Fibroids are benign growths of the muscular wall of the uterus, the myometrium. Fibroids are very common, affecting more than one-third of women of childbearing age, according to the University of North Carolina Medical Center. Pedunculated fibroids grow outside the uterus and are connected to it by a stalk that may be thick or thin. They cause problems only if they grow large enough to press on nearby organs and structures, or if they twist on their stalks, causing extreme pain as the muscle tissue dies off. There are several ways to treat pedunculated fibroids.
Hysterectomy
Hysterectomy, removal of the entire uterus, is the traditional but most drastic way to remove pedunculated fibroids. Although hysterectomy may be done vaginally, in some cases a pedunculated fibroid is too large to be removed any way except through a laparotomy. Laparotomy is a major abdominal operation that involves a hospital stay of several days, a large uterine incision, long recovery time, and potential complications such as infection or hemorrhage. Laparotomy also leaves a large external scar and may result in adhesion formation in the abdomen. Women who have had a hysterectomy are no longer able to bear children.
Myomectomy
Myomectomy is the removal of the pedunculated fibroid while leaving the uterus intact. Myomectomy is the treatment of choice for women who may still want to have children. Myomectomy can be done laparoscopically, through small incisions (if pedunculated fibroids are small enough). Larger fibroids require a laparotomy. Laparoscopic myomectomy is often performed as an outpatient procedure and recovery time is about two weeks, according to Dr. Parker.
Uterine Fibroid Embolization
Uterine Fibroid Embolization (UFE), also called uterine artery embolization or UAE, is used to shrink fibroids by blocking blood flow to the tumor. Early studies indicate that UAE could be dangerous if used to treat pedunculated fibroids. Several studies reported cases in which the pedunculated fibroids separated from the uterus after UAE and floated into the abdominal cavity, causing inflammation in the cavity that necessitated abdominal surgery. Gynecologist William Parker, M.D., professor at the UCLA School of Medicine, discussed a 2008 report from the Journal of Vascular and Interventional Radiology written by R. Margau et al reporting on the use of UFE in 16 women with pedunculated fibroids. None of the women studied had detached fibroids, although Dr. Parker surmised that women who had very thin stalks attached to the pedunculated fibroids probably were not offered the procedure. He concluded that UFE may be an option in some cases.
References
- Fibroids: A Gynecologist's Second Opinion; William Parker, M.D. UCLA School of Medicine
- Fibroids: A Gynecologist's Second Opinion; Outcomes after Uterine artery Embolization for Pedunculated Subserosal Leiomyomas
- Medline Plus: Uterine Fibroids
- University of North Carolina School of Medicine :UNC Fibroid Care Clinic
