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Uterine Fibroids

What are uterine fibroids? 

Uterine fibroids (also referred to as uterine leiomyomata, uterine leiomyomas, or uterine myomas) are benign tumors that originate in the uterus (womb). Although they are composed of the same smooth muscle fibers as the uterine wall (myometrium), they are many times denser than normal myometrium. Uterine fibroids are usually round or semi-round in shape.

Uterine fibroids are often described based upon their location within the uterus. Subserosal fibroids are located beneath the serosa (the lining membrane on the outside of the organ). These often appear localized on the outside surface of the uterus or may be attached to the outside surface by a pedicle. Submucosal (submucous) fibroids are located inside the uterine cavity beneath the lining of the uterus. Intramural fibroids are located within the muscular wall of the uterus. 

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What are symptoms of uterine fibroids?

More common symptoms of uterine fibroids are:

Abdominal fullness, gas, or constipation 
Bleeding between periods 
Increase in urinary frequency 
Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots 
Menstrual periods that may last longer than normal 
Pelvic cramping or pain with periods 
Sensation of fullness or pressure in lower abdomen 
Pain during intercourse 

Note: There are often no symptoms.

How do I know if I have uterine fibroids?

It's not likely that you do know when you have fibroid tumors of the uterus. Most uterine fibroids do not cause any symptoms and do not require treatment other than regular observation by a physician. Fibroids may be discovered during routine gynecologic examination or during prenatal care. 

Some women who have uterine fibroids may experience symptoms such as excessive or painful bleeding during menstruation, bleeding between periods, a feeling of fullness in the lower abdomen, frequent urination resulting from a fibroid that compresses the bladder, pain during sexual intercourse, or low back pain. Although reproductive symptoms such as infertility, recurrent spontaneous abortion, and early onset of labor during pregnancy have been attributed to fibroids to any of these symptoms. In rare cases, a fibroid can compress and block the fallopian tube, preventing fertilization and migration of the ovum or egg; after surgical removal of the fibroid, fertility is generally restored. 

What are my uterine fibroids treatment alternatives?  

Procedure

What is it?

Advantages

Disadvantages

Hysterectomy

Surgical removal of the uterus. Expect a hospital stay and a recovery period.

Fibroids never come back because the uterus is removed.

Reproductive potential is lost. Recovery time is typically 4-6 weeks. Other complications possible.

Abdominal myomectomy

Removal of one or more of the fibroids with open abdominal surgery.

Preserves the uterus and cervix and allows pregnancy.

A re-occurrence of the fibroid symptoms is possible if new fibroids grow. Recovery time is typically 2-4 weeks. Some complications possible.

Laparoscopic myomectomy or hysteroscopic myomectomy

One or more of the fibroids are removed using laparoscopic or endoscopic techniques.

Less invasive than open abdominal myomectomy, fibroids can be removed via abdominal endoscope or the cervix/vagina.

Not suitable for larger, multiple, or deep fibroids.
Recovery time is typically 1-4 weeks. Some complications possible.

Hormone therapy

GnRH drug treatment causes fibroid shrinkage.

Non-surgical conservative method of fibroid treatment.

Treatment is only effective for 6-12 months. Causes menopausal symptoms. May result in rapid return of symptoms after stopping treatment.

Uterine artery embolisation

The uterine artery is injected with polyvinyl alcohol beads, with a catheter, which block the flow of blood to the fibroids and cause necrosis.

Symptom relief with shorter hospital stay than hysterectomy or myomectomy.

Risks include premature menopause, serious infection, bleeding and embolisation of other than the fibroid(s). Strong pain during first two days often experienced.

Watchful waiting

No treatment. Monitoring for any progression of symptoms.

Sometimes fibroid symptoms diminish with menopause.

Fibroids can continue to grow with an increase in symptoms. Fibroids beyond a certain size may not be treatable with minimally invasive techniques.

High Intensity Focused Ultrasound Ablation by Haifu’s Model JC or Model JC200

 

 

Ultrasound beams are focused and sufficient ultrasonic energy is concentrated within volume while they propagate through tissues, the temperature in the focal region may be raised to levels at which the tumors are cooked, resulting in tissue ablation.

Non-invasive, no bleeding during treatment. Requires no hospital stay or anaesthesia. Reserves uterus and cervix as well as procreative function.

There might be skin burns, however, which can be avoided by a safety monitoring system

Case 1:A 41-year-old women who received HIFU ablation for uterine fibroids.

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Case 2:A 50 years old women received HIFU ablation for uterine fibroids. The lesion shrank significantly after treatment.

 

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