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Objective To explore the efficacy of Hongjin Xiaojie Concentrated Pills combined with mifepristone on patients following laparoscopic resection of multiple uterine leiomyomas, as well as their effects on serum sex hormone levels, transforming growth factor-β1 (TGF-β1), and insulin-like growth factor binding protein-3 (IGFBP-3). Methods A total of 124 patients with multiple uterine leiomyomas who were treated in our hospital from June 2020 to June 2022 were selected for this study. The patients were randomly divided into two groups of 62 each. All patients underwent laparoscopic myomectomy (LM). The observation group received combined treatment with Hongjin Xiaojie Concentrated Pills and mifepristone postoperatively, while the control group received only mifepristone. After three months of continuous treatment, clinical efficacy was compared between the two groups. Serum sex hormone levels (estradiol [E2], follicle-stimulating hormone [FSH], luteinizing hormone [LH]), as well as TGF-β1 and IGFBP-3 levels, were measured before and after treatment. The incidence of adverse reactions was recorded, and all patients were followed up for at least 12 months to compare recurrence rates at 6 and 12 months postoperatively. Results The total effective rate in the observation group was 98.39% (61/62), significantly higher than the 87.10% (54/62) in the control group (P＜0.05). After treatment, serum levels of E2, FSH, LH, and TGF-β1 significantly decreased in both groups (P＜0.05), while IGFBP-3 levels significantly increased (P＜0.05). Post-treatment, the observation group had significantly lower serum levels of E2, FSH, LH, and TGF-β1, and significantly higher IGFBP-3 levels compared to the control group (P＜0.05). The recurrence rates at 6 and 12 months post-surgery in the observation group were 1.61% and 4.84%, respectively, compared to 6.45% and 16.13% in the control group; the observation group had a significantly lower recurrence rate at 12 months (P＜0.05). The incidence of adverse reactions in the observation group was 6.45%, while it was 14.52% in the control group, with no significant difference between the two groups (P＞0.05). Conclusion The combination of Hongjin Xiaojie Concentrated Pills and mifepristone after laparoscopic myomectomy for multiple uterine leiomyomas effectively regulates serum sex hormones and levels of TGF-β1 and IGFBP-3, enhances clinical efficacy, and reduces postoperative recurrence. [ABSTRACT FROM AUTHOR]

Objectives To investigate the long-term efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for multiple uterine fibroids and the factors associated with recurrence.Materials and methods Five hundred and forty-nine patients with multiple uterine fibroids treated with USgHIFU from June 2017 to June 2019 were retrospectively analyzed. The Pictorial Blood Loss Assessment Chart (PBAC) was used to assess menstrual blood loss. The patients were asked to undergo pre- and post-USgHIFU magnetic resonance imaging (MRI) and complete routine follow-up after USgHIFU. Cox regression analysis was used to investigate the risk factors associated with recurrence.Results The median number of fibroids per patient was 3 (interquartile range: 3–4), and a total of 1371 fibroids were treated. Among them, 446 patients completed 3 years follow-up. Recurrence, defined as PBAC score above or equal to 100 and/or the residual fibroid volume increased by 10%, was detected in 90 patients within 3 years after USgHIFU, with a cumulative recurrence rate of 20.2% (90/446). The multi-factor Cox analysis showed that age was a protective factor for recurrence. Younger patients have a greater chance of recurrence than older patients. Mixed hyperintensity of fibroids on T2WI and treatment intensity were risk factors for recurrence. Patients with hyperintense uterine fibroids and treated with lower treatment intensity were more likely to experience recurrence than other patients after USgHIFU. No major adverse effects occurred.Conclusions USgHIFU can be used to treat multiple uterine fibroids safely and effectively. The age, T2WI signal intensity and treatment intensity are factors related to recurrence.

Objectives: To investigate the long-term efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for multiple uterine fibroids and the factors associated with recurrence. Materials and methods: Five hundred and forty-nine patients with multiple uterine fibroids treated with USgHIFU from June 2017 to June 2019 were retrospectively analyzed. The Pictorial Blood Loss Assessment Chart (PBAC) was used to assess menstrual blood loss. The patients were asked to undergo pre- and post-USgHIFU magnetic resonance imaging (MRI) and complete routine follow-up after USgHIFU. Cox regression analysis was used to investigate the risk factors associated with recurrence. Results: The median number of fibroids per patient was 3 (interquartile range: 3–4), and a total of 1371 fibroids were treated. Among them, 446 patients completed 3 years follow-up. Recurrence, defined as PBAC score above or equal to 100 and/or the residual fibroid volume increased by 10%, was detected in 90 patients within 3 years after USgHIFU, with a cumulative recurrence rate of 20.2% (90/446). The multi-factor Cox analysis showed that age was a protective factor for recurrence. Younger patients have a greater chance of recurrence than older patients. Mixed hyperintensity of fibroids on T2WI and treatment intensity were risk factors for recurrence. Patients with hyperintense uterine fibroids and treated with lower treatment intensity were more likely to experience recurrence than other patients after USgHIFU. No major adverse effects occurred. Conclusions: USgHIFU can be used to treat multiple uterine fibroids safely and effectively. The age, T2WI signal intensity and treatment intensity are factors related to recurrence. [ABSTRACT FROM AUTHOR]

MR-guided high-intensity focused ultrasound (MR-HIFU) is an effective method for treating symptomatic uterine fibroids, especially solitary lesions. The aim of our study was to compare the clinical and morphological outcomes of patients who underwent MR-HIFU due to solitary fibroid (SF) or multiple fibroids (MFs) in a prospective clinical trial. We prospectively included 21 consecutive patients with SF (10) and MF (11) eligible for MR-guided HIFU. The morphological data were assessed using mint Lesion™ for MRI. The clinical data were determined using the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire before and 6 months after treatment. Unpaired and paired Wilcoxon-test and t-tests were applied, and Pearson's coefficient was used for correlation analysis. A p-value of 0.05 was considered statistically significant. The volume of treated fibroids significantly decreased in both the SF (mean baseline: 118.6 cm3; mean 6-month follow-up: 64.6 cm3) and MF (107.2 cm3; 55.1 cm3) groups. The UFS-QOL showed clinical symptoms significantly improved for patients in both the SF and MF groups regarding concern, activities, energy/mood, and control. The short-term outcome for the treatment of symptomatic fibroids in myomatous uterus by MR-guided HIFU is clinically similar to that of solitary fibroids. [ABSTRACT FROM AUTHOR]

Hysterectomy, one of the most common surgical procedures performed in women worldwide, assumes a very important role in the definitive management of diverse gynecologic conditions. This case report presents a compelling instance of an iatrogenic bladder perforation that occurred during laparoscopically assisted vaginal hysterectomy in a 47-year-old woman with a high body mass index, extensive surgical history, and postural orthostatic tachycardia syndrome. Despite considerable preoperative planning and the use of minimally invasive techniques, the occurrence of physician-induced bladder perforation highlights the significance of understanding anatomical relationships and variations. The patient's previous abdominal surgeries including two cesarean sections, appendectomy, and cholecystectomy likely contributed to scar formation and adhesions, making dissection challenging. The case report and following discussion delve into anatomical variations, as well as the diagnosis and management of iatrogenic bladder injuries. The presented case serves as a valuable addition to the literature, contributing insights into the challenges and considerations surrounding urinary tract injuries during hysterectomy. This paper aims to review current research and guide practicing obstetricians and gynecologists in the management of intraoperative bladder injuries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Patibandla et al.)

Objective: To evaluate the shrinkage rate, symptom relief and improvement of the quality of life following ultrasound-guided high intensity focussed ultrasound (USgHIFU) for multiple uterine fibroids. Methods: From October 2015 to November 2016, 81 black women with multiple symptomatic fibroids underwent USgHIFU. The number of the fibroids ranged from 3 to 9. The shrinkage rate of fibroids, symptom severity score and quality of life were evaluated following USgHIFU. Magnetic resonance imaging (MRI), the uterine fibroid symptom and quality of life (UFS-QOL) questionnaire were used for evaluation. Results: The mean age of patients was 35.3 ± 5.9 years. The average weight of these patients was 68.4 ± 11.4 kg, with the median abdominal subcutaneous fat thickness of 38.0 ± 11.4 mm. The median fibroid volume was 36.0 (range: 1.8-1220.1) cm³. During HIFU, 60.5% of the patients reported lower abdominal pain, 43.2% sciatic/buttock pain, 60.5% skin “burning” sensation, 6.2% abnormal vaginal discharge and 13.6% transient leg pain. No severe complications were observed. The average volume reduction rate of fibroids in 21 patients who completed the follow-up was 32.5 ± 24.0, 42.3 ± 32.2 and 52.5 ± 36.3% 1, 3 and 6 months after HIFU, respectively. The UFS score decreased and the QOL values significantly increased during the follow-up period. Re-intervention treatment occurred in two of the 21 patients 6 months after HIFU. One patient conceived 3 months after HIFU, and she had a term vaginal delivery without any obstetrical complications. Conclusions: Based on our results, USgHIFU is safe and effective in treating patients with multiple uterine fibroids. [ABSTRACT FROM AUTHOR]

Objectives: Ulipristal acetate (UPA) is a selective progesterone receptor modulator, which has been used to treat uterine fibroids. Many published reports about the outcomes indicate effective control of bleeding and reduction in the fibroid volume following both short- and long-term therapy. However, the reported volume reduction varies across different reports. Therefore, the purpose of this study was to investigate the factors that can affect the volume reduction of uterine fibroids, after short-term UPA therapy in patients with symptomatic uterine fibroids.Study Design: Women treated with UPA for 3 months, between November 2013 and February 2017, for symptomatic uterine fibroids were evaluated retrospectively. The fibroid volume was measured using ultrasonography or magnetic resonance imaging. Response was defined as any reduction in volume after treatment and non-response was defined as no change or increase in volume.Results: Totally, 152 women were treated with UPA and the median volume reduction was 13.1% (interquartile range [IQR] -16.8 to 36.7). Response to treatment was seen in 92 of 152 (60.5%) patients, while 60 women (39.5%) showed no response. Median number of fibroids in the response group was less than that in the non-response group (P = 0.030; median 2, IQR 1-4 vs. median 4, IQR 1-6). On multivariate regression analysis, fewer number of uterine fibroids was an independent factor for predicting a good response to UPA (odds ratio 0.830, CI: 0.710-0.969, P = 0.019).Conclusion: An independent factor that can affect the volume reduction after a 3-month UPA therapy in women with uterine fibroids was the number of fibroids. This indicates that UPA might be ineffective for volume reduction in cases with multiple leiomyomas. However, future prospective studies comparing solitary and multiple leiomyomas for response to UPA are necessary. [ABSTRACT FROM AUTHOR]

Uterine leiomyomas are the most common pelvic neoplasm in females. They are non-cancerous monoclonal tumors that develop from the fibroblasts and smooth muscle cells of the myometrium. They can develop in females of reproductive age and post-menopausal as well. When symptomatic, they frequently manifest as abnormal uterine bleeding and/or pelvic pain or pressure. Reproductive effects are also possible in fibroids such as infertility and poor pregnancy outcomes. In this report, we present a case of a 39-year-old woman, G9P4A4, GA 16 weeks who came to the ER with an incomplete abortion at home after which she had large multiple uterine submucosal fibroids prolapsing into the vagina. On ultrasound, the placenta was still inside, and a large submucosal anterior uterine fibroid and a posterior uterine fibroid were found with sizes 10x10 cm and 2x3, respectively. Evacuation and curettage (E&C) could not be completed because fibroids were obstructing and limiting the access. The patient was managed medically and then discharged, after which she came back with prolapsing uterine fibroids and part of the placenta. In the end, she was managed by hysteroscopic myomectomy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Almusaylim et al.)

Multiple uterine fibroids is a frequent pathology, whose diagnosis and treatment are well documented and there are many guides elaborated in this regard. However, in patients diagnosed with multiple uterine fibroids and pelvic endometriosis who chose preservation of fertility, no treatment algorithm is established. We report the case of a 36-year-old patient, nulliparous, diagnosed with multiple uterine fibroids and persistently elevated levels of CA 125. The diagnosis of endometriosis was established after laparoscopy. Treatment with GnRH agonists was initiated and the patient achieved pregnancy 3 months after completion of therapy. In order to preserve fertility in patients with pelvic endometriosis and multiple uterine fibroids, a combined treatment may be used - uterine artery embolization, laparoscopic removal of ectopic endometrial tissue and GnRH agonists. [ABSTRACT FROM AUTHOR]