Successful pregnancies in women with diffuse uterine leiomyomatosis after hysteroscopic management.

OBJECTIVE

To describe the surgical and reproductive outcomes of early diffuse uterine leiomyomatosis with hysteroscopic myomectomy.

DESIGN

Retrospective report.

SETTING

University hospital.

PATIENT(S): Five consecutive women of reproductive age with innumerable small-sized (0.5-3 cm) diffuse uterine myomas with profuse menorrhagia.

INTERVENTION(S): Use of hysteroscopic myomectomy to excise only myomas impinging into the endometrial cavity, while leaving other intramural myomas in place.

MAIN OUTCOME MEASURE(S): Postoperative synechiae, recurrence, menstrual amount, conception, and pregnancy outcome.

RESULT(S): A total of 10 hysteroscopic surgeries were performed, among which 1 patient had repeated adhesiolysis for postoperative synechiae, 2 experienced repeated myomectomy because of submucosal myoma recurrence, and 1 underwent a scheduled two-step procedure with gonadotropin-releasing hormone analogue treatment in between. The uterus was successfully preserved and a normal amount of menstruation was restored in all (5/5) patients. All (3/3) patients who wished to conceive had successful conceptions, with four healthy deliveries.

CONCLUSION(S): Women with early-stage diffuse uterine leiomyomatosis can be treated by hysteroscopic resection, which has the benefits of preserving the uterus successfully, conceding a limited recurrence rate, and yielding satisfactory reproductive outcomes.