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Abstract
RÉSUMÉ
Introduction. Hysteroscopic treatment is the best therapeutic option for the management of submucosal myomas in women with a desire to become pregnant. Given the complexity of some huge myomas, a second look is often performed. Objective. Assessing the benefit of pre-surgical STEPW classification in predicting a second look hysteroscopy. Methodology. We carried out a descriptive cross-sectional study with retrospective data collection from January 2021 to February 2023. Results. Out of 74 hysteroscopic resections of myomas, 28 underwent a second look hysteroscopy, representing a prevalence of 37.8%. The average age of participants was 43.9 6,26 years and average number of submucosal myomas was 2.2 10.6 with a minimum of 1 and maximum of 5 myomas. Long operating time (more than one hour) was the reason for the second look hysteroscopy in 18 patients (60.7%), in six others mirror myomas (21.4%) and finally five others had presented signs of fluid overload (17.9%). Each myoma measured on average 42.7 10.6 mm with sizes varying between 30 mm and 60 mm. According to the STEPW classification, all our patients operated were in groups II and III in 64.3% (n=18) and 35.7% (n=10), respectively. Conclusion. Using the pre-surgical STEPW classification from the outset, would have made it possible to predict 100% of the second look hysteroscopy and allow discussion for operative feasibility.
ABSTRACT
Introduction. Le traitement hystéroscopique est la meilleure option thérapeutique pour le traitement des myomes sous muqueux chez la femme avec désir de maternité. Devant la complexité de certains myomes encore plus marqué, un second look est souvent réalisé. Objectif. Évaluer l’intérêt la classification pré-chirurgical de STEPW dans la prédiction de la réalisation d’un second look hystéroscopique. Méthodologie. Nous avons réalisé une étude transversale descriptive avec collecte de données rétrospectives allant de Janvier 2021 a Février 2023. Résultats. Sur 74 résections hystéroscopiques de myomes, 28 avaient réalisé un second look hystéroscopique soit une prévalence de 37.8%. L’âge moyen était de 43,9 6,26 ans; Le nombre moyen de myomes sous muqueux était de 2.2 10,6 mm avec minimum de 1 et maximum de 5 myomes ; le temps opératoire long était le motif du second look hystéroscopique chez 18 patientes (60,7%), chez six autres des myomes en miroir (21,4%) et enfin cinq autres avaient presenté des signes de surcharge hydrique (17,9%) chaque myome mesurait en moyenne 42,7 10,6 mm avec des tailles variant entre 30 et 60 mm; Selon la STEPW classification, toutes nos patientes opérées étaient du groupe II et du groupe III dans respectivement 64.3% (n=18) et 35,7% (n=10). Conclusion. La classification pré-chirurgicale STEPW si elle avait été utilisée d’emblée aurait permis de prédire 100% des 2nd look hystéroscopiques et même de discuter de la faisabilité opératoire.
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References
- Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003 Jan;188(1):100–7.
- Neuwirth RS, Amin HK. Excision of submucus fibroids with hysteroscopic control. Am J Obstet Gynecol. 1976 Sep 1;126(1):95–9.
- Polena V, Mergui JL, Perrot N, Poncelet C, Barranger E, Uzan S. Long-term results of hysteroscopic myomectomy in 235 patients. Eur J Obstet Gynecol Reprod Biol. 2007 Feb;130(2):232–7.
- Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus I, et al. Therapeutic management of uterine fibroid tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):156–64.
- Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol 1993;82:736–40. - Recherche Google [Internet]. [cited 2023 Oct 13]. ATF-8
- Lasmar RB, Xinmei Z, Indman PD, Celeste RK, Di Spiezio Sardo A. Feasibility of a new system of classification of submucous myomas: a multicenter study. Fertil Steril. 2011 May;95(6):2073–7.
- Lasmar RB, Barrozo PRM, Dias R, Oliveira MAP de. Submucous myomas: a new presurgical classification to evaluate the viability of hysteroscopic surgical treatment--preliminary report. J Minim Invasive Gynecol. 2005;12(4):308–11.
- Emanuel MH, Hart A, Wamsteker K, Lammes F. An analysis of fluid loss during transcervical resection of submucous myomas. Fertil Steril. 1997 Nov;68(5):881–6.
- Taskin O, Sadik S, Onoglu A, Gokdeniz R, Erturan E, Burak F, et al. Role of Endometrial Suppression on the Frequency of Intrauterine Adhesions after Resectoscopic Surgery. J Am Assoc Gynecol Laparosc. 2000 Aug 1;7(3):351–4.
- Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol. 2002 Mar 1;186(3):409–15.
- Levens ED, Wesley R, Premkumar A, Blocker W, Nieman LK. Magnetic resonance imaging and transvaginal ultrasound for determining fibroid burden: implications for clinical research. Am J Obstet Gynecol. 2009 May;200(5):537.e1-537.e7.
- Pereira AEDMM, Franco J, Machado FS, Geber S. Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions. Rev Bras Ginecol E Obstetrícia RBGO Gynecol Obstet. 2021 Jul;43(07):530–4.
References
Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003 Jan;188(1):100–7.
Neuwirth RS, Amin HK. Excision of submucus fibroids with hysteroscopic control. Am J Obstet Gynecol. 1976 Sep 1;126(1):95–9.
Polena V, Mergui JL, Perrot N, Poncelet C, Barranger E, Uzan S. Long-term results of hysteroscopic myomectomy in 235 patients. Eur J Obstet Gynecol Reprod Biol. 2007 Feb;130(2):232–7.
Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus I, et al. Therapeutic management of uterine fibroid tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):156–64.
Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol 1993;82:736–40. - Recherche Google [Internet]. [cited 2023 Oct 13]. ATF-8
Lasmar RB, Xinmei Z, Indman PD, Celeste RK, Di Spiezio Sardo A. Feasibility of a new system of classification of submucous myomas: a multicenter study. Fertil Steril. 2011 May;95(6):2073–7.
Lasmar RB, Barrozo PRM, Dias R, Oliveira MAP de. Submucous myomas: a new presurgical classification to evaluate the viability of hysteroscopic surgical treatment--preliminary report. J Minim Invasive Gynecol. 2005;12(4):308–11.
Emanuel MH, Hart A, Wamsteker K, Lammes F. An analysis of fluid loss during transcervical resection of submucous myomas. Fertil Steril. 1997 Nov;68(5):881–6.
Taskin O, Sadik S, Onoglu A, Gokdeniz R, Erturan E, Burak F, et al. Role of Endometrial Suppression on the Frequency of Intrauterine Adhesions after Resectoscopic Surgery. J Am Assoc Gynecol Laparosc. 2000 Aug 1;7(3):351–4.
Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol. 2002 Mar 1;186(3):409–15.
Levens ED, Wesley R, Premkumar A, Blocker W, Nieman LK. Magnetic resonance imaging and transvaginal ultrasound for determining fibroid burden: implications for clinical research. Am J Obstet Gynecol. 2009 May;200(5):537.e1-537.e7.
Pereira AEDMM, Franco J, Machado FS, Geber S. Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions. Rev Bras Ginecol E Obstetrícia RBGO Gynecol Obstet. 2021 Jul;43(07):530–4.