Diagnosis and management of vaginal leiomyoma: A case report and literature review

Objectives: Leiomyomas are benign mesenchymal tumors that consist of smooth muscle cells and varying amounts of fibrous stroma. Uterine leiomyomas are the most common, affecting 20% to 30% of reproductive-age women, but vaginal leiomyomas are rare. Treatments gradually diversify with increased awareness of vaginal leiomyoma, but transvaginal fibroid resection remains the commonly used scheme. Case report: Herein, we present the case of a 50-year-old asymptomatic woman who had a mass in the left anterior wall of the vagina discovered by gynecological examination and ultrasound. We used oxytocin diluent injection during surgery to create a water pad in the tissue space and then performed a transvaginal myomectomy. There was little or negligible intraoperative bleeding and no peripheral tissue injury, early or late postoperative complications, incision dehiscence, and no surgical site infection. Conclusions: Transvaginal ultrasonography is the preferred examination for vaginal leiomyomas, and transvaginal myomectomy is the classic treatment method. The formation of a water pad with oxytocin dilution can effectively reduce intraoperative bleeding and shorten surgery time

Asherman syndrome--one century later

Objective: To provide an update on the current knowledge of Asherman syndrome. Design: Literature review. Setting: The worldwide reports of this disease. Patient(s): Patients with Asherman syndrome who presented with amenorrhea or hypomenorrhea, infertility, or recurrent pregnancy loss. Intervention(s):Hysteroscopy and hysteroscopic surgery have been the gold standard of diagnosis and treatment respectively for this condition. Main outcome measure(s):The etiology, pathology, symptomatology, diagnosis, treatment, and reproductive outcomes were analyzed. Result(s): This syndrome occurs mainly as a result of trauma to the gravid uterine cavity, which leads to the formation of intrauterine and/or intracervical adhesions. Despite the advances in hysteroscopic surgery, the treatment of moderate to severe Asherman syndrome still presents a challenge. Furthermore, pregnancy after treatment remains high risk with complications including spontaneous abortion, preterm delivery, intrauterine growth restriction, placenta accrete or praevia, or even uterine rupture. Conclusion(s): The management of moderate to severe disease still poses a challenge, and the prognosis of severe disease remains poor. Close antenatal surveillance and monitoring are necessary for women who conceive after treatment.<br/

Impact of transcervical resection of endometrium on uterine and ovarian haemodynamics

This study prospectively evaluated the impact of transcervical resection of endometrium (TCRE) on uterine and ovarian haemodynamics. The study group comprised 35 women with abnormal (excessive) uterine bleeding who underwent TCRE. The patients were examined by transvaginal colour Doppler ultrasonography 1-4 days prior to operation, and then 1, 3, 6 and 12 months post-operatively, to measure resistance index (RI) and pulsatility index from uterine, arcuate, radial and ovarian arteries. Thirty-five patients were followed up for 1 year after TCRE. Thirty (85.7%) patients had adequately controlled menorrhagia as defined by the patients subjectively. Nine (25.7%) patients had amenorrhoea, 21 (60%) patients had hypomenorrhoea and five (14.3%) patients had lighter periods initially but the menorrhagia recurred within 1 year after the operation. However, patients who had relapse of menorrhagia at 1 year after TCRE had a lower RI at all levels of uterine arteries compared with those who had persistent improvement. The data suggest that patients who had TCRE per se did not have associated altered uterine and ovarian haemodynamics; however, compared with those who had persistent improvement, those who had relapse in symptoms had an associated lower RI (P &lt; or = 0.01) after TCRE at all levels of uterine arteries