Stanford University School of Medicine, Stanford, CA.
Department of Urology, Stanford, CA.
Am J Obstet Gynecol. 2019 May;220(5):471.e1-471.e11. doi: 10.1016/j.ajog.2019.01.230. Epub 2019 Jan 31.
Urinary and pelvic floor symptoms often are attributed to size and location of uterine fibroid tumors. However, direct supporting evidence that links increased size to worsening symptoms is scant and limited to ultrasound evaluation of fibroid tumors. Because management of fibroid tumors is targeted towards symptomatic relief, the identification of fibroid and pelvic characteristics that are associated with worse symptoms is vital to the optimization of therapies and prevention needless interventions.
We examined the correlation between urinary, pelvic floor and fibroid symptoms, and fibroid size and location using precise uterine fibroid and bony pelvis characteristics that were obtained from magnetic resonance imaging.
A retrospective review (2013-2017) of a multidisciplinary fibroid clinic identified 338 women who had been examined via pelvic magnetic resonance imaging, Pelvic Floor Distress Inventory questionnaire (score 0-300), and a Uterine Fibroid Symptoms questionnaire (score 1-100). Multiple linear regression analysis was used to assess the influence of clinical factors and magnetic resonance imaging findings on scaled Pelvic Floor Distress Inventory and Uterine Fibroid Symptoms scores. Data were analyzed with statistical software.
Our cohort of 338 women had a median Pelvic Floor Distress Inventory of 72.7 (interquartile range, 41-112.3). Increased Pelvic Floor Distress Inventory score was associated with clinical factors of higher body mass index (P<.001), noncommercial insurance (P<.001), increased parity (P=.001), and a history of incontinence surgery (P=.003). Uterine volume, dominant fibroid volume, dimension and location, and fibroid tumor location relative to the bony pelvis structure did not reach significance when compared with pelvic floor symptom severity. The mean Uterine Fibroid Symptoms score was 52.0 (standard deviation, 23.5). An increased Uterine Fibroid Symptoms score was associated with dominant submucosal fibroid tumors (P=.011), body mass index (P<.0016), and a clinical history of anemia (P<.001) or any hormonal treatment for fibroid tumors (P=.009).
Contrary to common belief, in this cohort of women who sought fibroid care, size and position of fibroid tumors or uterus were not associated with pelvic floor symptom severity. Whereas, bleeding symptom severity was associated with dominant submucosal fibroid tumor and previous hormonal treatment. Careful attention to clinical factors such as body mass index and medical history is recommended when pelvic floor symptoms are evaluated in women with uterine fibroid tumors.
尿路和盆底症状通常归因于子宫肌瘤的大小和位置。然而，将增大与症状恶化联系起来的直接证据很少，仅限于对子宫肌瘤的超声评估。由于子宫肌瘤的治疗针对的是症状缓解，因此确定与更严重症状相关的子宫肌瘤和盆腔特征对于优化治疗和预防不必要的干预至关重要。
我们使用从磁共振成像中获得的精确的子宫肌瘤和骨盆特征，检查了尿路、盆底和子宫肌瘤症状与子宫肌瘤大小和位置之间的相关性。
对一个多学科子宫肌瘤诊所进行了回顾性研究（2013-2017 年），该诊所对 338 名接受过盆腔磁共振成像、盆底窘迫量表问卷（0-300 分）和子宫肌瘤症状量表（1-100 分）检查的女性进行了检查。采用多元线性回归分析评估临床因素和磁共振成像结果对盆底窘迫量表和子宫肌瘤症状量表评分的影响。使用统计软件进行数据分析。
我们的 338 名女性队列的盆底窘迫量表中位数为 72.7（四分位距，41-112.3）。盆底窘迫量表评分升高与较高的体重指数（P<.001）、非商业性保险（P<.001）、更高的产次（P=.001）和失禁手术史（P=.003）等临床因素有关。与盆底症状严重程度相比，子宫体积、主要子宫肌瘤体积、尺寸和位置以及子宫肌瘤相对于骨盆结构的位置均无统计学意义。子宫肌瘤症状量表的平均评分为 52.0（标准差，23.5）。子宫肌瘤症状量表评分升高与主要黏膜下子宫肌瘤（P=.011）、体重指数（P<.0016）和贫血（P<.001）或任何子宫肌瘤激素治疗（P=.009）的临床病史有关。
与普遍看法相反，在寻求子宫肌瘤治疗的这组女性中，子宫肌瘤或子宫的大小和位置与盆底症状的严重程度无关。然而，出血症状的严重程度与主要黏膜下子宫肌瘤和先前的激素治疗有关。在评估患有子宫肌瘤的女性的盆底症状时，建议仔细注意体重指数和病史等临床因素。
