Surgically-Treated Uterine Fibroids
Uterine Fibroids remain a major cause of morbidity and mortality among women of various age groups. Many treatment options abound. The aim of this study was to determine the presentation and surgical treatment options offered in a private gynecology unit, in Enugu, Nigeria. A retrospective review of surgically managed cases of Uterine Fibroids between January 2001 and December 2015. Data was obtained from outpatient, ward, operating and laboratory case records. Analysis of data was done using SPSS version 20 with descriptive statistics of frequency and percentage. Chi-square test at 95% confidence interval was used to test for association between the independent variables and treatment given, with p-value set at <0.05. Three hundred patients presented during the study period but only 228 case records (76%) were adequate for analysis. The mean age of the women was 38.05 +/- 7.49 years with a range of 20-60 years. Abdominal pain, heavy bleeding and abdominal swelling were the commonest symptoms in descending order. Duration of symptoms was 1-3 years in 67% of clients and uterine size was 32-40 weeks in 12% of patients reviewed. The significant determinants of surgical treatment of choice were age and parity, both at p-value <0.001. Late presentation from ignorance and fear of surgery is a major problem in the management of uterine leiomyoma in our environment. Use of the tourniquet method at myomectomy helped to minimize blood loss despite the huge sizes of the myomas.
Late presentation with huge fibroid masses is common in our study population due to ignorance. Myomectomy remain the commonest surgical treatment for uterine fibroids in our environment. Use of the tourniquet at the cervical isthmus during myomectomy markedly limits blood loss resulting in no blood transfusion. The surgical treatment and outcome of fibroid in our study centre is comparable with the standard in the country.
Awareness programs educating women on the benefits of early presentation is advocated. Skill acquisition by gynaecologists to enable centers offer current non-surgical techniques such as Uterine Artery Embolization (UAE) to patients is encouraged. Caution is called for in performing prophylactic oophorectomy. It should be individualized and only undertaken after adequate patient information, comprehension and voluntary consent.
Journal of Women’s Health and Reproductive Medicine