Current Perspectives on Uterine Fibroids
https://doi.org/10.23946/2500-0764-2024-9-2-103-111
Abstract
In this paper, we aimed to: 1) discuss the approaches for increasing the effectiveness of organ-preserving surgical treatment of uterine fibroids; 2) analyse pre-operative preparation options for the formation of a restitutive scar during myomectomy. The article addresses the epidemiology of uterine fibroids in women, particularly in the reproductive age, and discussed the role of inflammation, disrupted nutrition, and proteolysis in the development of myomatous nodules. We also consider the terminology, classification, primary clinical symptoms of uterine fibroids, and discuss the causes of uterine scar incompetence. Various growth factors and collagen types have a differential impact on myometrial and on the formation of a restitutive scar. Finally, we talk about the histological and immunohistochemical methods in the diagnosis of uterine scar incompetence.
About the Authors
I. V. Zingalyuk
Siberian State Medical University
Russian Federation
Russian Federation
Dr. Ilya V. Zingalyuk, MD, Resident, Department of Obstetrics and Gynecology
2, Moskovskiy Trakt, Tomsk, 634050
O. A. Tikhonovskaya
Siberian State Medical University
Russian Federation
Russian Federation
Prof. Olga A. Tikhonovskaya, MD, DSc, Professor, Department of Obstetrics and Gynecology
2, Moskovskiy Trakt, Tomsk, 634050
S. V. Logvinov
Siberian State Medical University
Russian Federation
Russian Federation
Prof. Sergey V. Logvinov, MD, DSc, Professor, Head of the Department of Histology, Embryology and Cytology
2, Moskovskiy Trakt, Tomsk, 634050
I. A. Petrov
Siberian State Medical University
Russian Federation
Russian Federation
Prof. Ilya A. Petrov, MD, DSc, Professor, Department of Obstetrics and Gynecology
2, Moskovskiy Trakt, Tomsk, 634050
V. N. Tkachev
Siberian State Medical University
Russian Federation
Russian Federation
Dr. Vladimir N. Tkachev, MD, PhD, Associate Professor, Department of Obstetrics and Gynecology
2, Moskovskiy Trakt, Tomsk, 634050
D. Y. Chernov
Siberian State Medical University
Russian Federation
Russian Federation
Dr. Denis Y. Chernov, MD, Resident, Department of Obstetrics and Gynecology
2, Moskovskiy Trakt, Tomsk, 634050
References
1. De La Cruz MS, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017;95(2):100-107.
2. Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health. 2014;6:95-114. https://doi.org/10.2147/IJWH.S51083
3. Lou Z, Huang Y, Li S, Luo Z, Li C, Chu K, Zhang T, Song P, Zhou J. Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990-2019: an age-period-cohort analysis for the global burden of disease 2019 study. BMC Public Health. 2023;23(1):916. https://doi.org/10.1186/s12889-023-15765-x
4. Soliman AM, Yang H, Du EX, Kelkar SS, Winkel C. The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol. 2015;213(2):141-160. https://doi.org/10.1016/j.ajog.2015.03.019
5. Al-Hendy A, Myers ER, Stewart E. Uterine Fibroids: Burden and Unmet Medical Need. Semin Reprod Med. 2017;35(6):473-480. https://doi.org/10.1055/s-0037-1607264
6. Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3-9. https://doi.org/10.1002/ijgo.13102
7. Leppert PC, Jayes FL, Segars JH. The extracellular matrix contributes to mechanotransduction in uterine fibroids. Obstet Gynecol Int. 2014;2014:783289. https://doi.org/10.1155/2014/783289
8. Islam MS, Ciavattini A, Petraglia F, Castellucci M, Ciarmela P. Extracellular matrix in uterine leiomyoma pathogenesis: a potential target for future therapeutics. Hum Reprod Update. 2018;24(1):59-85. https://doi.org/10.1093/humupd/dmx032
9. Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M. Burden, Prevalence, and Treatment of Uterine Fibroids: A Survey of U.S. Women. J Womens Health (Larchmt). 2018;27(11):1359-1367. https://doi.org/10.1089/jwh.2018.7076
10. Barjon K, Mikhail LN. Uterine Leiomyomata. 2023 Aug 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
11. Borah BJ, Laughlin-Tommaso SK, Myers ER, Yao X, Stewart EA. Association Between Patient Characteristics and Treatment Procedure Among Patients With Uterine Leiomyomas. Obstet Gynecol. 2016;127(1):67-77. https://doi.org/10.1097/AOG.0000000000001160
12. Moawad NS, Palin H. Hysteroscopic Myomectomy. Obstet Gynecol Clin North Am. 2022;49(2):329-353. https://doi.org/10.1016/j.ogc.2022.02.012
13. Corrêa TD, Caetano IM, Saraiva PHT, Noviello MB, Santos Filho AS. Use of GnRH Analogues in the Reduction of Submucous Fibroid for Surgical Hysteroscopy: A Systematic Review and Meta-Analysis. Uso de análogo de GnRH na redução de mioma submucoso na histeroscopia cirúrgica: Revisão sistemática e meta-análise. Rev Bras Ginecol Obstet. 2020;42(10):649-658. https://doi.org/10.1055/s-0040-1712446
14. Lasmar RB, Lasmar BP, Moawad NS. Hysteroscopic myomectomy. Medicina (Kaunas). 2022;58(11):1627. https://doi.org/10.3390/medicina58111627
15. Agboola AD, Bello OO, Olayemi OO. A clinical audit of the patterns of presentations and complications of abdominal myomectomy at the University College Hospital, Ibadan, Nigeria. J Obstet Gynaecol. 2021;41(7):1145-1150. https://doi.org/10.1080/01443615.2020.1845632
16. Mallick R, Odejinmi F. Pushing the boundaries of laparoscopic myomectomy: a comparative analysis of peri-operative outcomes in 323 women undergoing laparoscopic myomectomy in a tertiary referral centre. Gynecol Surg. 2017;14(1):22. https://doi.org/10.1186/s10397-017-1025-1
17. Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Prevention and Management of Complications in Laparoscopic Myomectomy. Biomed Res Int. 2018;2018:8250952. https://doi.org/10.1155/2018/8250952
18. Herrmann A, Torres-de la Roche LA, Krentel H, Cezar C, de Wilde MS, Devassy R, De Wilde RL. Adhesions after Laparoscopic Myomectomy: Incidence, Risk Factors, Complications, and Prevention. Gynecol Minim Invasive Ther. 2020;9(4):190-197. https://doi.org/10.4103/GMIT.GMIT_87_20
19. Holzer A, Jirecek ST, Illievich UM, Huber J, Wenzl RJ. Laparoscopic versus open myomectomy: a double-blind study to evaluate postoperative pain. Anesth Analg. 2006;102(5):1480-1484. https://doi.org/10.1213/01.ane.0000204321.85599.0d
20. Coyne K, Purdy MP, Bews KA, Habermann EB, Khan Z. Risk of hysterectomy at the time of myomectomy: an underestimated surgical risk. Fertil Steril. 2024;121(1):107-116. https://doi.org/10.1016/j. fertnstert.2023.09.017
21. Budny-Winska J, Pomorski M. Uterine niche after cesarean section: a review of diagnostic methods. Ginekol Pol. 2021;92(10):726-730. https://doi.org/10.5603/GP.a2021.0195
22. Martynov SA, Adamyan LV. Cesarean scar defect: terminological aspects. Gynecology. 2020;22(5):70-75. https://doi.org/10.26442/20795696.2020.5.200415
23. Tulandi T, Cohen A. Emerging Manifestations of Cesarean Scar Defect in Reproductive-aged Women. J Minim Invasive Gynecol. 2016;23(6):893- 902. https://doi.org/10.1016/j.jmig.2016.06.020
24. Gil Y, Badeghiesh A, Suarthana E, Mansour F, Capmas P, Volodarsky-Perel A, Tulandi T. Risk of uterine rupture after myomectomy by laparoscopy or laparotomy. J Gynecol Obstet Hum Reprod. 2020;49(8):101843. https://doi.org/10.1016/j.jogoh.2020.101843
25. Seydullaeva LA, Razumova PP, Khalmuratova KZh, Eszhanova AA, Zhumazhanova SK, Syzdykova A. Outcome of pregnancy with uterine incompetence after myomectomy. Astana medical journals. 2020;107(1):105-110.
26. Zhou Q, Zhou X, Feng L, Wang SS. Complete Rupture of the Pregnant Uterus: A 10-year Retrospective Descriptive Study. Curr Med Sci. 2022;42(1):177-184. https://doi.org/10.1007/s11596-021-2460-9
27. Tan SQ, Chen LH, Muhd Abdul Qadir DB, Chern BS, Yeo GS. Risk factors and outcomes of uterine rupture in Singapore: Emerging trends. Ann Acad Med Singap. 2021;50(1):5-15. https://doi.org/10.47102/annalsacadmedsg.2020319
28. Savukyne E, Bykovaite-Stankeviciene R, Machtejeviene E, Nadisauskiene R, Maciuleviciene R. Symptomatic Uterine Rupture: A Fifteen Year Review. Medicina (Kaunas). 2020;56(11):574. https://doi.org/10.3390/medicina56110574
29. Roberge S, Demers S, Berghella V, Chaillet N, Moore L, Bujold E. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211(5):453-460. https://doi.org/10.1016/j.ajog.2014.06.014
30. Sumigama S, Sugiyama C, Kotani T, Hayakawa H, Inoue A, Mano Y, Tsuda H, Furuhashi M, Yamamuro O, Kinoshita Y, Okamoto T, Nakamura H, Matsusawa K, Sakakibara K, Oguchi H, Kawai M, Shimoyama Y, Tamakoshi K, Kikkawa F. Uterine sutures at prior caesarean section and placenta accreta in subsequent pregnancy: a case-control study. BJOG. 2014;121(7):866-874. https://doi.org/10.1111/1471-0528.12717
31. Claeys J, Hellendoorn I, Hamerlynck T. The risk of uterine rupture after myomectomy: a systematic review of the literature and meta-analysis. Gynecol Surg. 2014;11:197-206. https://doi.org/10.1007/s10397-014-0842-8
32. Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, Berghella V. Trial of labor after myomectomy and uterine rupture: a systematic review. Acta Obstet Gynecol Scand. 2016;95(7):724-734. https://doi.org/10.1111/aogs.12920
33. Lofrumento DD, Di Nardo MA, De Falco M, Di Lieto A. Uterine Wound Healing: A Complex Process Mediated by Proteins and Peptides. Curr Protein Pept Sci. 2017;18(2):125-128. https://doi.org/10.2174/1389203717666160322145939
34. Ridiandries A, Tan JTM, Bursill CA. The Role of Chemokines in Wound Healing. Int J Mol Sci. 2018;19(10):3217. https://doi.org/10.3390/ijms19103217
35. Sun Q, Tang L, Zhang D. Molecular mechanisms of uterine incision healing and scar formation. Eur J Med Res. 2023;28(1):496. https://doi.org/10.1186/s40001-023-01485-w
36. Demura TA, Kogan EA, Donnikov AE, Kan NE, Kesova MI, Martynov AI, Bolotova OV, Sukhikh GT. [Clinico-morphological and moleculargenetic characteristic of the miometrium with failure of the uterine scar after the Cesarean section at women with undifferentiated forms of connective tissue dysplasia]. Arkh Patol. 2012;74(3):18-21.
37. Borzykh OB, Shnaider NA, Karpova EI, Petrova MM, Demina OM, Nasyrova RF. Collagen synthesis in the skin, its functional and structural features. Medical news of the North Caucasus. 2021;16(4):443-450. (in Russ). https://doi.org/10.14300/mnnc.2021.16108
38. Sidorova TA, Martynov SA. Risk factors and mechanisms of formation of scar defects on the uterus after cesarean section. Gynecology. 2022;24(1):11-17. (in Russ). https://doi.org/10.26442/20795696.2022.1.201356
39. Pekarev OG, Mayborodin IV, Pekareva EO, Pozdnyakov IM, Brega ES. Use of stem cells to improve the repartive properties of myometrial scar. Doctor.Ru. 2017;3(132):20-25. (in Russ).
40. Xu Q, Ohara N, Chen W, Liu J, Sasaki H, Morikawa A, Sitruk-Ware R, Johansson ED, Maruo T. Progesterone receptor modulator CDB-2914 down-regulates vascular endothelial growth factor, adrenomedullin and their receptors and modulates progesterone receptor content in cultured human uterine leiomyoma cells. Hum Reprod. 2006;21(9):2408-2416.. https://doi.org/10.1093/humrep/del159
41. Kareva EN, Samoylova TE. Uterine myoma: new and perspective options for medicinal treatment. Medical Council. 2020;3:49-58. (in Russ). https://doi.org/10.21518/2079-701X-2020-3-49-58
42. Farris M, Bastianelli C, Rosato E, Brosens I, Benagiano G. Uterine fibroids: an update on current and emerging medical treatment options. Ther Clin Risk Manag. 2019;15:157-178. https://doi.org/10.2147/TCRM.S147318
43. Tikhomirov AL, Ledenkova AA, Bataeva AE, Abyshova VG. Progesterone receptor antagonists in the structure of combination organ-saving treatment for uterine myoma. Оbstetrics and gynecology. 2012;5:113-117. (in Russ).
44. Lethaby A, Puscasiu L, Vollenhoven B. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev. 2017;11(11):CD000547. https://doi.org/10.1002/14651858.CD000547.pub2
45. De Milliano I, Van Hattum D, Ket JCF, Huirne JAF, Hehenkamp WJK. Endometrial changes during ulipristal acetate use: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2017;214:56-64. https://doi.org/10.1016/j.ejogrb.2017.04.042
46. Bezhenar VF, Kondrat’ev AA, Arakelyan BV, Sadykhova EE. Myomectomy from the standpoint of immunohistochemical characteristics of the uterine tumor and the choice of method of preoperative preparation. Gynecology, Obstetrics and Perinatology. 2019;18(2):13-26 (In Rus). https://doi.org/10.20953/1726-1678-2019-2-13-26
47. Murji A, Whitaker L, Chow TL, Sobel ML. Selective progesterone receptor modulators (SPRMs) for uterine fibroids. Cochrane Database Syst Rev. 2017;4(4):CD010770. https://doi.org/10.1002/14651858.CD010770.pub2
48. Kapur A, Angomchanu R, Dey M. Efficacy of Use of Long-Term, LowDose Mifepristone for the Treatment of Fibroids. J Obstet Gynaecol India. 2016;66(1):494-498. https://doi.org/10.1007/s13224-016-0861-7
49. Guriev TD, Aleksandrovich LS, Sheshukova NA, Borovkova EI. Combined Benign Hyperproliferative Conditions of the Uterus. Obstetrics and gynecology: News, Opinions, Training. 2014;2(4):63-72.
Review
For citations:
Zingalyuk I.V., Tikhonovskaya O.A., Logvinov S.V., Petrov I.A., Tkachev V.N., Chernov D.Y. Current Perspectives on Uterine Fibroids. Fundamental and Clinical Medicine. 2024;9(2):103-111. (In Russ.) https://doi.org/10.23946/2500-0764-2024-9-2-103-111
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