Philosophy of Management

Treatment Methods of Management

 

Treatment Methods of Management

Management of uterine fibroids is a philosophical approach. The philosophy of the physician should be what is the best treatment for the patient, considering her desire and informed decision. The patient philosophy should be what is the best treatment for me considering relief of symptoms, minimization of blood loss, prevention of pelvic adhesions and chance for childbearing function, if desired. Other considerations would be cost, time in the hospital, and time away from work.

Surgical or invasive procedures would be:

Conservative

  • Laparoscopic myomectomy or myolysis
  • Hysteroscopic myomectomy
  • Uterine Artery Embolization
  • Conventional myomectomy
  • Laser/ultrasonic myomectomy

Radical

  • Hysterectomy

Minimally invasive surgery, i.e. laparoscopy and hysteroscopy should be considered as temporary solutions only. Even though these procedures are outpatient and less expensive, they also can only remove fibroids that are visible or growing to the surface of the uterus (externally or internally). Therefore, both procedures are limited as to the fibroids that can be removed.

These procedures are for primary relief of symptoms, knowing that the fibroids may still remain within the walls of the uterus and by their growth over time, symptoms may recur.

Our experience over the past 20 years has dictated that the only way to remove all fibroids from the uterus, minimize blood loss and facilitate the prevention of adhesions is by abdominal laser/ultrasonic myomectomy.

Our experience has allowed us to refute many surgical precepts, and institute new modalities, including expanded criteria for the preservation of a woman’s organs, if she so desires. This consideration should be given regardless of age or reproductive desires. My greatest contribution as a physician is to educate the patient and encourage the patient to participate in the decision for the treatment recommended.

Myomectomy requires a 2 day hospital stay and the patient can return to her work activities as early as 2-3 weeks.

The information provided here is for general information or educational purposes only. A complete physical exam and consultation is the only way a medical decision can be reached.