Uterine fibroid

Disease Description

Uterine fibroid is one of the common problems in modern gynecology, ranking second after inflammatory diseases of the pelvic organs. A fibroid is a benign, well-demarcated tumor of the body or cervix of the uterus.

According to WHO data, myomatous nodules are diagnosed in 30-35% of women of reproductive age (more often after 30 years). However, in recent years, the incidence in women under the age of 30 has increased from 2% to 12.5%.

Symptoms indicating the need for diagnosis and treatment

Among all women diagnosed with fibroids, only one-third have symptomatic manifestations, which directly depend on its localization.

• Subserosal fibroid: frequently diagnosed, located under the peritoneum and protruding above the uterine surface. In 70% of cases, it does not cause clinical manifestations. Some patients experience lower abdominal and lower back pain, a feeling of pressure on the pelvic organs (including the rectum and urinary bladder), and constipation.
• Intramural fibroid: the most common localization of myomatous nodules, situated within the thickness of the uterine wall. Their number may increase over time, reaching 25 or more. With small fibroids, no clinical picture is observed. Some patients are troubled by pelvic pain, painful menstruation, and painful sexual intercourse.
• Submucosal fibroid: diagnosed less frequently than the others but has more pronounced characteristic symptoms. The most significant manifestations include heavy and prolonged menstruation, intermenstrual bleeding (in the middle of the cycle), and dull or sharp lower abdominal pain. Submucosal fibroid may lead to anemia (due to significant blood loss).

Diagnosis and treatment

Diagnosis

High-precision equipment installed in gynecological offices of leading international clinics makes it possible to detect even the smallest nodules that are still beyond the reach of the doctor’s hands.

The most common diagnostic methods include:

• Ultrasound examination (US): the primary method for diagnosing fibroids. In Europe, state-of-the-art ultrasound technologies — three-dimensional (3D) and four-dimensional (4D) imaging — are actively used.
• Magnetic resonance imaging (MRI): used for diagnosing large or hard-to-reach fibroid nodules.
• Hysteroscopy: an endoscopic examination of the uterine cavity “from the inside.” Hysteroscopes in leading hospitals are the most advanced devices with high-resolution video cameras and minimal size.
• Contrast sonography: a method involving the introduction of a contrast agent followed by ultrasound evaluation of the tumor.
• Auxiliary methods: laboratory diagnostics, biopsy, and tumor markers.

Treatment

Modern treatment of uterine fibroids applied in the world’s top clinics is performed according to international clinical protocols, with particular attention to the evidence base and the appropriateness of the applied methods.

Effective types of uterine fibroid treatment:

• Myomectomy: a surgical procedure in which only the fibroid is removed while the uterus remains intact
• Ablation: literally “vaporization” of the fibroid using a laser or electrocoagulation, performed inside the uterus
• Uterine artery embolization: a minimally invasive procedure in which the physician blocks blood flow in the vessels supplying the tumor
• Focused ultrasound therapy: an advanced method of remote tumor destruction under MRI guidance

Innovations in world clinics

One of the significant innovations in uterine fibroid treatment is the use of the Da Vinci robotic platform.

A study comparing the results of robotic and laparoscopic surgery in the treatment of uterine fibroids, published in the journal Obstetrics and Gynecology, showed that the robotic system has a number of advantages over conventional surgery, namely:

• Lower intraoperative blood loss
• Higher effectiveness in fibroid removal or uterine artery embolization (no secondary episodes occurred)
• Shorter and easier postoperative recovery period
• Lower number of cases requiring conversion to open surgery (laparotomy) when the fibroid cannot be accessed through a mini-incision. This is explained by the fact that the robot has seven degrees of freedom