Prolapsed uterine leiomyoma (fibroid)
- William H Parker, MD
William H Parker, MD
- Clinical Professor
- Department of Obstetrics and Gynecology
- UCLA School of Medicine, Los Angeles
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
Uterine leiomyomas (fibroids) are common benign smooth muscle tumors [1,2]. Fibroids may develop anywhere within the muscular wall of the uterus, including submucosal, intramural, or subserosal positions (figure 1). For women with a pedunculated submucosal fibroid that is contained within the uterine cavity, removal is typically performed using hysteroscopy. Infrequently, uterine contractions will push a pedunculated submucosal fibroid through the cervical canal and it may prolapse into the vagina . Pedunculated fibroids that dilate the cervix or prolapse through the cervix into the vagina can usually be removed via the vagina.
Removal of subserosal or intramural fibroids through a vaginal colpotomy incision is an uncommonly performed procedure that has also been referred to as vaginal myomectomy . This approach has been associated with an increased risk of infection compared with other surgical approaches to myomectomy. This procedure is not discussed here.
Vaginal myomectomy for a prolapsed submucosal uterine fibroid is reviewed here. Hysteroscopic, abdominal, and laparoscopic approaches to myomectomy are discussed separately. (See "Hysteroscopic myomectomy" and "Abdominal myomectomy" and "Laparoscopic myomectomy and other laparoscopic treatments for uterine leiomyomas (fibroids)".)
INCIDENCE AND RISK FACTORS
There are no data regarding the incidence or risk factors of prolapsed uterine leiomyomas in particular. In general, uterine leiomyomas are the most common type of pelvic tumor in women, with a prevalence of up to 80 percent. Submucosal fibroids account for approximately 15 to 20 percent of these and an unknown proportion of submucosal leiomyomas prolapse through the cervix. In our experience, this clinical finding is uncommon, but is not exceedingly rare. The epidemiology and risk factors of uterine leiomyomas are discussed separately. (See "Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history", section on 'Prevalence' and "Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history", section on 'Risk factors'.)
Prolapse of a submucosal leiomyoma through the cervix may present with symptoms of vaginal bleeding, discharge, or pelvic pain. Some women are asymptomatic, and the finding is noted incidentally on pelvic examination.
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- INCIDENCE AND RISK FACTORS
- CLINICAL PRESENTATION
- Incidental finding on pelvic examination
- DIAGNOSTIC EVALUATION
- Pelvic examination
- Imaging studies
- Pathology evaluation of mass
- DIFFERENTIAL DIAGNOSIS
- VAGINAL MYOMECTOMY
- Surgical planning
- - Informed consent
- - Operative setting
- - Anesthesia
- - Antibiotic prophylaxis
- - Thromboprophylaxis
- PREGNANT WOMEN
- REFERRAL TO A SPECIALIST
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS