The excision of uterine fibroids by vaginal myomectomy: a prospective study.

OBJECTIVE

To evaluate the clinical effectiveness and safety of the excision of uterine fibroids by vaginal myomectomy.

DESIGN

Prospective study.

SETTING

A gynecology department of a university teaching hospital.

PATIENT(S): Women with menorrhagia, pelvic pain, symptoms of pressure, or subfertility attributable to moderate-sized uterine fibroids who otherwise would have required abdominal or laparoscopic myomectomy.

INTERVENTION(S): Vaginal myomectomy.

MAIN OUTCOME MEASURE(S): The feasibility of vaginal surgery, operative complications, postoperative recovery, and relief of symptoms.

RESULT(S): Myomectomy was completed vaginally in 32 (91.4%) of 35 patients and none required hysterectomy. The overall operating time was 78 minutes, the estimated operative blood loss was 313 mL, and the mean postoperative hospital stay was 4 days. Pelvic hematomas developed in 4 patients, and one colpotomy required resuture. Seventy-four percent of the women reported relief of their symptoms at 3 months' follow-up. Three patients have had full-term pregnancies since the operation.

CONCLUSION(S): Myomectomy can be performed by the vaginal route in selected cases with low morbidity and a good short-term success rate. Unlike open myomectomy, it requires no skin incision, and unlike laparoscopic myomectomy, it can be used in patients who have numerous, relatively large, and intramural fibroids.