What Is a Hysterectomy?

A hysterectomy is a surgical procedure in which a woman’s uterus is removed. The uterus is a small, muscular organ in the female pelvis that functions to nourish and house a fetus while it is growing in the mother’s body. Hysterectomies are performed for a wide variety of reasons, and a surgeon may elect to perform a hysterectomy as an emergency, life-saving procedure. Alternatively, a hysterectomy may be an elective procedure in which the woman and her healthcare provider decide that this surgical intervention is the best option for her long-term health. Hysterectomy is the second most commonly performed surgical procedure (after cesarean section) for women of childbearing age in the United States, where about 1 in 3 women undergo a hysterectomy by the age of 60.

Types of Hysterectomy

Your surgeon might recommend this type of hysterectomy based on your personal health history. For instance, if you’ve had extensive scarring from prior surgeries, such as surgery for fibroid removal. This approach involves removing the uterus and cervix through the vagina. If possible, in some cases, the uterus is cut into smaller pieces before it’s removed. This type of surgery is often performed for noncancerous conditions as it is used to remove the uterus through the vagina. This alone, however, should not be interpreted as cancer not being present. A radical hysterectomy removes the uterus, cervix, upper part of the vagina, and surrounding tissues. Be sure to talk to your doctor about what will be done with your fallopian tubes and ovaries. These structures are often removed at the time of this surgery. This type of hysterectomy is usually recommended when cancer is present. Typically, this type of surgery is performed with a larger abdominal incision, and it requires a longer recovery.

Hysterectomy is a treatment for a variety of conditions, including certain types of cancer, long-term pelvic pain, and abnormal bleeding. Some conditions that require hysterectomy can be life-threatening. There are different types of hysterectomy. All types are available using minimally invasive surgical techniques, such as with a laparoscope or robot. Some types of hysterectomy may be done through the vagina. Others are done through a larger abdominal incision. Less invasive types of hysterectomy may have benefits, such as shorter recoveries. But more complex conditions are more likely to require more extensive hysterectomies. Talk to your physician about the best type of hysterectomy for you and what to expect. A total hysterectomy removes the uterus and the cervix. A partial hysterectomy removes only the uterus and leaves the cervix in place.

Surgical Techniques for Hysterectomy

Traditional approaches to hysterectomy – vaginal and abdominal – may be combined with laparoscopy. Of the 600,000 hysterectomies performed in the United States each year, about 70 percent are abdominal and 25 percent are vaginal, with the remaining 5 percent done laparoscopically. None of the types of surgery is appropriate for everyone. The first choice is always to do surgery vaginally, because it doesn’t require an incision, a patient goes home faster, and she recovers faster. But if the indication is more complex – say a large uterus – usually an abdominal approach is required.

Surgical techniques for hysterectomy broadly include a vaginal approach, in which the uterus is removed through the vagina; an abdominal approach, in which the uterus is removed through an abdominal incision; and a laparoscopically assisted vaginal approach. Each type of surgery has its benefits, and the right choice for you may depend on several factors, including why the surgery is being performed and your individual medical condition. Your doctor will also consider whether the surgery is likely to be straightforward or more complicated, and your own preferences, such as whether you hope for a quicker recovery or place value on feeling little or no pain during and after surgery.

Open Surgery Hysterectomy

The abdominal hysterectomy is usually performed due to high levels of the uterus or large uterus, often because of cancer of the uterus, or often due to adhesions or scarring from past operations that distort the pelvic region. Also abdominal hysterectomy alone is the preferable process for certain women whose abdomen or pelvis has continuous condition through which the operations with minimally do not go. The abdominal alternative additionally is suitable for some overweight with excess quantities of belly fat with uteruses (tummy fat). It is a less popular way at present time, the majority of the hysterectomies in United States arranging with the laparoscopy, and da Vinci process (the procedure carried out by the robot). But, the process certainly leaves a tough surgical scar, hospitalization time significantly increasing it, as well as necessary restoration time.

An open surgery hysterectomy usually is performed if an abdominal hysterectomy is required. The procedure involves making a 5 to 7 inch incision into the bottom of the belly and removing the uterus through it. The major gain of the open surgery hysterectomy is that a surgeon has plenty of space to see and work with the patient’s uterus, fallopian tubes, and ovaries. She/he can control bleeding, protect the bladder, examine other pelvic organs, grooves, and tissue to detect the health issue. The operation may include separating and reconnecting fallopian tubes, if the doctor must remove uterine tubes and cervix. The process takes 1 to 2 hours, and mostly anesthesia is required.

MIP Hysterectomy

Laparoscopic, or minimally invasive (MIP) hysterectomy can often be used instead of traditional hysterectomy. MIP hysterectomy is affiliated with smaller incisions and reduced pain, as well as a more rapid recovery. Unfortunately, not all patients are appropriate candidates for MIP hysterectomy. For example, a patient with a large fibroid uterus may not be a good candidate for MIP hysterectomy because the fibroid uterus may not be able to be removed through the small laparoscopic incision in the abdomen. Most MIP hysterectomies are done with the assistance of a device called a power morcellator. This is a device that cuts large organs into smaller pieces, which can be easily removed from the body through small incisions. Unfortunately, power morcellators can spread the cancerous tumor a patient may have to other parts of the patient’s body. If this occurs, it may make it very difficult, if not impossible, to cure the cancer.

Comparison of MIP Hysterectomy and Abdominal Hysterectomy

The length of the MIP hysterectomy surgical time is approximately 2.5 hours;  Although no long-term difference has been noticed between a MIP and abdominal hysterectomy, a short-term one has been demonstrated. The vaginal surgery has a quicker decrease in hemoglobin, requires fewer pain medications, and causes the patient to spend less time in the hospital.  The MIP procedure is being utilized to a greater extent than any of the other healthier operations. Even maternal-fetal medicine specialists and gynecologic oncologists, who do not perform this kind of surgery on a regular basis, are finding that it is becoming a more common procedure than an abdominal hysterectomy.

People who follow the evolution of surgery may be aware of many medical advances. In the not-too-distant past, when a woman needed a hysterectomy, it meant a large incision in the abdomen. This resulted in a two-month recovery. With the advent of laparoscopic surgery, the recovery was shortened to six weeks. During the past few years, the technique for using laparoscopic instruments has become so advanced that a new surgery, MIP – minimally invasive hysterectomy, includes the removal of the cervix and uterus through the vagina.

Risks of Hysterectomy

It is unethical to remove healthy organs from patients. Published studies have revealed that 76% of all major complications (e.g., injury to the bowel, bladder, urethra, or major blood vessels) and 90% of minor complications (less serious) occurred in surgeries in which hysterectomy was performed.  Hysterectomies were recommended by  male doctors who believed the uterus was the most dangerous organ in the female body, and only castration would cure women from mental illness and other non-related to reproductive organs.

Why should we focus on discussing the risks of a hysterectomy? Hysterectomy is the most frequently performed gynecologic surgical procedure, with approximately half a million women undergoing the procedure every year. It becomes counterproductive to inform the public about the lack of long-term consequences of the procedure when the scientific literature and women’s personal experience indicate the opposite. The general topic is about negative results of the procedure on women’s health. Specific problems include bladder, bowel, vascular, and lymphatic system damage, osteoporosis, absent menstruation, menopause, etc. Hysterectomy is associated with many serious adverse effects, both in the short and long term. These risks, both known and unknown, should be thoroughly considered and weighed against the risks of other treatment options, on a case-by-case basis, before a decision is made to remove a normal, non-cancerous uterus.

What to Expect After a Hysterectomy?

Your short-term hysterectomy recovery will likely last about six weeks. This doesn’t mean that emotionally and mentally, you’ll feel back to your normal self, but your body repairs much of the trauma done to it during surgery; at least, as best as it can in a month and a half. There are a few milestones to keep in mind as you heal. After about three weeks, more rigorous activities like picking children up, doing laundry and light housework should be doable without much discomfort or risk of prolonging your hysterectomy recovery. After four or five weeks, intercourse can be resumed, as well as activities like driving and exercising. After six weeks, you can generally ease back into heavy lifting, standing for lengthy periods of time, working and a majority of your other pre-hysterectomy activities.

If your ovaries were removed, you will have immediate symptoms, which may feel severe because they come on so quickly. You may even need pills or patches to replace the hormones your ovaries would otherwise be producing. Because of the lack of hormone, you’ll be at risk for a condition called osteoporosis, which weakens the bones and may affect your ability to walk without pain or risk injuring the bones in a fall; and for fractured bones, which can happen as a result of osteoporosis or from a fall.

The type of hysterectomy you have will determine how long you stay in the hospital and how long it will be before you recover. After a hysterectomy, you’re likely to start menopause if you haven’t already. Whether your ovaries were removed or not, you may have hot flashes, vaginal dryness, mood changes, night sweats, and sleep problems related to this change in life. If your ovaries were not removed during surgery, you may delay menopause by about 2 years. Some types of surgery will also allow for a bit of time before you start these symptoms because they allow the ovaries to stay healthy and continue to produce hormones.

L’article The Different Types of Hysterectomy and Their Benefits est apparu en premier sur Tunisia Medical Travel.

What is an ovarian cyst?

An ovarian cyst is a sac filled with fluid that forms on or inside an ovary. This is an activity which normally occurs during the menstrual cycle, and such cysts will form and go away. However, in some cases where the cysts continue to grow, they sometimes become cancerous. Cysts can be extremely painful, especially in period pain, sharp or irregular pain in the leg or abdomen. It can be grinding and severe or cause discomfort in the cervix. Cysts come in different shapes and sizes. For example, a follicular cyst, which is the most common type, results from the growth of a follicle. A corpus luteum cyst forms when in the final stage of releasing an egg, and a dermoid cyst forms from cells that make eggs. Other types of cysts include endometrial, haemorrhagic, and cystadenomas.

Ovarian cyst symptoms

Abdominal or pelvic pain can be a symptom of an ovarian cyst. The pain can be caused by the cyst’s size, pressure from surrounding organs, or its rupture. The severity of the pain can range from mild to severe. If the cyst is in the early stages of formation, it may cause a dull, non-specific ache. However, if the cyst grows larger in size, the pain can become more severe as the cyst pushes against the surrounding organs. If the cyst ruptures, the sudden acute pain on one side of the lower abdomen may be an indication of hemorrhage or significant irritation to the peritoneum. This is an emergency situation, and you should seek medical care if these symptoms occur. Another cause of severe pain occurs if the cyst causes the ovary to twist on itself (torsion). This prevents the blood supply from getting to the ovary and can be very painful. This is also an emergency situation. More than half of the women who have a cyst experience pain in the lower part of their abdomen. Usually, it occurs about two weeks before your period is due and then goes away a few days after it starts. This is due to the hormones involved in your menstrual cycle and the cyst’s response to these hormonal changes.

What causes ovarian cysts?

Cysts caused by ovulation

Another type of cyst that is related to the menstrual cycle is a cyst that forms on what is known as the corpus luteum. The corpus luteum is what is left of the follicle after the egg has been released. The purpose of the corpus luteum is to produce hormones that are needed to conceive. If pregnancy does not occur, the corpus luteum disintegrates. If the corpus luteum fills with blood, it can cause a cyst to form and the cyst can become very large and cause pain. This is known as a haemorrhagic cyst, and these types of cysts can sometimes twist the ovary and cause severe pain. Haemorrhagic cysts can be diagnosed with an ultrasound, and symptoms are monitored. They often resolve themselves within a few months without the need for further intervention.

Cysts caused by ovulation are the most common ovarian cysts. These cysts form when the follicle that releases an egg does not do so, and the follicle swells with fluid. This type of cyst can range in size and normally affects women during their childbearing years. Normally, these cysts cause no pain and appear and disappear without the woman ever knowing that she had them. In other instances, there may be minimal symptoms such as a dull ache or pain, or the cyst can cause the feeling of being bloated when the swelling becomes severe. When this type of cyst is diagnosed, a woman is told that she has an unruptured follicle, which is another way of describing the type of cyst. This diagnosis may cause concern, but an unruptured follicle will resolve itself without intervention and there will be no long-term implications.

Cysts caused by other medical conditions

The most common site of cysts caused by other medical conditions is on the surface of the ovaries. The cysts can be numerous and quite varied in size. This type of cysts are often the result of a condition called polycystic ovary syndrome (PCOS). This is a hormonal disorder which causes many small fluid-filled sacs to form in the ovaries. Each sac is actually an undeveloped follicle in which the egg matures. However, due to the hormone imbalance in PCOS, this process is interrupted and ovulation does not occur. Instead, the follicles remain as cysts on the ovaries. PCOS is a very common condition in women of reproductive age and affects approximately 4-7% of the population.

Exactly the same as functional ovarian cysts, cysts caused by other medical conditions may be located on the inside or on the surface of the ovaries. Each type can cause a lot of pain and may or may not produce symptoms. However, there is one thing that sets them apart. They are the result of an independent underlying condition, a non-ovarian problem that has resulted in the development of the cysts on the ovaries.

Cysts caused by abnormally growing cells

Another type of cyst, which can form after the egg has been released, is a corpus luteum cyst. A cyst develops in this case when the sac does not degenerate and fluid accumulates, causing the sac to swell. This type of cyst can grow to become 4 inches in diameter and cause pain or bleeding in the uterus. This cyst can resolve on its own in a few weeks; however, it may grow and cause hemorrhage into the cyst and affect twist or cause torsion of the ovary. This may require surgical intervention. Sometimes during this process, a follicle may fail to release an egg and continue to grow to become a cyst. This type of cyst is known as a follicular cyst and is a simple cyst. This cyst can grow to become 2.5 inches in diameter and usually does not cause any pain, disappearing after a few periods. This cyst forms when the LH surge fails to trigger ovulation, and the hormone FSH continues to stimulate the follicle.

The growth of a functional cyst involves normal cell division. This is what exactly causes the mishap? In the normal ovary, a follicle is a fluid-filled sac that contains an egg. Follicles develop each month in the normal ovary. Usually, several follicles begin to develop, however, the one that will ovulate is the dominant follicle, which continues to grow while the others degenerate. The dominant follicle is surrounded by cells that secrete estrogen, and when the egg is mature, the follicle ruptures and releases the egg. The empty sac of the dominant follicle then becomes a corpus luteum which secretes large amounts of progesterone to prepare the uterus for possible pregnancy. If pregnancy does not occur, the corpus luteum degenerates, causing a drop in levels of progesterone and estrogen. At this point, the beginning of the next menstrual cycle begins. This is the typical process each month in the normal ovary.

Types of ovarian cysts

Functional ovarian cysts

Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. Most women will develop at least one cyst at some point in their lives. Ovarian cysts are very common in women with regular periods. A cyst is a general term used to describe a fluid-filled structure. Ovarian cysts are one of the most common causes of pelvic pain in premenopausal women and one of the most frequent causes of gynecologic surgical procedures. The US Food and Drug Administration (FDA) has recently advised that a common type of ovarian cysts known as ovarian cysts should be diagnosed within the « cyst population » in postmenopausal women, in order to rule out the possibility of ovarian cancer.

Definition

A functional ovarian cyst is a sac that forms on the surface of a woman’s ovary during or after ovulation. It holds a maturing egg. At the time of ovulation, the egg is released from the sac (known as the follicle or « egg sac ») and the sac will dissolve. In certain cases, the sac may not dissolve and remain on the ovary. This type of functional ovarian cyst, known as a follicular cyst, usually results from a pregnancy hormone being released.

Symptoms and effect on fertility

Most functional ovarian cysts do not cause any symptoms. They are usually discovered during a routine pelvic examination. Cysts that do cause symptoms may produce an aching pain in the abdomen on the side of the cyst. This pain may be due to the cyst becoming large, bleeding, bursting (rupture), twisting (torsion) or putting pressure on surrounding organs. Cysts that bleed or rupture may result in sudden and severe pain. This may require treatment and should be consulted with a doctor. Ovarian cysts found in women of childbearing age may be associated with an increased risk of infertility. This is due to the scarring left on the ovary from the cyst, or from the cyst itself hindering the process of ovulation.Another type of functional ovarian cyst is a corpus luteum cyst which forms if the sac does dissolve, but seals back up and accumulates fluid inside. This type of cyst will usually dissolve on its own within a few weeks. Both types of cysts produce hormones and usually do not cause any symptoms.

Treatment

Observation may be the only required treatment for an asymptomatic ovarian cyst. This is especially so for postmenopausal women. In women of childbearing age, who are premenopausal, observation is reasonable for 6-8 weeks for a small cyst. This is to assess if the cyst will resolve on its own as some cysts will go away after 1-2 menstrual cycles. Further steps include use of hormonal contraceptives (the combined pill, patch, or vaginal ring) which may reduce the risk of new cysts developing. Using the progestogen only pill (mini-pill) is also an option. This is said to decrease the risk of functional ovarian cysts. If the cyst is large, persists or causes symptoms then surgical intervention may be required. This is necessary if the cyst has any chance of being an ovarian cancer. It is notable here that functional ovarian cysts are the only type of ovarian cysts that hold a possibility of being ovarian cancer.

Dermoid cysts (sometimes called benign mature cystic teratomas)

Dermoid cysts are a kind of mature cystic teratoma. This type can be very interesting because it can contain other tissues rather than just fluid. It could contain sebum (a fatty oil substance from the skin), hair, cartilage. Dermoid cysts develop from the same cells that eggs are made from, so they are only diagnosed in women.  They can be found by chance when looking for another problem, as they do not show many symptoms and are rare. If a dermoid cyst is found and it is small and not causing any problems, it can be left unless there is a concern about cancer. If removed, it should be done by a specialist called a gynecologic oncologist as it is most commonly found on the ovaries and can be hard to remove. Usually only the cyst is removed and there are rarely any complications. It is worth the removal of the cyst as there have been rare cases where the material inside has caused a shock-like pain if released into the ovary. Although it is rare, dermoid cysts have a chance to become cancerous, usually in postmenopausal women.

Cystadenomas

Cystadenomas are a growth that spreads from the surface of the ovary and unlike functional cysts, which develop as part of the menstrual cycle, are tumors. They are named depending on the type of cells that are inside the cyst and are usually filled with watery liquid. Cystadenomas are formed from cells on the outer surface of the ovary and for this reason there are two types, serous cystadenomas and mucinous cystadenomas. Serous cystadenomas are filled with a thin, watery liquid and are usually benign, only 15% are malignant. Mucinous cystadenomas are filled with a thick, mucousy liquid and are 80% of the time, malignant. Women that are perimenopausal are more likely to develop a malignant form of the cyst. Both types of cystadenomas have symptoms which are similar to those of functional cysts and can be diagnosed using an ultrasound or CA125 blood test. If the cyst is large or is causing symptoms the usual recommended treatment is to surgically remove the cyst or remove the ovary with the cyst inside, depending on the age of the women and whether she wishes to have children. In some cases however, it is difficult to differentiate between a cystadenoma of low malignancy and a borderline malignancy cyst so removal of the ovary is often the preferred treatment.

Endometriomas

Characterized by the presence of endometrial lining entopic in the ovary. They may be associated with a previous history of endometriosis. Women typically present with pelvic pain and may have a palpable adnexal mass. The cyst contents may be hemorrhagic, so-called « chocolate cyst, » appearing as homogeneous low-level echoes with occasional acoustic shadowing on ultrasound. Surgical cystectomy is the treatment of choice. Ovarian cancer is a risk in patients with long-term endometriomas, particularly if they are bilateral and diagnosed in postmenopausal women. Endometrioid and clear cell ovarian cancers can arise in association with endometriosis and can potentially be mistaken for a primary endometrioid or clear cell cancer of the ovary. Tumor and cyst removal is the treatment of choice in early disease. Hysterectomy and bilateral salpingo-oophorectomy may be indicated in severe cases when fertility is no longer desired.

L’article Ovarian Cyst: Types, Causes, Symptoms, and Treatment est apparu en premier sur Tunisia Medical Travel.

What is a myomectomy?

Myomectomy is the term used for the surgical removal of fibroids, which are noncancerous growths, from the wall of the uterus. The traditional method of performing a myomectomy is open surgery, through a large abdominal incision. Often, the fibroids are dissected away from the normal uterine muscle and removed singly through a smaller incision. The type of myomectomy procedure varies depending on the size, number and location of fibroids. Uterine size is also a factor in the choice of myomectomy procedure. Patients typically stay in the hospital for two to five days and require six to eight weeks for a full recovery. Open surgery myomectomy is the most invasive surgical option for fibroid removal. It requires the longest recovery time, but is often the necessary approach for removing very large, deep fibroids. It is well suited for women who wish to maintain fertility because, if the uterine incisions are carefully repaired, the procedure can also be done without compromising the integrity of the uterus for the patient who is interested in childbearing in the future. A laparoscopic myomectomy is a minimally invasive procedure that removes the fibroids without removing the uterus. This procedure uses a power morcellator to divide the fibroids into smaller fragments. These fragments are then removed through small incisions in the abdomen. Due to limitations by the FDA and concern with potential spread of parasitic and uterine malignancies with electric power morcellation, this type of myomectomy is less commonly performed at this time. This approach typically requires less recovery time than open surgery, but morcellation of fibroids may be associated with an increased incidence of fibroid recurrence.

What are fibroids and where do they grow in the uterus?

Fibroids are tumors that grow in the uterus. They are almost always benign (not cancerous). Many women who have fibroids do not have any symptoms. In those that do, symptoms can be influenced by the location, size, and number of fibroids. Fibroids are the most common type of growth found within the uterus. There is no known cause for fibroids; however, it is thought that genetic, hormonal, and environmental factors are all influences. Fibroids can range in number and size from a single growth to multiple growths, and from being very small to very large. Fibroids grow with the womb muscle tissue. The location of a fibroid can influence the symptoms it may cause. Submucosal fibroids grow just underneath the womb lining and can crowd into the uterus cavity. Intramural fibroids grow within the walls of the uterus. Subserosal fibroids grow on the outside of the uterus. Pedunculated fibroids grow on the outside of the uterus and are attached by a narrow stem.

Why is a hysterectomy more common than a myomectomy?

A hysterectomy is the second most common surgery among women in the US and costs 4.3 billion dollars annually, accounting for one-third of all gynecological admissions. The high rate of hysterectomies can be attributed to the fact that this procedure completely cures fibroids and prevents recurrence. Secondly, in cases where women have very large or multiple fibroids, the myomectomy is deemed impractical or excessively risky as it may result in incomplete removal of the fibroids or excessive blood loss. In some cases, surgery is best avoided altogether as the risks may greatly outweigh the benefits. This is particularly true in older women, postmenopausal women, or women in poor health. Women who no longer plan to conceive do not consider fibroid recurrence an issue and opt for a hysterectomy following a surgeon’s recommendation. While myomectomy is the only fibroid treatment that may preserve fertility, it can only be recommended to women with a small number of fibroids located on the inner or outer wall of the uterus. Submucous fibroids and intramural fibroids which distort the uterine cavity can be removed by hysteroscopy or myomectomy, respectively. However, there are few assurances that fibroids will not recur, and the chances of successful pregnancies or pregnancy complications following the procedure are relatively unknown.

When to opt for a myomectomy?

The main reasons to have a myomectomy are:

• Fertility/Pregnancy: If you are infertile and your fibroids are believed to be the cause, a myomectomy can help. Depending on the location of the fibroid, it can hinder your chances of conceiving. Myomectomy has been known to increase fertility levels and the chances of having a successful pregnancy after the procedure has been performed;
• Relief of Symptoms: If you are having pain or if the fibroids are causing other symptoms such as pressure on the bladder or rectum and you have tried medicine or hormonal treatment without relief, myomectomy is a good treatment choice;

If you have been diagnosed with fibroids and are having symptoms such as heavy menstrual bleeding, pain in the pelvic region or pressure on the bladder or rectum, this is a good option. If you are planning to get pregnant, and the fibroid is the likely cause of infertility, a myomectomy is a good option. However, if you are in or past menopause, you may not need to have the fibroid(s) removed, unless they are causing discomfort. If you are not experiencing symptoms, your doctor may monitor your fibroids during routine examinations.

Symptoms of fibroids

Depending on the location of the fibroids, they can cause chronic abdominal pain and/or discomfort. If the fibroid is located low in the uterus, it may obstruct the rectum, causing constipation. If it is located near the spinal column, it may cause back pain. The types and severity of symptoms for fibroids are vast; each woman may have different symptoms.

Effect on pregnancy – location can determine effect. Fibroids located just underneath the lining of the uterus can cause prolonged, heavy periods. Fibroids in the uterine cavity are detrimental to a woman’s fertility. Fibroids located near the lower segment of the uterus can physically obstruct both natural conception and implantation of an embryo. Fibroids anywhere in the uterus can cause pre-term labor. Extrusion of the embryo can occur if the fibroid distorts the shape of the uterine cavity. Women with fibroids have a caesarean section rate of over 30%. This is an invasive surgical procedure with a long recovery time and carries all the risks of major surgery.

Diagnostic tests prior to myomectomy

Laboratory tests

Myoma is always asymptomatic. If we can diagnose symptoms earlier, we can start the treatment earlier. That’s why finding a test to diagnose myoma in the pre-symptomatic or early symptomatic stage is necessary. So we can start the treatment as soon as possible and prevent possible complications. There are two valuable serum tests that have been studied in myoma, which are the measurement of CA-125 and LDH isoenzyme. Measurement of CA-125, a tumor marker used to detect cancers of the ovaries, endometrium, and breast, has provided interesting but inconclusive results. In one study, measurement of CA-125 using a reference laboratory range of normal values (0-35 U/mL) showed that the levels of CA-125 in myoma were no different from the normal population and the correlation of these levels with the size of the myoma was not significant. Suggestions of more significant levels of CA-125 in postmenopausal women with myoma compared with premenopausal women with the same abnormality need to be balanced, as age itself can cause increased CA-125. Because surgery is often performed with endometrial cancer, measurement of CA125 might be useful to determine whether or not there is a malignant tumor associated with the myoma. For the measurement of high CK, high CK reaches significance when accompanied by an increase in lesion size, which is inversely related to the distance with the doctor who intends to operate on a tumor. High CK is also another form of damage to cells and tissues, which correlates with plasmin levels. Today, this indicates the occurrence of myoma tumor in CAM-myoma.

Endovaginal ultrasound

There are two types of ultrasound: transabdominal ultrasounds and transvaginal ultrasounds. For a transabdominal ultrasound, a water-resistant covering is applied to the skin and a scanning probe is moved over a gel to take the images. For a transvaginal ultrasound, a tapered probe is inserted into the vaginal canal and the images can be taken. The latter is proximity imaging in which images can be obtained closer to the target, which allows for a better resolution of the uterus. An ultrasound done for suspected fibroids should be done in close proximity to the time of menses. Fibroids can degenerate, in which there is cystic change and/or bleeding into the fibroid. These degenerative findings can mimic a cancerous process, so it is important to denote the difference if there is suspicion of leiomyosarcoma.

As for diagnosing leiomyomata in women who present with menorrhagia and a known leiomyomata, there are no data that suggest that a pelvic ultrasound will change the management of this patient. If a submucous myoma is suspected, then a hysterosonogram, saline infusion sonohysterogram, and/or hysteroscopy are the tests of choice. Occasionally, a transvaginal ultrasound will suspect leiomyoma, but not be clear on whether it is leiomyoma or leiomyosarcoma. In these cases, mainly if there is thought to possibly be a sarcomatous mass, an MRI will be ordered.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is a valuable tool for diagnosing uterine fibroids, with T1-weighted images revealing them as distinct low signal intensity lesions against the intermediate to high signal intensity of the adjacent myometrium. This clarity aids in distinguishing fibroids from normal uterine tissue. T2-weighted images, on the other hand, depict fibroids as high signal intensity, enabling the visualization of both submucous and intramural fibroids. Utilizing T2-weighted images is crucial for accurately diagnosing submucous fibroids, which might otherwise be mistaken for intra-cavity masses if only T1-weighted images are used. Additionally, three-dimensional MRI imaging provides comprehensive anatomical information, facilitating the assessment of structural abnormalities both before and after surgery by revealing the abnormality’s complete extent and its relationship with surrounding normal structures.

Types of myomectomy

Hysteroscopic myomectomy

When fibroids grow on the inside of the uterine cavity or inside the muscle layer, the size of the uterine cavity can become enlarged giving the impression at an ultrasound examination that a large fibroid exists within it. This can also lead to a diagnosis of unexplained infertility or recurrent miscarriage. This technique is limited to women with submucous fibroids and is not appropriate for those with fibroids deeply embedded in the uterine wall. It is probably more suited to those women who may wish to conceive at a future date, since the impact of surgery on the uterine cavity as well as reducing the risk of uterine rupture in late pregnancy. Hysteroscopic myomectomy is performed using a hysteroscope, a long, thin tube inserted into the vagina in association with a built-in camera to provide a visual guide. No incisions are involved, and the recovery time is swift. As an observer recently mentioned to me, it is « amazing » during the operation to watch the release of the fibroid and seeing the uterus inside just like a map.

Laparoscopically-assisted myomectomy

Laparoscopic myomectomy is a type of myomectomy usually used for removing subserous and intramural fibroids. It is also applicable to the submucus fibroids that have a small connection to the uterus. This procedure can be performed on an outpatient basis, but if the fibroids are numerous and/or large, the patient may require a longer hospital stay. Using general anesthesia, the laparoscope is inserted through the navel allowing the physician to visualize the pelvic region. Three to four additional abdominal incisions are made for insertion of other surgical instruments. A power morcellator can be used to enable removal of even large fibroids through small incisions. The morcellator attaches to the laparoscope and basically shaves off small pieces of the fibroid until it is completely removed from the uterus. This is advantageous because studies show that a myomectomy can weaken the uterus wall and thin down the layer of endometrium. Both of these factors can increase the chances of a miscarriage. Using this tool, fibrous tissue can be removed without taking any uterine tissue and also it stops the growth of new fibroids because the new fibroids are developed from older fibroids. Laparoscopic myomectomy may also reduce post-operative pain and aid in a quicker recovery.

Robotic-assisted laparoscopic myomectomy

Robotic-assisted laparoscopic myomectomy is performed by an experienced surgeon in an operating room. It is considered by many to be the least invasive and most technologically advanced form of myomectomy. The procedure is similar to traditional laparoscopic myomectomy but with a few exceptions. After the uterine cavity is filled with a saline solution to lift the uterus away from other organs, making visualization easier, a small incision is made in or around the navel. This directs the gynecologist to insert a laparoscope to view the internal pelvic cavity and the surgical instruments. If at this point the gynecologist feels that the myomectomy is too complex, the robot can be used as a control mechanism by the gynecologist’s hand to perform the detailed movements of the laparoscopic instruments. This is not often the case, since most laparoscopic techniques are sufficient in the removal of fibroids. Using the laparoscope for visualization, 2 or 3 other small incisions are made in the abdominal wall. Comparing to traditional myomectomy, these incisions are significantly smaller and thus result in decreased amount of recovery time and less scarring. Through these earlier mentioned incisions, the surgeon would either use a particular cutting end called the PK cutlass to perform a myomectomy or use a laparoscopic ultrasound device. This technique can be extensive and thus require more than one setting in the event there are numerous fibroids, and the surgeon would not want to perform the myomectomy on all of them at once to avoid leaving scarring on the uterine wall, which could lead to future complications and even hysterectomy.

Open abdominal myomectomy

An abdominal myomectomy procedure is performed under general anesthesia. The fibroids are removed through an incision made in the lower abdomen. This procedure is recommended for women who have multiple fibroids. Their sizes are what determine if it is possible to have a successful myomectomy. The major drawback of myomectomy is that fibroids may recur. Uterine artery embolization has been successful in shrinking fibroids and reducing the symptoms caused by fibroids. This is a possible alternative to myomectomy.Prior to surgery, an intravenous (IV) line will be started and the area below your navel and up to the « bikini » line will be shaved. A catheter will be inserted into your bladder to keep it empty during surgery. General anesthesia is then administered and you will be asleep during the procedure. An incision is made through your skin and abdominal wall. Once the fibroid is reached, another incision is made in the uterus to remove the fibroid. This is the most popular method to remove fibroids. The uterus is then sutured and the abdominal incision is also sutured.

L’article Myomectomy: Types, Recovery, Risks, and Complications est apparu en premier sur Tunisia Medical Travel.

What is Hymenoplasty?

Hymenoplasty is a simple operation that involves the repair of the hymen. The hymen is a ring-like skin membrane that partly occludes the opening of the vagina, but does not enter within it, leaving the lateral 2/3 of the vaginal opening uncovered. Hymenoplasty is intended to repair a torn hymen, which may have been damaged due to the insertion of tampons, physical activity, or rape. Once the hymen is successfully repaired, patients will notice that the hymen is restored to how it was before it was torn, meaning that it will bleed and be painful when it is next stretched. This can be useful for cultural ritual or traditions, where the presence of an intact hymen is a sign of virginity and may only be broken after the woman is married. Many patients seek hymenoplasty for personal reasons, feeling that it will bring resolution to a painful experience.

Details of Hymenoplasty Operation

Details of the hymenoplasty operation are fully and clearly described by the plastic surgeon to the patient before preparing for the procedure. A thorough explanation of the procedure helps the patient and surgeon to make a good decision, as it is strictly the patient’s personal decision. The normal follow-up visit begins with a review of the surgery on paper and discussion about the reasons the patient wants to proceed, with the goal of improving emotional distress caused by a traumatic event. Then, a physical examination follows to confirm there aren’t any easily identifiable anatomical anomalies. Approximately 1 – 1.5 hours is required; however, in the case of a complicated case such as a microperforate septate hymen, it may take longer. On the day of the surgery or just before, the patient will be asked to sign a consent form and preoperative photographs are taken.

The operation is usually done as a day case, under local anesthesia with or without sedation, so patients are able to arrange their own transport and don’t have to stay in the hospital longer than necessary. If the patient is extremely anxious, the procedure can be done under general anesthesia or in the hospital. During the operation, one should prepare oneself for a number of strange noises and sensations, but it is unlikely to feel any pain! The basic procedure involves the creation of the hymenal ring using the hymenal remnants. An effective method involves the removal of the torn edges, and single interrupted sutures are used to approximate the tissues. The sutures will dissolve themselves in approximately 10-14 days.

Why Some Women Desire Reconstruction of the Hymen, Hymen Repair ?

It is worth noting that people from all cultures seek hymenoplasty, and that the decision is not always linked to cultural background. Each individual case is unique and the decision can be a complex issue influenced by many different factors. In many cases, the decision for a woman to have her hymen repaired is her own. These are frequently women who come from the same cultural backgrounds outlined above, although women do seek the procedure for a variety of reasons. Many are very distressed after having lost their virginity in a way which was non-consensual. The procedure allows them to put this event behind them and look to the future. This should not necessarily be seen as an unhealthy act of denial, for some women closure on this issue is an important part of the healing process. The procedure can also be an effective means of concealing a sexual past from a prospective husband. Not all women view this as an act of deceit, rather a method of ensuring that their partner will accept them for who they are.  Having migrated to Europe, women  may find themselves integrated into a more liberal society. This may lead to them entering into relationships with men from their native culture who have the same expectations as to their bride’s virginity as they themselves once did. Frequently, these women feel that they do not want to be judged by standards that they no longer hold and the decision may weigh heavily on them as a matter of internal conflict.  Certainly in many cases, the decision to have hymenoplasty is not the woman’s own, but rather the decision of her family. This is common in cultures where a high premium is placed on virginity and many restrictions are placed on women with regard to contact with men, particularly prior to marriage. In such cultures, the loss of virginity is still seen as a severe social stigma bringing shame on the woman and her family. In extreme cases, loss of virginity can and does result in honor killings. In these situations, the woman may feel that she has little or no choice but to undergo the procedure. Failure to do so could result in rejection by her family, or at the least, a lifetime of shame and social exclusion.

Cost of Hymenoplasty

In Australia, this type of procedure will cost around $3000 to $4000. It is not a widely accepted procedure, and there is a low demand for the procedure in comparison to Europe or America, thus the price will be more expensive. In Malaysia, the cost of a hymenoplasty is significantly lower than Western countries. This is due to the lower cost of living and abundance of medical resources in the country. A procedure will cost between $800 and $2000. France is known to have the cheapest and best gynecological resources in the world. A good procedure may only cost $1000 to $2000. In some cases, health insurance may cover part or all of the cost. Hymen reconstruction is also available in Middle Eastern countries. However, it is illegal to become a certified hymen reconstruction surgeon. This means that standard doctors or gynecologists will perform the procedure, which may lead to complications or an unsatisfactory result. High and upper-middle-class girls in the Middle East will often fly to a Western country to undergo the procedure.

Hymenoplasty is considered a cosmetic procedure and, depending on different geographic, economic, and subjective factors, the cost of the procedure will vary from doctor to doctor. If you live in a different state or country, flight and accommodations should be taken into consideration. In the US and Europe, this type of procedure is pretty expensive. Clinics may charge between $2000 and $5000 for a procedure. If you find a price a lot cheaper than $2000, then you should be wary and investigate the procedure in more depth.

L’article Hymenoplasty: What is Hymen Reconstruction? est apparu en premier sur Tunisia Medical Travel.

1.Uterine Fibroids

The final common pathway to hysterectomy is uncontrollable vaginal bleeding. Hysterectomy is utilized for the treatment of numerous gynecologic conditions. As conclusive treatment of symptomatic uterine fibroids, hysterectomy continues to be the most definitive manner of eradicating this disease process. Given that uterine fibroids are so common in the reproductive years, it stands to reason that symptomatic uterine fibroids are responsible for a large number of hysterectomies. Uterine fibroids place a major economic strain on the health care systemThis includes both the cost of medical and surgical treatment as well as the price of days lost from work. A very important fact often forgotten by many health care providers is that there are substantial morbidity rates associated with conventional surgical management of fibroids, particularly for women desiring preservation of childbearing. This becomes a major issue given that a majority of women affected by uterine fibroids are in the reproductive years.

The only fertility sparing treatment for symptomatic uterine fibroids is myomectomy. Unfortunately, the majority of myomectomy operations are performed for the immediate or short-term relief from symptoms of fibroids with the eventual need for hysterectomy as a result of recurrence. Given the age distribution of women affected by uterine fibroids this translates to an undesirable outcome for many women. Although hormonal suppression offers a medical option for fibroid treatment, it does not provide a conclusive cure. The relatively high recurrence rate of fibroid-related symptoms after both myomectomy and medical treatment continues to prompt many to seek definitive surgical therapy offered by hysterectomy. Although many women undergoing hysterectomy for fibroids may not be ideal candidates for various forms of non-surgical fibroid treatment, this is generally due to the fact that a substantial proportion of women with symptomatic fibroids are inherently poor candidates for any uterine sparing treatment because of the nature and severity of their symptoms. This ultimately results in the agentive referral by patients for definitive surgical treatment of their fibroids with hysterectomy. In Making an informed decision is crucial for any woman taking into consideration the countless possible indications for hysterectomy. With fibroids being the leading indication, improved patient and physician education about uterine sparing treatment methods, the prevalence of various other disease processes leading to hysterectomy and the risks and benefits of the various treatment options will all serve to optimize the decision making process allowing for some women to avoid inappropriate or unnecessary hysterectomy.

2.Gynecological Cancer

Gynecological cancer, including endometrial and cervical cancer, is the most common indication for a hysterectomy. The degree of spread of the cancer and the physical condition of the patient will determine the type of hysterectomy necessary. If the cancer is localized within the uterus, with no spread to the cervix, ovaries, or fallopian tubes, a simple hysterectomy may be sufficient. If the surgeon feels it necessary, removal of the fallopian tubes and ovaries can be accomplished with a bilateral salpingo-oophorectomy. This procedure is often completed with the simple hysterectomy, rather than a more invasive operation at a later time. It is rare to perform a simple hysterectomy with preservation of ovaries because most patients with this type of cancer will eventually develop cancer of the ovaries and require a secondary surgery.

3. Uterine Prolapse

Uterine prolapse occurs from a weakening of the pelvic muscles and ligaments. The uterus drops into the vaginal canal. This condition can be associated with incontinence, problems with emptying the urinary bladder, or recurring urinary tract infections. An individual with uterine prolapse often feels fullness or pulling in the pelvis or vagina. Some women are unable to bear children due to uterine prolapse. There are several stages of uterine prolapse; in the early stages, the uterus may only move slightly into the vaginal canal. In the most severe stage, the uterus can sag so far the cervix points out of the vaginal opening. Women who have suffered from uterine prolapse often feel frustrated as it can greatly disrupt one’s daily activities. This condition is commonly seen following childbearing and menopause; however, it is often seen in women who are obese or have a chronic cough due to lung disease. A vaginal hysterectomy can be performed to treat uterine prolapse.

4. Abnormal Bleeding

Dysfunctional or abnormal uterine bleeding is diagnosed when all other causes of bleeding such as polyps, fibroids, infection, or pregnancy related conditions are ruled out. This can be a frustrating diagnosis for both the patient and the doctor. The bleeding may be heavy or light, frequent or infrequent and occur before and after menopause. This irregular bleeding can cause anxiety, social embarrassment, affect employment, and interfere with usual activities. In many cases a cause for the abnormal bleeding may not be found.

Fibroids are non-cancerous growths of the muscle cells of the uterus. They can be located on the inside or outside lining of the uterus and most commonly cause increased menstrual bleeding. Fibroids may also cause painful periods or heavy prolonged menstrual bleeding lasting for days or weeks as well as bleeding in between periods. Fibroids are the single most common indication for hysterectomy comprising approximately 30-40% of all hysterectomies. Fibroids can range in size from very small to large growths taking up the entire abdominal cavity. Fibroids are also the most common reason for a woman to have a hysterectomy in her close to the time of menopause. At times fibroids can be difficult to diagnose as the symptoms may be similar to other conditions so it is possible that fibroids may not be diagnosed until surgery is performed. Fibroids and heavy bleeding can also cause anemia and the associated symptoms of tiredness and weakness.

5. Endometriosis

In severe cases of endometriosis symptoms are severe and pain is considerable. A hysterectomy is felt to be the most radical solution to the problem but there is debate as to its success as in many cases the symptoms do not resolve. Hysterectomy will certainly stop periods and in theory stop the symptoms although in women with severe endometriosis, the removal of the womb can cause very severe pain in the short term. Hysterectomy is usually accompanied by removal of the ovaries which are responsible for production of the hormone which in turn stimulates growth of the endometriosis. This procedure is far more successful in postmenopausal women who have endometriosis as they no longer have symptoms related to ovarian hormone production.

Endometriosis is a condition where the lining of the womb grows elsewhere in the abdomen and causes heavy and irregular periods, sometimes accompanied by pain. It is not possible to be sure how common the condition is because in many women it produces no symptoms and it can be very difficult to diagnose. An estimate is that between 20-30% of women of reproductive age may have the condition. Measures to improve the condition are aimed at fairly minor surgery to alleviate symptoms and no radical surgery.

6. Endometrial Hyperplasia

Treatment consists of correcting the underlying cause of estrogen stimulation. Patients with simple hyperplasia who wish to retain their fertility may want to try progestin therapy. It has been shown that irregular bleeding will cease, and 80% to 90% of the patients will regress to a normal endometrial lining. The progestin needs to be taken for at least 3 weeks out of every month. After 6 to 9 months of progestin therapy, another D&C with biopsy is done to confirm regression to a normal endometrial lining. If the patient has not responded, a hysterectomy is indicated. Women with complex or atypical endometrial hyperplasia should be treated more aggressively with a hysterectomy. Excessive and unopposed estrogen stimulation is the cause of endometrial hyperplasia, which is the excessive growth of cells in the endometrium. Estrogen may overstimulate the endometrial lining due to obesity, polycystic ovary disease, anovulatory states, or estrogen replacement therapy. Symptoms include irregular bleeding, longer menstrual periods, or an increase in bleeding.

7. Adenomyosis

Adenomyosis is a condition in which the inner lining of the uterus, the endometrium, breaks through the uterine wall. This thickening of the uterine wall caused by the growth of endometrial tissue can cause debilitating pain and prolonged heavy bleeding in some women and can be a source of severe pain and discomfort. Little is known about the condition’s prevalence, but it is estimated that adenomyosis may be present in 20% of all women, and can be the cause of pain and severe discomfort in 60% of those women. Unfortunately, these symptoms are often attributed to other conditions such as fibroid tumors or dysmenorrhea, and the correct diagnosis of adenomyosis is often delayed. Adenomyosis occurs most likely in women aged 35-50, but can affect younger women too and is usually resolved upon menopause. Women who have had children are less likely to experience severe adenomyosis.

8. Severe Pelvic Inflammatory Disease (PID)

There are significant challenges in understanding exactly why chronic PID is associated with an increased risk of hysterectomy. This is particularly difficult since only a small percentage of women with a history of PID go on to develop severe scarring or damage which will require hysterectomy. PID has long been associated with sexually transmitted diseases such as gonorrhea and Chlamydia. However, studies have shown that these organisms are capable of ascending to the upper genital tract and setting up PID soon after acute infection with no long-term consequences. Other factors must be involved in later development of severe chronic PID.

The single biggest risk for development of chronic pelvic infection and PID is a history of appendectomy.  Women with prior tubal ligation are also at increased risk of subsequent development of severe PID and those women undergoing elective tubal sterilization should be made aware of this risk. Other potential causative factors include an initial episode of PID, intrauterine contraceptive devices, early age at first intercourse, heavy smoking. Unfortunately, even identification of risk factors such as these does not necessarily enable a woman to predict her risk of developing severe PID and the potential future need for hysterectomy.

L’article 8 Common Reasons for a Hysterectomy est apparu en premier sur Tunisia Medical Travel.

What Are Ovarian Cysts?

By definition, a cyst is a fluid-filled sac. « Cyst » is derived from the Greek word « kystis » which means « bladder » and the Latin « cista » meaning « box » or « basket. » There are various types of cysts. In the ovaries, there are two types of cysts: functional and complex. A functional cyst is the most common and is often formed during the menstrual cycle. These cysts occur when either the egg is not released, or the follicle that releases the egg does not dissolve after the egg is released. In both cases, the sac that the egg is contained in becomes a cyst. This is not to be alarmed about, as 3 out of every 4 women will experience the formation of functional cysts at one point in their lives and often go undetected, resolving on their own. What are ovarian cysts? Most simply stated, an ovarian cyst is a tiny sac filled with fluid that forms on or within the ovary. Cysts can range widely in size, from as small as a pea to larger than an orange. A cyst can be found in one or both ovaries. Depending upon the type of cyst, it can dissolve on its own, or in some cases, may require surgical removal.

What Is Ovarian Cancer?

Ovarian cancer is a growth of abnormal malignant cells that begins in the ovaries (women’s reproductive glands that produce ova). Cancerous (malignant) ovarian tumors begin in the ovaries and can spread to the pelvis and abdomen. The cancer can also spread to the lymph nodes and other areas apart from the lungs and liver. Tumors in the ovaries can be benign (not cancer) or malignant (cancer). These can also spread in the female reproductive system. The two types of tumors are named after the kind of cells they are made up of. Ovarian cancers are the 7th most common cancer in women around the world. They are most common in women aged over 50. However, it is still possible for the disease to occur in younger women and very rarely in children. Overall, the 5-year survival rate for women with ovarian cancer is 45%.

Epithelial ovarian cancer is the most common type of ovarian cancer . These tumors occur on the surface of the ovary and are the most likely to spread to other parts of the body. There are certain factors that can put women at a higher risk of getting the disease, such as a family history of breast or ovarian cancer, being of an older age, and carrying the BRCA1 or BRCA2 genes. Women who have had their fallopian tubes tied (tubal ligation) have also been found to have a decrease in the risk of developing ovarian cancer. On the other hand, it has been found that this type of cancer is more common in women who have taken estrogen hormone replacement therapy after menopause. Another factor to this cancer is the use of talcum powder. This has been linked to ovarian cancer. In some cases, the powder can travel up into the ovaries and remain in place for a long period of time, causing irritation.

Can the Symptoms Be Similar?

Yes, there are similarities that it can be hard to diagnose. A complex ovarian cyst and ovarian cancer share some of the same symptoms. This can be dangerous because it is often discovered that a woman has ovarian cancer after the cancer has spread, and this is due to the fact that the symptoms were ignored and thought to have been caused by the cyst. Ovarian cyst symptoms include pelvic or abdominal pain, painful periods, feeling full after eating only a small amount, and urinating often. Ovarian cancer symptoms are very similar, and due to the seriousness of ovarian cancer, it is of the utmost importance that cancer is either confirmed or ruled out if a woman has one or more of these symptoms. An overnight hospital stay is due to bloat and pelvic pain from the torment is interfering with other activities in some cases. An ultrasound would be necessary followed by blood tests for ovarian cancer on CA125 to rule it out, and ruled as that.

Which Ovarian Cysts May Raise Your Cancer Risk?

Women with endometriosis have a particular type of ovarian cyst linked to the abnormal tissue. They are at higher risk of developing ovarian cancer, but the increase in risk is thought to be very small.Women with PCO have a larger number of small cysts in the ovary. They also often have high levels of hormones called androgens and high insulin levels. Women with PCO have the condition of large cysts and high levels of these hormones may be at higher risk of developing ovarian cancer. This could be because both PCO and ovarian cancer are influenced by high hormone levels.Cysts are thought to be pre-cancerous when they have abnormal cells that may become cancer. The chance of a cyst being pre-cancerous is higher in older women. This is a serious concern if the cyst is complex and has solid areas.

How Often Are Ovarian Cysts Cancerous?

This is a common concern. The extent of the risk of a cyst being cancer is really dependent on the type of cyst.

1. In women under age 50, half of all cysts are functional or physiological. The vast majority of these are not, nor will they become, cancerous;
2. The most common type of cyst is called a functional cyst. Its frequency varies, being found in approximately 7% of postmenopausal women. They do not occur often in premenopausal women;
3. The second most common type of cyst is a dermoid cyst. These cysts are often asymptomatic and might be found during a routine pelvic exam. It is estimated that 1-2% of all women have a dermoid cyst. Dermoid cysts are non-cancerous;
4. Endometrioid and clear cell cysts are less common. These are typically malignant in nature;
5. Cystadenomas are growths on the ovary that are commonly partially cystic that can be benign or cancer;

How Are the Treatments for Ovarian Cysts and Ovarian Cancer Different?

The cyst form implies a non-cancerous growth, and treatment in this case can range from close observation to surgery.In cases of functional cysts , it is quite possible that a medical treatment directed to the underlying problem could have the potential to shrink the cyst and prevent its reoccurrence. The other form of non-cancerous ovarian masses are tumors. These are also treated dependent on the likelihood of the mass being cancerous. In cases where it can be shown or strongly suggested that the tumor is benign (non-cancerous), it may be removed by a minimal access keyhole type surgery called laparoscopy. This will prevent the need for a major operation. In cases of more doubtful diagnosis, a referral to a gynecologist oncologist would be suggested. This is a sub-specialist who deals only with cancers of women’s reproductive organs. The likely treatment for a referral to a gynecological oncologist would be major surgery to remove the tumor and the affected ovary. In almost all cases, this can be done by minimal access surgery. This is with small incisions like for a laparoscopy but has the added advantage of being able to fully stage the cancer and remove any other affected tissue. When ovarian cancer is diagnosed at an early stage (I or II) and is confined to the ovary, treatment is aimed at removing the disease. Often the recommended treatment is surgery to take out the cancer. This is usually done by a comprehensive surgical staging procedure. This is when the surgeon removes both ovaries and fallopian tubes, the uterus, and the omentum (a small fatty pad in the abdomen). Then, other samples of pelvic and abdominal tissue are taken to see if cancer is present. This is called debulking surgery. Often patients with more advanced disease (stage III or IV) will, in addition, receive chemotherapy. This will be the same regardless of the type of cancerous ovarian mass. Ovarian cancer usually is responsive to platinum-based chemotherapy given with paclitaxel, and combination chemotherapy results in substantial improvement in both objective response rates and survival compared with single-agent therapy.

L’article Ovarian Cyst vs. Ovarian Cancer est apparu en premier sur Tunisia Medical Travel.

1.Uterine fibroids

endometriosis, fibroids are the most common reason for a hysterectomy. There is a very good reason for this. Between 10 and 30 percent of women having a hysterectomy are having it because of uterine fibroids. Uterine fibroids are the most common, non-cancerous growths in women and they grow from the muscle layers of the womb. They can be found in up to 25 percent of white women and over 50 percent of black women in their reproductive years. Surgeons doing hysterectomies for fibroids will be removing more than one fibroid from patients up to 64 percent of the time.

Fibroids can cause problems at any time, but probably the most common time they can become problematic is during the perimenopausal years when hormone levels are changing. Fibroids frequently grow in response to hormones and they cause symptoms due to their size and/or location. Symptoms can include:

• Heavy menstrual bleeding, which can lead to anemia;
• Pain or pressure in the pelvis and low back;
• Increased menstrual pain;
• Difficult urination;
• Symptoms related to pregnancy loss or infertility (there is a 2-4 fold increased risk of having some of these symptoms treated if the woman is having a hysterectomy);

2.Cancer

Invasive cervical cancer was once the leading cause of cancer death for women in the US, and while this is no longer the case, there are still an estimated 12,200 new cases in 2010. It is highly preventable with regular screening tests and prompt treatment when abnormal cell changes are found. Although there are different surgical options specific to the stage of the disease, in many cases, surgery may involve removing the uterus and cervix, which is an effective treatment for early cervical cancer. With the incidence of advanced cervical cancer decreasing, it is actually becoming less common to see a hysterectomy for cervical cancer in the older age groups, and it is more likely that the patient undergoing the surgery is younger. This is particularly difficult for women who have not had children when the diagnosis occurs. With the technical advances in radical trachelectomy, fertility-sparing surgery is increasingly becoming a feasible option for women with early cervical cancer who have a strong desire to bear children.

3.Endometriosis

The pain of endometriosis can be so severe and debilitating that it seriously affects women’s lives. This damage may result in adhesions, which are bands of scar tissue that may cause pelvic tissues and organs to stick together. Endometrial tissue is more likely to have an abnormal appearance or be located in areas outside the uterus in women who have pain symptoms or infertility. In addition, researchers have found that the severity of endometriosis does not determine the pain levels experienced.

Women who have severe pain may have mild endometriosis, while women with severe endometriosis may have little pain or even no pain at all.It should be noted that there is no association between retrograde menstruation and the extent of endometriosis. Many women with retrograde menstruation in their pelvic cavity do not develop endometriosis.

4.Adenomyosis

Adenomyosis is a condition of the uterus in which the lining of the uterus begins to grow into the muscular wall of the uterus. The result of this is enlargement of the uterus. It can cause symptoms such as heavy or prolonged menstrual bleeding, painful menstruation, and painful intercourse. A woman may also have no symptoms at all. Adenomyosis is often discovered by chance during a routine gynecological examination, investigation, or pelvic ultrasound when a woman is being investigated for another condition.

Adenomyosis is not cancer, though the symptoms may at times imitate those of fibroids or act as a coexisting condition. In the reproductive age group, the symptoms may resolve with the onset of natural or medically induced menopause. This may relieve the symptoms to the point that no further treatment is needed. Treatment for adenomyosis ranges from analgesia, anti-inflammatory drugs, or hormone medication to surgical excision of the adenomyosis or ultimately hysterectomy.

5.Infection

Infection can occur after any type of surgery. The wound infection rate is about 2% to 4% for women who have had an abdominal hysterectomy and less than 1% for women who have had a vaginal or laparoscopic hysterectomy. Infections can usually be treated easily with a course of antibiotics, but if an infection is severe, it may require further surgery to drain the infected area. Internal infections, such as bladder or kidney infections, are usually associated with urinary tract injuries. If a urinary tract injury occurs during surgery, the bladder or ureters (the tubes that drain the kidneys into the bladder) may need repairing, and a catheter may need to be inserted for a short time. This is a relatively uncommon side effect, but it is more common when a woman has had an abdominal hysterectomy. In extremely rare cases, a severe infection can cause damage to or even destroy the uterus transplant site . This can result in a life-threatening infection and may require further major surgery to clean the affected area.

6.General abnormal bleeding

Abnormal vaginal bleeding is the common sign that leads patients to seek medical advice. It’s usually defined by bleeding in between normal menstrual periods, heavy menstrual flow, and other abnormal bleeding. There are numerous causes of abnormal bleeding, and in some cases, once the cause being treated has been cured, there will be no prolonging effect on the patient. For instance, bleeding due to hormone replacement therapy will stop once the medication is halted. Causes of abnormal bleeding consist of a wide range of conditions such as cervical or endometrial polyps, a foreign object in the vagina, or ectopic pregnancy. In some cases, it might be a sign of a serious life-threatening condition like cervical, endometrial, or vaginal cancer. Any postmenopausal bleeding is considered abnormal, and the patient should seek immediate medical attention as it may signify a serious underlying cause. In this case, the patient usually will undergo a series of examinations to confirm the cause.

7.Uterine prolapse

A uterine prolapse is literally defined as a slipping or falling of the uterus from its usual position in the body into the vaginal canal. It is important to understand the normal anatomy to understand the implications of a uterine prolapse. The uterus is held in position by « suspensory ligaments. » There are two anterior and two posterior ligaments. The posterior ligaments are attached to the sacrum and the anterior ligaments are connected to the pubic bone. These ligaments function to hold the uterus in an anteverted position, which means tilted forward with respect to the vaginal canal to which it is connected. A loss of support of the uterus may occur when the ligaments become weakened and are no longer able to support the uterus due to things such as a difficult childbirth, chronic coughing, obesity, anything that places a chronic strain on the pelvic floor muscles. At this point, you may experience feelings of heaviness or notice a bulge at the vaginal opening. A milder form of a prolapse is known as a « procidentia » in which the entire uterus protrudes outward and may even be expelled from the body.

Uterine prolapse can predispose a woman to experience stress urinary incontinence or affect her bladder and bowel function. In some severe cases, it may be very difficult to keep a pessary in place due to the lack of support of the vaginal walls which will be discussed in further detail. Some women may also experience ulceration at points on the exposed cervix or even necrosis of the uterus which is obviously a very serious issue.

7.Uterine prolapse

A uterine prolapse is literally defined as a slipping or falling of the uterus from its usual position in the body into the vaginal canal. It is important to understand the normal anatomy to understand the implications of a uterine prolapse. The uterus is held in position by « suspensory ligaments. » There are two anterior and two posterior ligaments. The posterior ligaments are attached to the sacrum and the anterior ligaments are connected to the pubic bone. These ligaments function to hold the uterus in an anteverted position, which means tilted forward with respect to the vaginal canal to which it is connected. A loss of support of the uterus may occur when the ligaments become weakened and are no longer able to support the uterus due to things such as a difficult childbirth, chronic coughing, obesity, anything that places a chronic strain on the pelvic floor muscles. At this point, you may experience feelings of heaviness or notice a bulge at the vaginal opening. A milder form of a prolapse is known as a « procidentia » in which the entire uterus protrudes outward and may even be expelled from the body.

Uterine prolapse can predispose a woman to experience stress urinary incontinence or affect her bladder and bowel function. In some severe cases, it may be very difficult to keep a pessary in place due to the lack of support of the vaginal walls which will be discussed in further detail. Some women may also experience ulceration at points on the exposed cervix or even necrosis of the uterus which is obviously a very serious issue.

8.Delivery complications

The « ideal delivery experience » is often shattered into pieces after a chaotic chain of events resulting in an emergency c-section. If one were to envision the experience and recovery involved with a hysterectomy, a failed attempt at delivering a baby would be it. Women who have experienced a failed induction of labour or laboured for as little as one contraction are at risk of requiring a hysterectomy due to the trauma that their uterus has sustained. A major abruption or rupture involving the uterus, cervix, or the blood vessels that supply the uterus is a life-threatening situation for both mother and baby. The severity of these complications can sometimes require an emergency hysterectomy as a means to save the mother’s life or to control the hemorrhaging that has ensued. Women who have required a c-section, regardless of the circumstances, are also at a slightly increased risk of requiring a hysterectomy at some point in the future. This specific form of hysterectomy known as a « repeat c-section hysterectomy » can be rather complex due to the presence of adhesions from previous surgery and compromise of blood supply to the surrounding organs.

9.Placenta accreta

Placenta accreta and its related conditions affect around 7 in 10,000 pregnancies, however this number is rising with the increasing rate of caesarean section. Some studies suggest that accreta and increta affect 40% of pregnancies in women with placenta previa that require a repeat caesarean section. This is because in a previous caesarean section, scar tissue forms in the uterine wall where the incision was made. Normally, the placenta avoids these scarred areas, however in cases of accreta, the placenta has grown into these scarred areas. Up to 66% of patients with placenta accreta will require a blood transfusion, usually due to heavy blood loss during delivery. Any condition of accreta raises the risk of hysterectomy with rates of near 50% with increta and 90% with percreta to effectively control heavy bleeding and prevent hemorrhage.

During a normal pregnancy, the placenta grows into the wall of the uterus and remains there until the baby is born and the placenta follows. In most cases, the placenta detaches from the uterine wall after the baby is born and the uterus then contracts and shrinks, allowing the placenta to be expelled. In some cases, however, the placenta is very deeply attached and fails to detach after delivery, either partially or completely. This is known as a retained placenta. This can cause serious complications including severe bleeding, hemorrhage, and infection, usually occurring within the first 24 hours after delivery. In the case of a partial or complete placenta accreta, the placenta has become so deeply attached that it cannot separate from the uterine wall causing severe bleeding and poor placenta delivery.

10.Gender affirming surgery

Appropriate surgical treatment of the transgender patient is a topic of much discussion and is an evolving field in medicine. Clear guidelines and standards of care for surgical treatment of transgender patients do not exist at this time. This is reflected in the variability in surgical practices seen across centers and the lack of surgical options for certain patient populations. Services for the gender change to male patient are particularly limited in the areas of gynecologic surgery and urology. Transgender individuals still face significant barriers when seeking medical care, with 19% being refused medical care due to their transgender or gender-nonconforming status and 28% experiencing harassment in a medical setting.

Gender affirming surgery is a mastectomy procedure as well as a removal of the reproductive organs. Oophorectomies are not done at MGH and are not typically included in female to male transgender surgery. Hysterectomies are typically done only for medical reasons and not as part of gender affirming surgery. Most often, removal of the uterus and ovaries is done as part of a complex pelvic organ removal needed to treat pelvic pathology. A simple hysterectomy, removal of the uterus only, is not the assumption for males seeking pelvic organ removal, and hysterectomies are not done on quite the same population that is seeking gender change to male.

L’article 10 Reasons for Hysterectomy, Plus Benefits and Side Effects est apparu en premier sur Tunisia Medical Travel.