Outcomes From Leiomyoma Therapies Comparison With Normal Controls

ArticleinObstetrics and Gynecology 116(3):641-52 · September 2010with14 Reads
DOI: 10.1097/AOG.0b013e3181ed36b3 · Source: PubMed
To assess the severity of symptoms caused by uterine leiomyomas, their effect on health-related quality of life, and the change after treatment compared with a normal control group. A multicenter nonrandomized prospective study was completed assessing 12-month outcomes from three leiomyoma treatments. Outcome measures included the Uterine Fibroid Symptom and Quality of Life and the Short Form 36 questionnaires. Women scheduled for hysterectomy, myomectomy, or uterine artery embolization were recruited, as well as normal control group members. Questionnaires were completed at baseline and at 6 and 12 months posttreatment. Baseline characteristics were summarized using descriptive statistics. General linear models were used to examine differences among the patient groups. A total of 375 patients completed baseline enrollment: 101 normal, 107 embolization, 61 myomectomy, and 106 hysterectomy. At baseline, the mean Uterine Fibroid Symptom and Quality of Life Symptom Severity score for women in the normal control group was 15.3 (+/-14.5) and 64.8 (+/-20) for the leiomyoma patients (P<.001). At 6 and 12 months, the mean Symptom score for women in the normal control group was unchanged, while the leiomyoma treatment group score reduced to a mean of 17.8 (+/-17.5) at 12 months. Similar magnitude changes occurred among the Uterine Fibroid Symptom and Quality of Life health-related quality of life subscale scores for the normal control group members and leiomyoma patients. At 12 months, the hysterectomy group reported significantly lower symptoms and better health-related quality of life than the other two therapies (P<.001). At 12 months after treatment, all three leiomyoma therapies resulted in substantial symptom relief, to near normal levels, with the greatest improvement after hysterectomy. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00390494. II.
    • "Study, provided in USA in 2010, compare different kinds of surgical treatment in cases of leiomyoma and its outcomes. The frequency of adverse events was similar among the groups (6.7% of uterine artery embolization, 13.3% of myomectomy, and 13.3% of hysterectomy) [47]. Another study observe patients with LM and infertility (primary and secondary) after surgical treatment. "
    [Show abstract] [Hide abstract] ABSTRACT: Leiomyoma is the most frequent benign monoclonal tumor (cells behave identically in culture) of the female reproductive system. It affected almost 50% of childbearing age women, deteriorating the quality of life and may cause infertility. The unique features of this pathology is the absence of detailed understanding of pathogenic mechanisms and continuous morbidity among any age groups. Despite the huge amount of articles and studies related to leiomyoma, review pretend to depict herein actual and non-trivial information. This review assemble a versatile description of medical and biological aspects of leiomyomas. Explanation of genetic, molecular, pathophysiological mechanisms of uterine fibroid growing predetermine marked clinical symptoms of pathology. Mentioned model systems show multivariation of leiomyomas in human and animals. Review gives an opportunity analyze separate facets and collect it in one deep understanding of leiomyomas.
    Full-text · Article · Jan 2016
    • "UAE has proved to be a safe and effective treatment alternative with a low rate of periprocedural complications and significant improvement of fibroid-related symptoms in many observational and comparative studies (Razavi et al., 2003; Siskin et al., 2006; Hehenkamp et al., 2008; Hald et al., 2009; Freed and Spies, 2010; Spies et al., 2010). Based on good and consistent scientific evidence, the American College of Obstetricians and Gynecologists judged the procedure as a safe and effective option for appropriately selected women who wish to retain their uteri (ACOG, 2008). "
    [Show abstract] [Hide abstract] ABSTRACT: To investigate the long-term changes in health-related quality of life (HRQOL) after uterine artery embolization (UAE) for symptomatic fibroids, we conducted a prospective cohort study. Eighty-two women completed the validated uterine fibroid symptom and QOL (UFS-QOL) questionnaire before UAE. Short-term results after a median of 8 months (range: 3-20) have been published previously. Patients were asked to complete the questionnaire again after a median of 6.3 years (range: 5-7.6). Secondary outcome measures were the frequency of additional surgical or endovascular procedures due to treatment failure and the menstrual status. A total of 4/82 patients (5%) were lost to follow-up. Of the remaining 78 patients, 11 underwent surgery or repeat UAE (hysterectomy n = 6, myomectomy n = 1, UAE n = 4) at a median of 13 months (range: 5-70) after UAE. Two patients failed clinically but did not undergo a second intervention. The overall treatment failure rate 6 years after UAE was 17%. Clinical long-term follow-up regarding symptom control and quality of life was available in the remaining 65 patients. Symptom severity scores decreased from a median of 37.50 (quartile range, QR: 28.13-53.13) to 0.00 (QR: 0.00-10.94) (P < 0.001), whereas the HRQOL total score increased from a median of 64.66 (QR: 46.34-79.10) to 100.00 (QR: 96.12-100.00) (P < 0.001). Both scores also improved significantly compared with short-term results (P = 0.006 and P = 0.041). Permanent amenorrhea was observed in five patients at a median of 18 months (range: 10-46) after UAE and at a mean patient age of 50 years. UAE leads to durable relief of fibroid-related symptoms and sustained improvement in HRQOL. After 6 years, clinical failure can be expected in 17%, and most of these patients require secondary invasive treatment.
    Full-text · Article · Jun 2011
  • [Show abstract] [Hide abstract] ABSTRACT: In a single-centre, randomized trial, gasless laparoscopic myomectomy was compared with conventional laparoscopic myomectomy. The study examined feasibility, safety, reliability and post-operative outcomes. Estimated blood loss, duration of surgery, early post-operative outcomes and length of hospital stay were recorded. Compared with conventional laparoscopic myomectomy, gasless laparoscopy resulted in significantly lower intra-operative blood loss (median 100 ml vs 80 ml, respectively) and duration of surgery (median 94 min vs 71 min, respectively). Post-operative abdominal drainage volume was significantly lower after gasless laparoscopy than after conventional laparoscopy (median 100 ml vs 240 ml). There was no significant difference between duration of post-operative fever, post-operative time to flatus or length of hospital stay. Both forms of laparoscopy are suitable for uterine myomectomy, and comparison of these methods showed that gasless laparoscopy had potential advantages over conventional laparoscopy.
    Article · Feb 2011
    J-J WangJ-J WangF YangF YangT GaoT Gao+2 more authors ...H-F LiH-F Li
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