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Fibroid recurrence and symptom improvement in 127 patients having undergone abdominal myomectomy
P-549 Recalcitrant cervical stenosis unresponsive to traditional attempts at cervical dilatation. Successful intrauterine pregnancy following frozen embryo transfer after fluoroscopically guided cervical dilatation and stenting. Lubna Pal, Carlos G. Forcade, John J. Stangel, Barry R. Witt. Albert Einstein Coll of Medicine, Bronx, NY; New York United Medical Ctr, Port Chester, NY. Objective: To report a case of recalcitrant cervical stenosis successfully managed by cervical dilatation under fluoroscopic guidance. Design: Case Report. Materials and Methods: A 33-year-old G1P0 with secondary infertility and cervical stenosis underwent cervical dilatation under general anesthesia. An HSG performed demonstrated a patent left tube and a distally blockage right fallopian tube. The patient was referred for management of infertility by IVF. Possibility of ZIFT (zygote intrafallopian transfer) was entertained in view unsuccessful subsequent attempts at cervical cannulation in the office and evidence of a normal appearing left tube on HSG. A potential need for resorting to embryo cryopreservation and possible need for a gestational carrier in the event of failed ZIFT/ET were discussed. The patient underwent ovarian hyperstimulation with a plan for mock embryo transfer (ET) at the time of egg retrieval. In the event of failure to negotiate the cervix for ET, a diagnostic laparoscopy was planned for ZIFT. The patient underwent transvaginal ultrasound (US) guided oocyte retrieval on 12/01 and 8 oocytes were recovered; attempts at mock ET were unsuccessful due to severely stenosed cervix. On the 3rd day post retrieval, a diagnostic laparoscopy performed to assess suitability for ZIFT provided evidence of significant tubal disease. The procedure was abandoned and embryos were cryopreserved. A decision was made to proceed with cervical dilatation under fluoroscopic guidance and if successful, to follow with an artificial FET cycle. Results: The patient underwent successful mechanical dilatation of the cervix under fluoroscopic guidance on 2/22/02. Under IV sedation, a 0.035 guide wire was introduced through the cervical canal into the uterine cavity. A 6-French (2mm diameter) catheter was threaded over the wire and then replaced with a 9-French (3mm diameter) peel-away sheath thus progressively dilating the cervical canal. Intrauterine placement of the guide wire and the catheter tip was confirmed on fluoroscopic visualization of the entire uterine cavity. A 7-French distal balloon-tipped catheter was then placed through the peel-away sheath, taped to the patient’s left groin and retained in the uterine cavity for the next 3 days. Antibiotic prophylaxis was provided for the duration of retention. Catheter was removed in the office on 2/25/02, immediately followed by successful cervical cannulation. The patient was commenced on hormone replacement in preparation for the FET cycle. Three embryos were transferred on 3/15/02 under US guidance using an Echotip Wallace Catheter. A single intrauterine pregnancy was confirmed on transvaginal ultrasound scan 3 weeks after ET and has progressed uneventfully to term. Conclusion: Cervical dilatation by guide wires of micro calibers and under fluoroscopic guidance may minimize creation of false passages and trauma incurred during routine dilatation and should be considered in obstinate cases of cervical stenosis.
P-550 Fibroid recurrence and symptom improvement in 127 patients having undergone abdominal myomectomy. Ben E. Montgomery, Michael J. Glassner, Charles J. Dunton. The Lankenau Hosp, Wynnewood, PA. Objective: 1) To characterize preoperative and intraoperative risk factors for fibroid recurrence and requirement for subsequent surgical procedures, and 2) assess patient symptom improvement and satisfaction after having undergone abdominal myomectomy. Design: Retrospective cohort review with follow-up questionnaire survey. Materials and Methods: The medical records of 331 patients having undergone abdominal myomectomy by a single operator from March 1994 to November 2002 were reviewed. Questionnaires were sent to these patients assessing the patient’s recurrence of fibroids, requirement for additional surgical procedures attributed to fibroid recurrence, symptom improvement, and general patient satisfaction with having chosen abdominal myomectomy as a modality to treat their fibroids. Potential parameters influencing outcome measures were collected from the medical record and
FERTILITY & STERILITY威
included race, age, abdominal myomectomy: questionnaire response interval (number of years), number of fibroids, total fibroid weight, largest fibroid, prior abdominal myomectomy, uterine size, and patient weight. Results: A total of 331 questionnaires were mailed to patients. Forty questionnaires did not reach the intended patient and were returned to the author with insufficient address. A total of 291 questionnaires were assumed to have reached patients, and 127 were returned completed (43.6% response rate). Overall, 19.7% of patients had been told by their physician that their fibroids had returned, and 4.7% of patients underwent an additional procedure secondary to recurrence of their fibroids. Symptoms were noted as “much improved” in 90.6% of patients, and 86.6% of patients were “very satisfied” with having chosen abdominal myomectomy as a modality to treat their uterine fibroids. In order to determine statistical significance among risk factors and outcome measures, Fisher exact tests were applied to the data comparisons. Univariate analysis demonstrated that women greater than 40 years of age were more likely to report symptoms as much improved as compared to patients less than forty years of age (95% vs. 80%, p⬍0.01). The number of fibroids at abdominal myomectomy significantly impacted the risk of fibroid recurrence. Women with greater than 10 fibroids at abdominal myomectomy reported fibroid recurrence in 38% of cases versus only 12% of women with less than or equal to 10 fibroids (p⬍0.01). The incidence of fibroid recurrence was reported as 7% in the first two years after abdominal myomectomy, and the incidence sharply rose after two years to 29% (p⬍0.01). Conclusion: Abdominal myomectomy is an effective surgical treatment for women with symptomatic uterine fibroids. Significant symptom improvement is noted in women that have undergone abdominal myomectomy, most notably in women over the age of forty years. Fibroid recurrence is a concern for women that undergo a less than definitive procedure to treat their uterine fibroids. Women with less than ten fibroids at the time of initial abdominal myoemectomy have a reduced risk for recurrence as compared to women with greater than 10 fibroids.
P-551 Decline in vital capacity (VC) and risk for Post-Operative Pulmonary Complications (PPCs) after Abdominal Surgery (AS) for Non-Malignant Gynecologic Disorders (N-MGD). Stephen V. Pappachen, Peter R. Smith, Siddarth Shah, Veronica DeBrito, Fayez Bader, Bhaskar Sahay. Long Island Coll Hosp, Brooklyn, NY. Objective: Reduction in lung volumes after AS promotes PPCs (atelectasis and pneumonia). We studied the effect of incentive spirometry (IS) vs. deep breathing exercises (DBE) on reducing the decline in VC in patients (PTs) undergoing elective lower AS (LAS) for N-MGD. Design: Prospective, blind and randomized. Materials and Methods: Pts ⬎18 yrs were randomized to IS or DBE. Slow VC was recorded and PTs were taught IS or DBE in the pre-op holding area. Post-operatively, PTs were asked to perform IS or DBE 10 times hourly while awake. VC, occurrence of PPCs and pain scale were recorded daily by an investigator blind to IS/DBE assignment. Data were analyzed by a repeated measures multivariate analysis of variance model and correlation analysis. P⬍ .05 was the level of significance for all analyses. Results: PPCs occurred in 4/119 PTs (3.4%), 2 in IS, 2 in DBE. Mean VC fell 28% by post-op day #1 (POD-1) in IS and 22% in DBE. VC increased 16% and 4% in IS and DBE respectively from POD-1 to POD-2 (p⫽ .02 for IS vs. DBE). Changes in VC did not correlate with pain scores in either group. Conclusion: VC fell significantly in PTs undergoing LAS for N-MGD, but PPCs were infrequent. Decline in VC did not correlate with pain scale and is likely due to reflex inhibition of diaphragmatic function. IS may be more effective than DBE in restoring VC to pre-op levels. Clinical Implications: The effect of LAS on post-op lung volumes is considerable, but the clinical impact (PPCs) is modest. IS may be preferable to DBE as a post-op lung expansion technique.
HUMAN SEXUALITY P-552 Severity of female sexual dysfunction in partners of men after radical prostatectomy correlates with erectile function of the male partner.
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P-550 Fibroid recurrence and symptom improvement in 127 patients having undergone abdominal myomectomy. Ben E. Montgomery, Michael J. Glassner, Charles J. Dunton. The Lankenau Hosp, Wynnewood, PA. Objective: 1) To characterize preoperative and intraoperative risk factors for fibroid recurrence and requirement for subsequent surgical procedures, and 2) assess patient symptom improvement and satisfaction after having undergone abdominal myomectomy. Design: Retrospective cohort review with follow-up questionnaire survey. Materials and Methods: The medical records of 331 patients having undergone abdominal myomectomy by a single operator from March 1994 to November 2002 were reviewed. Questionnaires were sent to these patients assessing the patient’s recurrence of fibroids, requirement for additional surgical procedures attributed to fibroid recurrence, symptom improvement, and general patient satisfaction with having chosen abdominal myomectomy as a modality to treat their fibroids. Potential parameters influencing outcome measures were collected from the medical record and
FERTILITY & STERILITY威
included race, age, abdominal myomectomy: questionnaire response interval (number of years), number of fibroids, total fibroid weight, largest fibroid, prior abdominal myomectomy, uterine size, and patient weight. Results: A total of 331 questionnaires were mailed to patients. Forty questionnaires did not reach the intended patient and were returned to the author with insufficient address. A total of 291 questionnaires were assumed to have reached patients, and 127 were returned completed (43.6% response rate). Overall, 19.7% of patients had been told by their physician that their fibroids had returned, and 4.7% of patients underwent an additional procedure secondary to recurrence of their fibroids. Symptoms were noted as “much improved” in 90.6% of patients, and 86.6% of patients were “very satisfied” with having chosen abdominal myomectomy as a modality to treat their uterine fibroids. In order to determine statistical significance among risk factors and outcome measures, Fisher exact tests were applied to the data comparisons. Univariate analysis demonstrated that women greater than 40 years of age were more likely to report symptoms as much improved as compared to patients less than forty years of age (95% vs. 80%, p⬍0.01). The number of fibroids at abdominal myomectomy significantly impacted the risk of fibroid recurrence. Women with greater than 10 fibroids at abdominal myomectomy reported fibroid recurrence in 38% of cases versus only 12% of women with less than or equal to 10 fibroids (p⬍0.01). The incidence of fibroid recurrence was reported as 7% in the first two years after abdominal myomectomy, and the incidence sharply rose after two years to 29% (p⬍0.01). Conclusion: Abdominal myomectomy is an effective surgical treatment for women with symptomatic uterine fibroids. Significant symptom improvement is noted in women that have undergone abdominal myomectomy, most notably in women over the age of forty years. Fibroid recurrence is a concern for women that undergo a less than definitive procedure to treat their uterine fibroids. Women with less than ten fibroids at the time of initial abdominal myoemectomy have a reduced risk for recurrence as compared to women with greater than 10 fibroids.
P-551 Decline in vital capacity (VC) and risk for Post-Operative Pulmonary Complications (PPCs) after Abdominal Surgery (AS) for Non-Malignant Gynecologic Disorders (N-MGD). Stephen V. Pappachen, Peter R. Smith, Siddarth Shah, Veronica DeBrito, Fayez Bader, Bhaskar Sahay. Long Island Coll Hosp, Brooklyn, NY. Objective: Reduction in lung volumes after AS promotes PPCs (atelectasis and pneumonia). We studied the effect of incentive spirometry (IS) vs. deep breathing exercises (DBE) on reducing the decline in VC in patients (PTs) undergoing elective lower AS (LAS) for N-MGD. Design: Prospective, blind and randomized. Materials and Methods: Pts ⬎18 yrs were randomized to IS or DBE. Slow VC was recorded and PTs were taught IS or DBE in the pre-op holding area. Post-operatively, PTs were asked to perform IS or DBE 10 times hourly while awake. VC, occurrence of PPCs and pain scale were recorded daily by an investigator blind to IS/DBE assignment. Data were analyzed by a repeated measures multivariate analysis of variance model and correlation analysis. P⬍ .05 was the level of significance for all analyses. Results: PPCs occurred in 4/119 PTs (3.4%), 2 in IS, 2 in DBE. Mean VC fell 28% by post-op day #1 (POD-1) in IS and 22% in DBE. VC increased 16% and 4% in IS and DBE respectively from POD-1 to POD-2 (p⫽ .02 for IS vs. DBE). Changes in VC did not correlate with pain scores in either group. Conclusion: VC fell significantly in PTs undergoing LAS for N-MGD, but PPCs were infrequent. Decline in VC did not correlate with pain scale and is likely due to reflex inhibition of diaphragmatic function. IS may be more effective than DBE in restoring VC to pre-op levels. Clinical Implications: The effect of LAS on post-op lung volumes is considerable, but the clinical impact (PPCs) is modest. IS may be preferable to DBE as a post-op lung expansion technique.
HUMAN SEXUALITY P-552 Severity of female sexual dysfunction in partners of men after radical prostatectomy correlates with erectile function of the male partner.
S303