Uterine Fibroid Surgery: Options and Risks Explained - Obstetrics and Gynecology

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Uterine fibroids, also known as leiomyomas, are benign tumors that can develop in the uterus. They can vary in size, number, and location, and while many women with fibroids experience no symptoms, others may face issues such as heavy menstrual bleeding, pelvic pain, or urinary frequency, as you mentioned. Given your situation, where you have a fibroid measuring approximately 7.2 x 6.4 x 6.5 cm located near the cervix and bladder, it's understandable that you're feeling anxious about the surgical options available.

When it comes to surgical interventions for uterine fibroids, there are several options, each with its own set of benefits and risks. The main surgical approaches include:
1. Myomectomy: This is the surgical removal of fibroids while preserving the uterus. It can be performed through various methods:
- Abdominal Myomectomy: This involves a larger incision in the abdomen and is typically used for larger or multiple fibroids. It allows for direct access to the uterus but comes with a longer recovery time and more postoperative pain.

- Laparoscopic Myomectomy: This minimally invasive technique uses small incisions and a camera to guide the surgery. It generally results in less pain and quicker recovery compared to abdominal myomectomy, but it may be more challenging if the fibroid is located near the cervix or major blood vessels.

- Hysteroscopic Myomectomy: This is performed through the vagina and cervix using a hysteroscope. It is suitable for fibroids located within the uterine cavity but may not be appropriate for larger fibroids or those located outside the uterine wall.

2. Hysterectomy: This is the complete removal of the uterus and is considered when fibroids are large, numerous, or when other treatments have failed. A hysterectomy can be performed abdominally, laparoscopically, or vaginally. While it effectively eliminates fibroids and associated symptoms, it also means that you will no longer be able to conceive.

3. Uterine Artery Embolization (UAE): This is a non-surgical procedure that involves blocking the blood supply to the fibroids, causing them to shrink. While it is less invasive, it may not be suitable for all women, especially those who wish to preserve their fertility.

Given the location of your fibroid near the cervix and bladder, surgical access may indeed be more complicated. The proximity to major blood vessels and the bladder increases the risk of complications during surgery, such as bleeding or damage to surrounding organs. Therefore, the choice of surgical method should be made carefully, considering the size and location of the fibroid, your overall health, and your future reproductive plans.

In terms of recommendations, it would be prudent to discuss the following with your healthcare provider:
- The specific risks associated with each surgical option, particularly in relation to the fibroid's location.

- The potential for preserving your fertility if that is a concern for you.

- The expected recovery times and any postoperative care that may be necessary.

It may also be beneficial to seek a second opinion from a specialist in minimally invasive gynecologic surgery, particularly one experienced with fibroids located in challenging positions. This could provide you with more clarity and confidence in making your decision.

Ultimately, the goal is to alleviate your symptoms while minimizing risks and preserving your health. Open communication with your healthcare team will be key in navigating this decision.