Medicine an Surgery notes

Apr 24th, 2015
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Myomectomy As an Alternativeto Hysterectomy for Women WhoHave Completed Childbearing: APilot StudyDavid Blair Toub, M.D.Dept of Obstetrics and GynecologyPennsylvania Hospitaldavid blair toub, m.d.Uterine Fibroids:33% of all benign hysterectomies Generally treated by myomectomy or otherconservative measures in women who desirefertility, hysterectomy in older women Definitively treated by hysterectomy Regress after menopause (51.8 years)david blair toub, m.d.Why Is Myomectomy Not Preferred?Reputation as bloody operation Fibroid recurrence is possible risk Adhesion formation Wallach: Hysterectomy usually is a simplerprocedure than multiple myomectomy, aswell as the procedure to which mostgynecologists are more accustomed (Te Linde:Operative Gynecology, Seventh Edition)david blair toub, m.d.Hysterectomy Risks:Ureteral injury (0.1 - 0.5%) Changes in libido (25-33%) and orgasm Depression Decreased time to ovarian failuredavid blair toub, m.d.Patient Population:Women with symptomatic fibroids (n = 14) 11 s/p TL , 3 with undesired fertility Age range 26 - 50 (mean 38.4 years) Endometrial sampling done if IMB and 35 Autoblood encouraged GnRH-a if corpus 16 weeksdavid blair toub, m.d.Exclusions:Patient desires fertility Patient declines uterine conservation Abnormal cervical or uterine histology Medical contraindications to surgerydavid

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