Surgical treatment options for uterine myomas

Miomi maternice dobroćudne su novotvorine glatkih mišićnih stanica. Javljaju se u do 80% žena reprodukcijske dobi. U većini slučajeva su asimptomatski (75%). Simptomi uključuju prolongirano i obilno menstrualno krvarenje, bol u trbuhu, smetnje mokrenja ili defekacije te neplodnost. Etiologija nije u potpunosti razjašnjena, no poznato je da na razvoj mioma velik utjecaj imaju ženski spolni hormoni, koji, vezanjem na receptore na stanicama mioma, potiču proliferaciju stanica te proizvodnju ekstracelularnog matriksa. Čimbenici rizika za razvoj mioma su rasa, dob, rana menarha, kasna menopauza, nuliparitet, povišen indeks tjelesne mase te konzumacija kofeina i alkohola. Prema međunarodnom udruženju ginekologa i opstetričara (FIGO), dijele se u 9 skupina u odnosu na njihov položaj unutar stijenke maternice. U većini slučajeva ostaju asimptomatski, no u žena s izraženim simptomima potrebno je odabrati najprikladniju metodu liječenja. Zbog očuvanja plodnosti te izbjegavanja kompleksnih kirurških zahvata, može se uvesti farmakološka terapija. Ona obuhvaća oralnu kombiniranu hormonsku kontracepciju, intrauterine uloške koji oslobađaju levonorgestrel, selektivne modulatore progesteronskih receptora, agoniste i antagoniste GnRH te inhibitore aromataze. Kad se simptomi ne mogu kontrolirati lijekovima, pacijentica postaje kandidat za kirurško liječenje. U pacijentica koje žele sačuvati maternicu teži se izvođenju miomektomije, kad god je to moguće. Miomektomija se može učiniti abdominalnim, laparoskopskim ili histeroskopskim pristupom, ovisno o veličini i položaju tumora. U bolesnica koje ne žele sačuvati maternicu, ili u onih čiji se simptomi ne mogu liječiti drugim metodama, kirurška metoda izbora jest histerektomija. Ona predstavlja jedino trajno rješenje simptoma uzrokovanih ovim novotvorinama. Prilikom svake od navedenih operacija mogu se javiti određene komplikacije, od kojih su najčešća krvarenja, infekcije, ozljede okolnih organskih sustava te embolija. Komplikacija specifična za histerektomiju jest dehiscencija bataljka rodnice, dok je nakon miomektomije moguća ruptura maternice u kasnijoj trudnoći.Uterine fibroids are benign growths of smooth muscle cells. They occur in up to 80% of women of reproductive age. In most cases, they are asymptomatic (75%). Symptoms include prolonged and heavy menstrual bleeding, abdominal pain, urinary or bowel disturbances, and infertility. The etiology is not fully understood, but it is known that estrogen and progesterone have a significant impact on the development of these tumors. By binding to receptors on fibroid cells, estrogen and progesterone promote cell proliferation, cell survival, and extracellular matrix production. Risk factors for the development of these neoplasms include race, age, early menarche, late menopause, nulliparity, elevated body mass, caffeine and alcohol consumption. According to the International Federation of Gynecology and Obstetrics (FIGO), fibroids are classified into 9 groups based on their location within the uterine wall. In most cases, fibroids remain asymptomatic, but in women with pronounced symptoms, appropriate treatment methods need to be chosen. Pharmacological therapy can be introduced to preserve fertility and avoid complex surgical procedures. This includes oral combined hormonal contraception, levonorgestrel-releasing intrauterine devices, selective progesterone receptor modulators, gonadotropin-releasing hormone agonists and antagonists, and aromatase inhibitors. When symptoms cannot be controlled with medication, the patient becomes a candidate for surgical treatment. In patients who wish to preserve the uterus, myomectomy is the preferred whenever possible. This can be performed through an abdominal, laparoscopic, or hysteroscopic approach, depending on the size and location of the tumor. In older patients who do not wish to preserve the uterus or in cases where symptoms cannot be treated by other methods, hysterectomy is the method of choice. It represents the only permanent solution for symptoms caused by these growths. Each of the mentioned surgeries can be associated with certain complications, with the most common being bleeding, infections, injuries to surrounding organ systems, and embolism. A specific complication for hysterectomy is vaginal cuff dehiscence, while uterine rupture in later pregnancy is possible after myomectomy