DEBULKING SURGERY FOR FIBROIDS AND THE IMPACT ON BLADDER SYMPTOMS
HOULIHAN1, M. T. HYAKUTAKE 2, N. A. KOENIG 3, T. LEE 4, R. GEOFFRION 3;
1Univ. of Calgary, Calgary, Canada, 2Univ. of Alberta, Edmonton, Canada, 3Univ. of British Columbia, Vancouver, Canada, 4Ctr. for Hlth.Evaluation and Outcome Sci., Vancouver, Canada.
Introduction: Uterine fibroids are the most common tumor of the female reproductive tract.1 Although it has been reported that lower urinary tract symptoms (LUTS) are more prevalent in women with fibroids,2,3 this relationship is poorly understood. Moreover data regarding the effect of treatment of uterine fibroids on LUTS is limited.
Objective: Our primary objective was to determine whether surgical debulking of uterine fibroids affects LUTS. Secondary objectives were: to define the baseline prevalence and type of LUTS in women undergoing fibroid surgery; to explore links between fibroid location, type of surgery, size of debulked fibroids and postoperative changes in LUTS.
Methods: This was a prospective cohort study (2011-2017) of women with symptomatic fibroids undergoing myomectomy or hysterectomy at our institution. Baseline demographics were collected. Women were excluded if they were undergoing treatments for bladder symptoms. The Urinary Distress Inventory (UDI) subscale of the validated Pelvic Floor Distress Inventory (PFDI) questionnaire was administered before and six weeks after surgery. Score changes were assessed using Wilcoxon signed rank test.
Results: Sixty-one women consented to participate. Mean age was 43.9 (range 29.0-62.0). The majority had regular, heavy periods with a mean period length of 8.7 days (range 2.5-30). More than half had severe cramping needing pain medications. At baseline, 96.6% of women had LUTS with pressure and frequent urination as the most common symptoms. The most common surgical procedure performed for fibroid debulking was abdominal myomectomy (36.7%), followed by total abdominal hysterectomy (30%) and hysteroscopic myomectomy (26.7%). Most women had multiple fibroids and 60.7% of women had at least one fibroid larger than 5 cm. Mean fibroid weight removed was 522.7 g (range 6-1314 g). Six weeks postoperatively, median improvement in the UDI total score was clinically and statistically significant at 39.5 (p<0.001). Significant improvements were noted in irritative UDI subscale scores. Although postvoid residuals were normal in most women at baseline and did not change after fibroid debulking, significant improvements were noted in subjective obstructive symptoms as per the UDI obstructive subscale. Baseline fibroid location was not associated with worsening LUTS. There was a significant association between anterior/fundal versus posterior/multiple fibroid removal and improvement in LUTS. There was no significant change in LUTS based on type of surgery, fibroid weight, size of largest fibroid or number of fibroids removed.
Conclusions: LUTS are common in women with symptomatic uterine fibroids. Baseline irritative symptoms are more common than obstructive symptoms and improve following fibroid removal. Fibroid debulking may be offered as treatment for LUTS of the storage type in symptomatic women.
References: 1. Am J Obstet Gynecol 2003. Jan;188(1):100-7. 2. Fert Steril 2003. Jan;79(1):112-9. 3. Am J Obstet Gynecol 2007. Jun;196(6):519.e1-11