In a study in the December issue of The Female Patient, physicians at Thomas Jefferson University Hospital in Philadelphia present a case history of a 35-year-old women whose numerous fibroids formed a large mass in her pelvic area that, when initially diagnosed, was of a size comparable to a full-term pregnancy.
"Traditionally, treatment for such a large fibroid mass in the uterus has been limited to hysterectomy, because the patient would bleed extensively if an attempt was made to merely remove the fibroids." says Jay Goldberg, M.D., MSCP, lead author and director of the Jefferson Fibroid Center at Thomas Jefferson University. "In this particular case though, hysterectomy was not an option because the patient strongly desired future fertility and uterine preservation."
To meet the patient’s wishes and remove the fibroids, the physicians developed a plan to perform two procedures a month apart.
The Jefferson physicians first performed a uterine fibroid embolization (UFE), a minimally invasive radiologic procedure that blocks the arteries that supply blood to the fibroid tumors. The procedure was done to reduce the blood flow within the patient’s uterus and the risk of hemorrhaging at the time of surgery.
One month later, the patient underwent an abdominal myomectomy. In this procedure, the fibroids are removed through an abdominal skin incision. After the UFE, her initially 38-week sized uterus had decreased to a 34-week size, with decreased blood flow. Eleven large fibroids were removed during the myomectomy, with minimal blood loss. The patient was discharged from the hospital on the second day post-surgery and experienced no complications.
Dr. Goldberg, who is also director, Division of General Obstetrics at Thomas Jefferson University, and his colleagues recommend the combination of procedures for women who want to preserve their uterus. "We are noting a trend toward more women requesting uterine-preserving treatment for fibroids—even with massively enlarged uteri, and even when future fertility may not be a consideration," they write.
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