Special Issue "Pathogenesis, Diagnosis, Medical and Surgical Treatment of Uterine Fibroids"

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: closed (31 December 2020).

Special Issue Editors

Prof. Dr. Simone Ferrero
E-Mail Website
Guest Editor
Ospedale Policlinico San Martino, University of Genova, Largo R Benzi 10, I-16132 Genoa, Italy
Interests: gynecology; endometriosis; fibroids; laparoscopy; hormonal therapy; hysteroscopy; ultrasonography; gynecological surgery; minimally invasive surgery; infertility
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Dr. Fabio Barra
E-Mail Website
Co-Guest Editor
IRCCS, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
Interests: endometriosis; inflammation; minimally invasive surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Salvatore Giovanni Vitale
E-Mail Website
Co-Guest Editor
Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties University of Catania, Catania, Italy
Interests: hysteroscopy; infertility; minimally invasive surgery; uterine fibroids
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Uterine fibroids (also named leiomyomas or myomas) are one of the most common benign gynaecological conditions affecting reproductive-age women. They consist mainly of smooth muscle cells with different amounts of fibrous tissue, clearly surrounded by a neurofibrovascular network, called pseudocapsule, which enables their enucleation and enhances myometrial healing. Despite being often asymptomatic, depending on their location and size, uterine fibroids may cause heavy menstrual bleeding, pain symptoms, recurrent miscarriage, and infertility; these symptoms cause significant morbidity and impairment of women’s quality of life. Overall, uterine fibroids are the most common worldwide indication for hysterectomy. Because of the wide spread of this disease, clinical interventions and costs associated with uterine fibroids are continuously growing. The diagnosis of uterine fibroids is mainly based on transvaginal ultrasonography; however, differential diagnosis with uterine sarcomas may be challenging. Depending on their numerousness, position in the uterine wall, and size, uterine fibroids can be surgically treated by laparotomy, laparoscopy, robotic surgery, or hysteroscopy. Hormonal therapies may be used either for the long-term treatment of uterine fibroids or to facilitate surgical approach. The purpose of this Special Issue is to update knowledge on epidemiology, pathogenesis, clinical features, pathological and molecular characteristics, diagnosis, and the treatment of uterine fibroids. Understanding the cellular and molecular processes that contribute to myoma formation could lead to targeted therapies to prevent and treat this disease. We encourage the submission of original manuscripts and reviews on this subject.

 

Prof. Simone Ferrero
Dr. Fabio Barra
Dr. Salvatore Giovanni Vitale
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Uterine fibroids
  • Uterine myomas
  • Pathogenesis
  • Diagnosis
  • Ultrasonography
  • Uterine sarcoma
  • Laparoscopy
  • Hysteroscopy
  • Minimally invasive surgery
  • Hormonal therapies.

Published Papers (2 papers)

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Research

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Article
A Prospective Intervention Trial on Tailored Radiofrequency Ablation of Uterine Myomas
Medicina 2020, 56(3), 122; https://doi.org/10.3390/medicina56030122 - 12 Mar 2020
Cited by 2 | Viewed by 1102
Abstract
Background and Objective: Investigating the use of radiofrequency myolysis (RFM) for the treatment of fibroids through less invasive access by combining transvaginal ultrasound, hysteroscopy and laparoscopy. Materials and Methods: Fifty-four premenopausal women with 106 symptomatic uterine myomas. Patients underwent RFM in three ways: [...] Read more.
Background and Objective: Investigating the use of radiofrequency myolysis (RFM) for the treatment of fibroids through less invasive access by combining transvaginal ultrasound, hysteroscopy and laparoscopy. Materials and Methods: Fifty-four premenopausal women with 106 symptomatic uterine myomas. Patients underwent RFM in three ways: Vaginal Ultrasound-guided RFM (VU-RFM), Laparoscopic RFM (L-RFM) and Hysteroscopic-RFM (H-RFM). The mean patient age was 43 years; 52 symptomatic uterine myomas were subserosal, 44 intramural and 10 submucosal. The outcomes evaluated at 1 and 12 months after RFM were myoma size (volume-diameter), “Uterine Fibroid Symptom and Quality of Life (UFS-QOL)” questionnaire and a 10-point Visual Analogue Scale (VAS). The therapy was completed with a single ablation in all patients, no complication was registered. The average number of fibroids treated per intervention was two with the use of different accesses: 64/106 VU-RFMs (60.4%), 32/106 L-RFMs (30.2%) and 10/106 H-RFMs (9.4%). Results: Volume and diameter of fibroids were significantly reduced by, respectively, 51.3% and 20.1% in the first 30 days post-intervention (p < 0.001) up to a maximum of 73.5% and 37.1% after the second follow-up visit at 12 months (p < 0.001). A similar trend was shown in terms of disability with a progressive and significant reduction of symptoms (menorrhagia, dysmenorrhea, dyspareunia and pollakiuria) demonstrated by percentage variation of UFS-QOL Symptom Severity and VAS scores to −74.3% and −45.3% as well as −84.9% and −74.3%, respectively, at 1 and 12 months after RFM (p < 0.001). An overall improvement in the quality of life was also demonstrated by a significant increase in the UFS-QOL total score of +38.2% in the first 30 days post-intervention up to +44.9% after the second follow-up visit at 12 months (p < 0.001). The overall average surgery time of the RFM for each patient was 48 minutes, and the time to treat each fibroid by Vaginal Ultrasound-guided RFM (23 min) was found to be significantly less than those of laparoscopy or hysteroscopy (respectively 35 and 34 min) (p < 0.05). An electromagnetic virtual needle tracking system (VNTS) was successfully tested during the RFM procedures, and real-time contrast-enhanced ultrasound (CEUS) has proven to be effective in determining the duration of myolysis through the identification of eventual residual areas of enhancement within the fibroids. Conclusion: Radiofrequency can be considered a minimally invasive and safe procedure for the treatment of uterine myomas through the customization and possible combination of transvaginal, laparoscopic or hysteroscopic accesses. The standardization of the ablation technique with pre-intervention biopsy and new technologies such as VNTS and CEUS spares healthy uterine tissue and may change the future management of symptomatic uterine fibroids. Full article
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Review

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Review
Current Treatment Options for Cervical Leiomyomas: A Systematic Review of Literature
Medicina 2021, 57(2), 92; https://doi.org/10.3390/medicina57020092 - 21 Jan 2021
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Abstract
Background and objectives: Cervical leiomyomas are a rare benign disease. Although they are mainly treated surgically, currently, there is not a standardized treatment for cervical leiomyomas. This study aims to summarize current literature evidence about treatment options for cervical leiomyomas. Materials and [...] Read more.
Background and objectives: Cervical leiomyomas are a rare benign disease. Although they are mainly treated surgically, currently, there is not a standardized treatment for cervical leiomyomas. This study aims to summarize current literature evidence about treatment options for cervical leiomyomas. Materials and methods: A systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect, and the Cochrane Library, including observational prospective and retrospective studies, case series and case reports. We collected data regarding studies related to treatment options for cervical leiomyomas, evaluating the following aspects: study design, population, treatment type, rate of surgical complications, and fertility outcome. Results: According to literature research, 38 articles were included. Among 214 patients, the weighted average age was 39.4 years-old; 23 patients were pregnant. Most of the leiomyomas (78%) were extracervical; in 22% of cases (29 patients) were intracervical; 188 patients (88%) received surgical treatment, 6 (3%) received exclusive conservative management and 21 (10%) underwent interventional radiology treatment. One hundred twenty-seven patients (67.5%) underwent myomectomy, while 54 (28.7%) and 7 (3.7%) hysterectomy and trachelectomy, respectively. Cervical myomectomy was performed by open surgery in 21 out of 127 cases (16.5%), while in 92 (72.4%) and 6 (4.7%) patients the surgical approach was performed by traditional and robot-assisted laparoscopy, respectively. The total rate of surgical complications was 5.6%. Conclusion: Surgery is the primary therapeutic option for cervical leiomyomas with a low rate of surgical complications. Interventional radiology techniques have reported promising but still limited results. Full article
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