Which tumor to consider as such is a debatable question. It is customary to refer to giant nodes from 10-12 cm in diameter. Such formations are poorly amenable to conservative therapy, and their removal within healthy tissues requires special skill of the surgeon. Often, with giant tumors of the uterus, the only method to solve the problem becomes.

A photo of a giant fibroid is presented below:

On a note

Uterine leiomyoma according to ICD-10 has code D25, regardless of the size of the node.

It is important to understand that theoretically a benign tumor can reach any size if its growth is not limited by anything.

Distinctive features of large myomatous nodes

It's important to know

If a woman is planning a pregnancy, treatment of a large fibroid should not be delayed.

Successful conception of a child does not mean that the pregnancy will pass without complications. With large fibroids, placental insufficiency and concomitant fetal growth retardation are often recorded. Pregnancy against the background of a large tumor can end prematurely, and rarely any of the women manage to bring the baby to at least 36-37 weeks.

Childbirth with myomatous nodes from 6 cm in size is quite often complicated by anomalies of labor activity and bleeding. According to the reviews of women who gave birth with a large fibroid, it becomes clear: the percentage of cesarean section in this case is very high.

With large fibroids, a woman can hardly give birth on her own. In this case, as a rule, a caesarean section is used.

• Fitness and sports. Intense exercise that increases blood flow to the pelvic organs is not recommended. It is forbidden to train the press and pelvic muscles;
• Yoga. You can do it, but asanas that affect the abdominal muscles are excluded;
• Visiting the sauna and bath. Although the effect of heat on the growth of the myomatous node has not been proven, gynecologists do not recommend getting involved in such procedures;
• Taking medication. Do not take drugs that can affect the growth of fibroids.

There are no special prohibitions regarding intimate hygiene. A woman can use panty liners, absorbent pads, and tampons (such as Tampax). The latter option is not very convenient, since it does not always allow you to fully assess the amount of bleeding during bleeding. There is no prohibition on sexual life, provided that the woman feels well.

The prognosis for large myomatous nodes depends on the timeliness of diagnosis. The sooner a tumor is detected and treatment is started, the easier it will be to stop its growth and prevent the development of complications.

Treatment methods for large fibroids

Case study: removal of a giant uterine fibroid

Uterine fibroids - the reaction of a woman's body to the impact of damaging factors, which is manifested by the formation of myomatous nodes. Women have heard that with uterine fibroids, surgeons perform an operation - they remove the organ. When detecting myomatous nodes in the uterus, many patients experience fear, they develop a depressive state. Do not worry, because the operation to remove fibroids can be avoided.

Please note that this text was prepared without the support of our.

You will be booked in for an appointment with the leading specialists of the advanced. They use an innovative organ-preserving method for the treatment of fibroids - embolization of the uterine arteries. This operation, performed under local anesthesia, allows you to get rid of the symptoms of fibroids and save the uterus. You have the opportunity to get an urgent consultation if you send the results of preliminary studies

Modern views on the causes of uterine fibroids

According to many gynecologists, uterine fibroids are a benign tumor of the reproductive system that grows from immature muscle cells of the uterine wall. It occurs in 32-40% of women of reproductive age. Recently, there has been a tendency to "rejuvenate" this disease. Uterine fibroids are increasingly being diagnosed in young women and young girls. Many gynecologists show excessive oncological alertness and, with uterine myoma, perform an operation - removal of the uterus.

The doctors of the clinics with which we cooperate adhere to the modern theory of the origin of uterine fibroids. Myoma is not a tumor, despite the fact that it has signs of a tumor process. This is the reaction of the female body to frequent menstruation. The rudiments of fibroids can be laid during the intrauterine development of the female fetus. Of these, with a change in the hormonal background during the appearance of the first menstruation, the growth and progression of myomatous nodes begins.

The risk of malignancy of these formations is not higher than the probability of developing a cancerous tumor from intact cells of the muscular layer of the uterus. For this reason, our doctors do not remove the uterus with fibroids through surgery, but preserve the female reproductive organ. Endovascular surgeons perform a minimally invasive procedure called uterine artery embolization.

Ways to remove uterine fibroids

How to remove uterine fibroids? The leading method of treatment of fibroids today is the operation of removal of the uterus. 50% of all hysterectomies performed in the world are due to this pathology. The doctors of our clinics believe that the operation of removing the uterus for fibroids is performed in most cases without good reason and perform embolization of the uterine arteries.

Various types of myomectomy are widely used as surgical methods for the treatment of uterine fibroids:

• abdominal;
• laparoscopic;
• transcervical.

Doctors with uterine myoma perform myolysis using ultrasound, thermal ablation of myoma nodes with focused ultrasound. Our specialists for uterine myoma use a minimally invasive method - embolization of the uterine arteries.

In 80-90% of patients with uterine fibroids, radical operations are performed: subtotal and total hysterectomy. These surgical interventions are accompanied by the following negative consequences:

• significant surgical trauma;
• blood loss;
• loss of reproductive function in patients.

How are uterine fibroids removed? In most cases, hysterectomy is performed using a classic laparotomy approach. The least traumatic operation is hysterectomy, which is performed by vaginal access. The complication rate of this operation is 70% lower compared to laparotomy. Hysterectomy is also partially or completely performed laparoscopically.

After hysterectomy with preservation of the ovaries in women, the production of ovarian hormones decreases, osteoporosis and urogenital disorders develop. Women remain in premenopause until the onset of natural menopause, which occurs 3 years earlier. These effects do not occur after uterine artery embolization.

How is myoma removed by myomectomy?

In the surgical treatment of women under 40, surgeons direct their efforts to preserve the uterus and specific functions of the female body. How is uterine fibroid surgery performed? At the present stage, conservative or organ-preserving operations have become widespread. Conservative myomectomy is also performed in women with an unrealized generative function or who want to preserve menstrual function.

Abdominal myomectomy is an open abdominal intervention that is performed through an incision in the anterior abdominal wall. This operation has an important advantage. It allows you to save the uterus and the reproductive function of a woman. Abdominal surgery for removal of uterine fibroids has the following disadvantages:

• • • more than six recovery period;
    • the formation of an adhesive process in the pelvis, which leads to infertility;
    • frequent re-growth of myomatous nodes from myoma rudiments not removed for technical reasons;
    • allergic complications;
    • development of uterine necrosis.

These complications are never observed after uterine artery embolization. A promising and gentle method of treating uterine fibroids is laparoscopic myomectomy. This method of removal of uterine fibroids is used in the treatment of pedunculated myoma nodes, small interstitial and subserous nodes. The rehabilitation period for laparoscopic myomectomy is much shorter than for abdominal surgery. Undesirable moments of laparoscopic myomectomy are the long duration of the operation, the impossibility of palpation and removal of all small nodes located between the muscles of the myometrium, which causes the survival and growth of the neoplasm. Doctors are currently successfully solving this problem with the help of intraoperative echography of the uterus. Laparoscopic myomectomy

In recent years, the operation to remove fibroid nodes in many foreign clinics is performed using the da Vinci robot system. The technology provides a three-dimensional surgical field and enables surgeons to achieve a high quality surgical suture.

Hysteroscopic surgery to remove fibroids is the treatment of choice for submucosal nodules. The doctor inserts a hysteroscope into the uterine cavity, resects the submucosal myomatous node, scrapes the uterine mucosa and burns it out to create amenorrhea. When performing a conservative myomectomy with a transcervical one, the woman's fertility (the ability to give birth to children) is restored, menstrual function is normalized.

Hysteroscopy is performed in the presence of a submucosal node with a diameter of not more than 5 cm in patients who do not have concomitant pathology from the pelvic organs. Embolization of the uterine arteries is performed in the presence of myoma formations of any size. In the presence of concomitant diseases, our doctors decide on the possibility of performing the procedure individually.

Uterine artery embolization surgery

Embolization of the uterine arteries is an organ-preserving method of treating uterine fibroids, which leads to a decrease in the size of myomatous nodes and relief of the clinical manifestations of the disease. The essence of the method lies in the introduction of embolizing particles (non-reabsorbable particles of polyvinyl alcohol) into the uterine arteries through a catheter. They are delivered by the bloodstream to the final sections of the arterial bed. In the tissues of the myomatous node, foci of massive necrosis and vascular thrombosis are formed.

Embolization of the uterine arteries in our clinics is performed by an endovascular surgeon. The embolization procedure does not require general anesthesia. The process of inserting a vascular catheter into the femoral artery is painless. The doctor performs local anesthesia at the puncture site.

Through a puncture in the groin, the surgeon inserts a thin catheter into the femoral artery, which then leads into both uterine arteries. First, the doctor injects an iodine-based contrast agent through the catheter and the patient is x-rayed. This allows the endovascular surgeon to ensure that the catheter has reached the correct site. At the moment, patients sometimes feel warm in the lower abdomen. Further, a suspension with emboli is introduced through the catheter. The operation is completed with control angiography. After making sure that the myoma is bled, the endovascular surgeon removes the catheter from the artery. The puncture site is covered with a sterile pressure bandage.

The total duration of the procedure is from 10 to 15 minutes. Next, the patient is transferred to the ward, where she is given analgesic therapy. Already 2.5 hours after the procedure, doctors allow you to bend your legs, after 6-7 hours the patient can get out of bed and eat.

The following complications are extremely rare after uterine artery embolization:

• thrombosis of the punctured artery;
• bruising at the insertion site of the catheter
• amenorrhea;
• catheter damage to the pelvic artery.

The experience of the doctors of our clinics, an individual approach to the tactics of managing each patient allows us to avoid these complications. The only "complication" that may occur is a bruise at the puncture site. In order to prevent complications after uterine artery embolization, our gynecologists conduct a comprehensive preoperative examination of the patient, which includes the following types of research:

• bacterioscopic examination of the vaginal microflora (if inflammatory changes are detected, antibiotic therapy is performed);
• oncocytological examination of endocervix and exocervix;
• ultrasound examination of the organs and vessels of the small pelvis with the determination of the blood flow velocity in the uterine, ovarian arteries and their branches (the assessment of blood flow parameters in the vessels of the uterus is carried out using ultrasonic triplex scanning of vessels in B-mode, Dopplerography and color Doppler blood flow mapping;
• hysteroscopy and separate diagnostic curettage, followed by histopathological examination (in case of impaired ovarian function, an increase in the median m-echo that does not correspond to the day of the menstrual cycle).

If a neoplasm of the ovary or one of the nodes is detected with a multiple growth pattern of the subserous type on a thin base, surgeons perform operative laparoscopy - removal of the ovary formation before embolization of the uterine arteries, followed by histopathological examination. Then embolization of the uterine arteries is performed, and after the size of the uterine neoplasm is reduced, laparoscopic removal of the myomatous node is performed. This tactic reduces the amount of blood loss and the risk of “strapping” the myomatous node into the abdominal cavity.

In most patients, after embolization of the uterine arteries, there is a complete recovery, myomatous nodes are significantly reduced in size. A year after the procedure, the size of the uterus approaches normal.

• changes in mental balance;
• vegetative disorders;
• arterial hypertension;
• development of obesity.

The threat of thyroid and breast cancer increases, interest in sexual life disappears, and, as a result, problems in relationships with a spouse or partner. Sometimes removal of the uterus is a forced decision when fibroids do not respond to alternative treatment. In this case, we advise you to first consult our gynecologists.

After the operation of myomectomy, the uterus is restored and six months later, the woman can theoretically plan a pregnancy. But postoperative scars remain on the uterus. They can cause complications during pregnancy and cause uterine rupture during childbirth. After embolization of the uterine arteries, no scars remain on the uterus, the structure of the organ is restored, and there are no complications during pregnancy and childbirth associated with the UAE procedure.

2 years after the operation of conservative removal of fibroids, 14% of patients have a recurrence of the disease. After 5 years, new myomatous nodes appear in almost all patients. Repeated removal operations leave new scars on the uterus, which threatens with problems when carrying a child. Due to the fact that after embolization of the uterine arteries, not only the dominant myomatous node, but also small formations, the beginnings of fibroids, lose their blood supply, the risk of recurrence is negligible. For this reason, our gynecologists perform uterine artery embolization in the presence of uterine fibroids.

Bibliography

• Savitsky G. A., Ivanova R. D., Svechnikova F. A. The role of local hyperhormonemia in the pathogenesis of the growth rate of the mass of tumor nodes in uterine myoma // Obstetrics and gynecology. - 1983. - T. 4. - S. 13-16.
• Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
• Meriakri A.V. Epidemiology and pathogenesis of uterine fibroids. Sib honey journal 1998; 2:8-13.