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Definition:

Fibroids are noncancerous or benign type of tumor that tends to grow in the muscular wall of
the uterus. They are of various sizes and can either occur in multiples or solitary (single).
Depending on the location of the fibroid within the uterine musculature they are classified as:
 
1. Serosal Fibroid: This is seen as a tumor that extends outwards through the uterine
wall which gives a knob like appearance to the uterus. It can either be connected to a
stock or stem ( like a flower connected to the stem) hence being called as
pedunculated.
 
2. Intramural Fibroid: These develop in the lining of the uterus and expand inwards
and therefore pose the maximum discomfort and cause heavy menstrual bleeding.
 
3. Submucosal Fibroid : They are seen just under the lining of the uterus. Since they are
in such close proximity to the uterus any increase in size; even if it’s a small change
would pose heavy menstrual flow along with pelvic pain and prolong periods.

Symptoms:

Menstrual complaints :
Heavy prolonged menstrual bleeding with or without pain and clots.
Pressure symptoms:
In huge fibroid which present as abdominal lump there are pressure symptoms like urinary
frequency or retention of urine.
Some might have constipation or bloating.
Fibroids are also incidentaly diagnosed on sonography as not all fibroids are symptomatic.

Investigations:

Sonography is the best diagnostic tool for fibroids. Rarely 3D
sonography or MRI pelvis is
performed for mapping the exact location of fibroid.

Treatment:

Factors which need to be considered before planning the treatment for fibroid are :
child bearing age group,infertility,site ,size and number of fibroid.
Those fibroids which are symptomatic need to be treated according to its symptoms .

Medical management :

1.Progesterone preparation has a limited role in the management of fibroid
2.GnRh analogues helps in temporarily decreasing the size of the tumor and hence
has a very few indications for its use.

Surgical management :

Laparoscopic Myomectomy It is a minimally invasive surgery / keyhole surgery with the advantages of early recovery,minimal pain,minimal blood loss and tissue damage.
This procedure is performed under general anaesthesia .A minimum of 34 small cuts less
then half cm are made on the abdomen .Laparoscope is a main optical equipment which is
inserted through the belly button and connected to videomonitor for visualisation of the
surgery on the screen .The rest of the ancillary cuts are used for enucleating the fibroid from
its location and delivering it out of the abdomen.
 
Hysteroscopic Myomectomy Hysteroscopicsurgery is performed under general anaesthesia and is a day care surgery indicated for submucous fibroids .The procedure is performed through the birth passage but not cuts are made in this area.Through the vagina hysteroscope enters the cervix ,and after visualisation of the fibroid it is resected out from the uterine cavity.
 
Laparoscopic Myomectomy and Hysteroscopic Myomectomy are procedures in which uterus
is conserved and hence proper patient selection is of prime importance .
Laparoscopic HysterectomyHysterectomy is removal of the uterus along with the cervix in those select few cases where family is complete and there are multiple and/or huge fibroids.


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