Symptomatic submucous uterine fibroid: outcome of conservative surgery in a tertiary care hospital


  • Pratiksha Gupta Department of Obstetrics and Gynecology, PGIMSR, ESI, Basaidarapur, New Delhi, India



Submucous myoma, Fibroid, Hysteroscopic myomectomy, Prostaglandin, Gonadotropin releasing hormone


Background: Leiomyoma are benign smooth muscle neoplasm’s that typically originate from the myometrium. The main objective was to evaluate the outcome of conservative surgical approach for submucous fibroid uterus is using prostaglandin preoperatively and gonadotropin releasing hormone (GnRh) in preoperative phase.

Methods: Thirty eight patients who had hysteroscopic myomectomy with a resectoscope for submucous fibroid were studied at the department of Obstetrics and Gynecology of the Government Medical College, Chandigarh and PGIMSR, New Delhi, India.

Results: Median age was 35 years (20 to 50). Abnormal uterine bleeding (AUB) was the most frequent indication (71.05%). Failure to conceive and repeated abortion was indication in 11 (28.94%) cases. GnRH analogue preparation was used in 8 (21.05%) of cases. A median of 37.10 (15 minutes to 60 minutes) minutes was required for the interventions. The myomectomy was combined with another operation in 15 patients. Complete resection was not possible in 4 patients, while 5 underwent a reoperation. No serious complications occurred, with satisfactory follow-up outcome as AUB was controlled in 89.48% of the patients.

Conclusions: Hysteroscopic myomectomy is a reliable procedure that is effective in controlling abnormal uterine bleeding, even it can be done in larger submucous fibroid using GnRh analogue, and prostidin.


Hoffman, Schorge, Schaffer, Halvorson, Bradshaw, Cunningham. Pelvic mass. In Barbaral. Hoffman editor. Textbook of Williams Gynecology, 4th edition. New York: Mc Graw Hill publisher. 2008.246-80.

Buttram VC, Reiter RC. Uterine leiomyoma: etiology, symptomatology, and management. Fertil Steril. 1981;36:433.

Cramer SF, Patel A. The frequency of uterine leiomyoma. Am J Clin Pathol. 1990;94:435.

Day Baird D, Dunson DB, Hill MC. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188:100.

Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol. 1993;82(5):736-40.

Lasmar RB, Barrozo PRM, Dias R, Oliveira MAP. Submucous fibroids: A new presurgical classification (STEP-w) to evaluate the viability of hysteroscopic surgical treatment-Preliminary Access in:

Cravello L, Agostini A, Beerli M, Roger V, Bretelle F, Blanc B. Results of hysteroscopic myomectomy. Gynecol Obstet Fertil. 2004;32(9):825-8.

American College of Obstetricians and Gynecologists (ACOG). Surgical alternatives to hysterectomy in the management of leiomyomas. Washington (DC): American College of Obstetricians and Gynecologists (ACOG). 2000;10. (ACOG practice bulletin; no. 16).

Hallez JP. Single-stage total hysteroscopic myomectomies: indications, techniques, and results. Fertil Steril. 1995;63:703.

Emanuel MH, Wamsteker K, Hart AA. Long-term results of hysteroscopic myomectomy for abnormal uterine bleeding. Obstet Gynecol. 1999;93:743.

Derman SG, Rehnstrom J, Neuwirth RS. The long-term effectiveness of hysteroscopic treatment of menorrhagia and leiomyomas. Obstet Gynecol. 1991;77:591.

Munro MG, Brill AI, Parker WH. In: Berek, Jonathan Berek editor. Textbook ofBerek & Novak's Gynecology, 14th Edition, New Delhi: Publisher Wolter Kluwer/ Lippincott Williams & Wilkins. 2007:749-804.

Ioannis S, Aristotelis A, Antonios T, Panagiotis S, John B. Fertility rates after hysteroscopic treatment of submucous myomas depending on their type. Gynecological Surgery. 2006;3:206-10.

Fernandez H, Sefrioui O, Virelizier C. Hysteroscopic resection of submucosal myomas in patients with infertility. Hum Reprod. 2001;16:1489.

Vercellini P, Zaina B, Yaylayan L. Hysteroscopic myomectomy: long-term effects on menstrual pattern and fertility. Obstet Gynecol. 1999;94:341.

Donnez J, Jadoul P. What are the implications of myomas on fertility? A need for a debate? Hum Reprod. 2002;17:1424.






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