Myoma Uteri

myomauteri-1-0-25kapak

Myomectomy of the Uterus Via Vaginal Route, Treatment of Vaginal and Cervical Myomas

Gonca Türker Ergün

Ankara Bilkent City Hospital, Department of Gynecology and Obstetric, Ankara, Türkiye

Türker Ergün G. Myomectomy of The Uterus Via Vaginal Route, Treatment of Vaginal and Cervical Myomas. Yavuz AF, ed. Myoma Uteri. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.85-90.

ABSTRACT

Myomas are benign tumors that originate from the muscle and connective tissue of the uterus. They can be submucosal, intramural, or subserosal, and may also occur in the cervix, within the broad ligament, or on pedicles. Uterine leiomyomas are the most common pelvic tumors in women. Their incidence during the reproductive period is between 20-40%. If leiomyomas are supplied with blood by adjacent organs such as the omentum, they are referred to as parasitic myomas. Leiomyomas are the most common cause of benign hysterectomies and are found in 77% of hysterectomy specimens. Clinically, they present with abnormal uterine bleeding, pressure symptoms, and pelvic pain. Some submucosal myomas are pedunculated and extend from the cervical canal into the vagina. This condition clinical- ly presents with cervical canal dilation and effacement, leading to severe uterine contractions, pain, foul-smelling discharge, and subsequent infections. In submucosal myomas, treatment involves exci- sion via hysteroscopic methods. For pedunculated myomas that dilate the cervix or protrude into the vagina, treatment involves vaginal surgeries. Prolapsed myomas should only be removed in the case of heavy bleeding, infection, pain, and urinary retention in pregnant women. In case of labor obstruction or expected to be, a cesarean section can be performed, and the myoma can be removed at another surgical session. Imaging studies help identify intraoperative ‘type 0’ myomas. A definitive diagnosis is made through pathology. Imaging is also useful in detecting other myomas (e.g., type 0) that may be identified intraoperatively. Rarely, it is beneficial for evaluating masses such as uterine sarcomas. Ultrasonography is the first step in diagnosis because it helps detect uterine lesions, is easy to access, and is cost-effective. Pelvic magnetic resonance imaging (MRI) has higher sensitivity than ultrasound in determining the size and location of myomas. Non-contrast MRI is generally sufficient for evaluat- ing the mass. Vaginal myomectomy is a successful treatment method for vaginal and cervical myomas.

Keywords: Hysterectomy; Vaginal; Uterine myomectomy; Leiomyoma; Myoma; Uterine contraction

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