Short- and long-term results of organ-sparing surgery in patients with severe diffuse adenomyosis at perimenopausal transition
https://doi.org/10.23946/2500-0764-2023-8-1-93-100
Abstract
Aim. To study the short- and long-term results of organ-sparing surgery in patients with severe diffuse adenomyosis who are in the perimenopausal age.
Materials and Methods. The study included 18 patients with severe diffuse adenomyosis who underwent fertility-sparing excision of diffuse adenomyosis by means of Osada procedure. Efficiency of surgical treatment and subsequent drug therapy was evaluated at 12 and 24 months of follow-up by pelvic ultrasound examination. The frequency of adenomyosis symptoms and quality of life were assessed using the standard SF-36 questionnaire.
Results. Recovery of the menstrual cycle, freedom from pain and anemia, and improved quality of life were documented in all cases (18/18), whereas onset of menopause occurred in half of the cases (9/18). In particular, all scales of the Physical Component Summary from SF-36 questionnaire were significantly improved at both follow-up time points.
Conclusion. Organ-sparing excision of diffuse adenomyosis using Osada procedure is the option of choice and might represent an alternative to hysterectomy in women with perimenopausal age, in addition to those of earlier reproductive age.
About the Authors
V. B. Tskhay
Voino-Yasenetsky Krasnoyarsk State Medical University; Federal Siberian Research Clinical Centre, Federal Medical-Biological Agency
Russian Federation
Russian Federation
Prof. Vitaliу B. Tskhay, MD, DSc, Professor, Head of the Department of Perinatology, Obstetrics and Gynecology; Supervisor on Obstetrics and Gynecology, Federal Siberian Research Clinical Centre
1, Partizana Zheleznyaka Street, Krasnoyarsk, 660022
Building 2, 26, Kolomenskaya Street, Krasnoyarsk, 660037
G. T. Mikailly
Voino-Yasenetsky Krasnoyarsk State Medical University; Regional Clinical Center for Maternal and Child Health
Russian Federation
Russian Federation
Dr. Gulnar T. Mikailly, MD, Assistant Professor, Department of Perinatology, Obstetrics and Gynecology; Obstetrician-Gynecologis
1, Partizana Zheleznyaka Street, Krasnoyarsk, 660022
2A, Akademika Kirenskogo Street, Krasnoyarsk, 660074
I. I. Tskhay
Federal Siberian University
Russian Federation
Russian Federation
Mrs. Irina I. Tskhay, Senior Lecturer, Department of Theoretical Economics
79, Svobodnyi Prospekt, Krasnoyarsk, 660041
References
1. Oliveira MAP, Crispi CP Jr, Brollo LC, Crispi CP, De Wilde RL. Surgery in adenomyosis. Arch Gynecol Obstet. 2018;297(3):581-589. https://doi.org/10.1007/s00404-017-4603-6
2. Цхай В.Б. Adenomyosis. Current Controversies. Pain. Hemorrhage. Infertility. Ed. by. V.E. Radzinsky. Moscow: Status Praesens, 2020. (In Russ).
3. Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F. The Impact of Adenomyosis on Women's Fertility. Obstet Gynecol Surv. 2016;71(9):557-568. https://doi.org/10.1097/OGX.0000000000000346
4. Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril. 2018;109(3):406-417. https://doi.org/10.1016/j.fertnstert.2018.01.032
5. Huang HK, Ding DC. Pelvic organ prolapse surgery following hysterectomy with benign indication: a national cohort study in Taiwan. Int Urogynecol J. 2018;29(11):1669-1674. https://doi.org/10.1007/s00192-018-3689-0
6. Cheng K, Liu X. Relationship between hysterectomy and stroke in National Health and Nutrition Examination Survey (NHANES) 2007- 2018: a cross-sectional study. Ann Transl Med. 2022;10(22):1209. https://doi.org/10.21037/atm-22-4681
7. Wilkinson J, Carter LA. Hysterectomy and hypertension: new evidence, but not yet settled. BJOG. 2018;125(13):1725. https://doi.org/10.1111/1471-0528.15411
8. Ramdhan RC, Loukas M, Tubbs RS. Anatomical complications of hysterectomy: A review. Clin Anat. 2017;30(7):946-952. https://doi.org/10.1002/ca.22962
9. Brandsborg B, Nikolajsen L. Chronic pain after hysterectomy. Curr Opin Anaesthesiol. 2018;31(3):268-273. https://doi.org/10.1097/ACO.0000000000000586
10. Lykke R, Løwenstein E, Blaakær J, Gimbel H. Hysterectomy technique and risk of pelvic organ prolapse repair: a Danish nationwide cohort study. Arch Gynecol Obstet. 2017;296(3):527-531. https://doi.org/10.1007/s00404-017-4470-1
11. Chiang CH, Chen W, Tsai IJ, Hsu CY, Wang JH, Lin SZ, Ding DC. Diabetes mellitus risk after hysterectomy: A population-based retrospective cohort study. Medicine (Baltimore). 2021;100(4):e24468. https:// doi.org/ 10.1097/MD.0000000000024468
12. Hyams LL. Adenomyosis, its conservative surgical treatment (hysteroplasty) in young women. NY State J Med. 1952;52(22):2778-2784.
13. Jun-Min X, Kun-Peng Z, Yin-Kai Z, Ya-Qin Z, Xiao-Fan F, Xiao-Yu Z, Li W, Bin W. A New surgical method of U-shaped myometrial excavation and modified suture approach with uterus preservation for diffuse adenomyosis. Biomed Res Int. 2018;2018:1657237 https://doi.org/10.1155/2018/1657237
14. Tan J, Moriarty S, Taskin O, Allaire C, Williams C, Yong P, Bedaiwy MA. Reproductive Outcomes after Fertility-Sparing Surgery for Focal and Diffuse Adenomyosis: A Systematic Review. J Minim Invasive Gynecol. 2018;25(4):608-621. https://doi.org/10.1016/j.jmig.2017.12.020
15. Li Z, Li X, Lin M, Qiu S, Wang L, Lai L, Luo X, Mo Z, Dong G, Lyu G, Li S. Clinical efficacy of myometrial and endometrial microwave ablation in the treatment of patients with adenomyosis who had anemia. Int J Hyperthermia. 2022;39(1):1335-1343. https://doi.org/10.1080/02656736.2022.2131001
16. Osada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online. 2011;22(1):94-99. https://doi.org/10.1016/j.rbmo.2010.09.014
17. Tskhay V, Schindler AE, Мikailly G. Operation, hormone therapy and recovery of the patients with severe forms of adenomyosis. Gynecol Endocrinol. 2018;34(8):647-650. https://doi.org/10.1080/09513590.2017.1397116
18. Kaplunov V.A., Tskhay V.B., Mikailli G.Т., Badmayeva S.Zh. Possibilities of organ-preserving surgical treatment of patients with diffuse adenomyosis combined with hysteromyoma. Siberian Medical Review. 2020;2(122):92-97. (Russ). https://doi.org/10.20333/2500136-2020-2-92-97
Review
For citations:
Tskhay V.B., Mikailly G.T., Tskhay I.I. Short- and long-term results of organ-sparing surgery in patients with severe diffuse adenomyosis at perimenopausal transition. Fundamental and Clinical Medicine. 2023;8(1):93-100. (In Russ.) https://doi.org/10.23946/2500-0764-2023-8-1-93-100
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