Does prior uterine surgery increase the risks of uterine leiomyoma and adenomyosis? a retrospective study

Yıl 2022, , 445 - 450, 15.03.2022

Nihal Mavral , Pınar Kırıcı , Kadriye Yakut , Filiz Avşar

https://doi.org/10.32322/jhsm.988207

Öz

Aim: Women frequently undergo obstetric and gynecologic surgeries throughout their life, and the two common gynecologic conditions are uterine leiomyoma (UL) and adenomyosis. This study aims to investigate the relationship between the presence and the types of prior uterine surgery and the risks of developing UL and adenomyosis.
Material and Method: This study is a single-center eleven-year cross-sectional study, in which we studied the effects of previous uterine surgery on developing UL and adenomyosis in patients who underwent hysterectomy for any indication in our hospital between 01/01/2004 and 31/12/2014.
Results: During the time period, 1299 eligible patients were included in the study. The median age was 49.0 years and the study population was mostly consisted of multigravid women. The overall prevalence of UL was 61.9% and the overall prevalence of adenomyosis was 18.3%.In the univariate analysis of patient characteristics for UL, age, gravida and parity were found as statistically significant protective factors for UL (OR [95.0% CI]: 0.92 [0.91-0.93], 0.91 [0.88-0.95], 0.88 [0.83-0.93], respectively). On the other hand, women who underwent previous any uterine surgery had 1.28 folded (95.0% CI: 1.02-1.61) risk for UL. However, we found that only undergoing myomectomy statistically significantly increased the risk of UL (OR [95.0% CI]: 8.59 [2.62-27.91]) among the types of uterine surgery. In the multivariate model, the protective effect of age remained (adjusted OR [95.0% CI]: 0.92 [0.91-0.94]), and the risk-increasing effect of having previous myomectomy dropped slightly with retaining its statistical significance (adjusted OR [95.0% CI]: 5.87 [1.78-19.41]). We also conducted similar analysis for adenomyosis, and we found that gravida was a risk factor (OR [95.0% CI]: 1.06 [1.01-1.12]), conversely to its risk-decreasing effect for UL. Also, women who had a history of any uterine surgery had 1.42 folded (95.0% CI: 1.07-1.88), and women who had a history of D&C had 1.62 folded (95.0% CI: 1.02-1.61) risk adenomyosis. In the multivariate model for the risk of adenomyosis, the risk-increasing effects of the gravida and the history of D&C decreased very slightly with saving their statistical significances (adjusted OR [95.0% CI]: 1.06 [1.01-1.12], 1.44 [1.07-1.95], respectively).
Conclusion: According to our findings, the frequency of adenomyosis is higher but, the frequency of UL is compatible with the literature. Patients, who underwent uterine surgery previously, diagnosed with adenomyosis and UL more than the others who did not, but this seems to be a correlation rather than a causative association.

Anahtar Kelimeler

Uterine surgery, hysterectomy, uterine leiomyoma, adenomyosis.

Kaynakça

• Boosz AS, Reimer P, Matzko M, Römer T, Müller A. The conservative and interventional treatment of fibroids. Dtsch Arztebl Int 2014; 111: 877-83.
• Flake GP, Andersen J, Dixon D. Etiology and pathogenesis of uterine leiomyomas: a review. Environ Health Perspect 2003; 111: 1037-54.
• Islam MS, Protic O, Stortoni P, et al. Complex networks of multiple factors in the pathogenesis of uterine leiomyoma. Fertil Steril 2013; 100: 178-93.
• Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94: 435-8.
• Weiss G, Maseelall P, Schott LL, Brockwell SE, Schocken M, Johnston JM. Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN). Fertility and sterility 2009; 91: 201-6.
• Shaikh H, Khan K. Adenomyosis in Pakistani women: four year experience at the Aga Khan University Medical Centre, Karachi. Journal of clinical pathology 1990; 43: 817-9.
• García-Solares J, Donnez J, Donnez O, Dolmans M-M. Pathogenesis of uterine adenomyosis: invagination or metaplasia? Fertility and sterility 2018; 109: 371-9.
• Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Human reproduction update 2020; 26: 392-411.
• Laughlin SK, Schroeder JC, Baird DD. New directions in the epidemiology of uterine fibroids. Semin Reprod Med 2010; 28: 204-17.
• Evans P, Brunsell S. Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician 2007; 75: 1503-8.
• Payson M, Leppert P, Segars J. Epidemiology of myomas. Obstet Gynecol Clin North Am 2006; 33: 1-11.
• Becker ER, Spalding J, DuChane J, Horowitz IR. Inpatient surgical treatment patterns for patients with uterine fibroids in the United States, 1998-2002. J Natl Med Assoc 2005; 97: 1336-42.
• Becker ER. National trends and determinants of hospitalization costs and lengths-of-stay for uterine fibroids procedures. J Health Care Finance 2007; 33: 1-16.
• Walker CL, Stewart EA. Uterine fibroids: the elephant in the room. Science 2005; 308: 1589-92.
• Okolo S. Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 2008; 22: 571-88.
• Townsend DE, Sparkes RS, Baluda MC, McClelland G. Unicellular histogenesis of uterine leiomyomas as determined by electrophoresis by glucose-6-phosphate dehydrogenase. Am J Obstet Gynecol 1970; 107: 1168-73.
• Benassayag C, Leroy MJ, Rigourd V, et al. Estrogen receptors (ERalpha/ERbeta) in normal and pathological growth of the human myometrium: pregnancy and leiomyoma. Am J Physiol 1999; 276: E1112-8.
• Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Research 2019; 8: 283.
• Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB. Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod 2001; 16: 2418-21.
• Panganamamula UR, Harmanli OH, Isik-Akbay EF, Grotegut CA, Dandolu V, Gaughan JP. Is prior uterine surgery a risk factor for adenomyosis? Obstet Gynecol 2004; 104: 1034-8.
• Levgur M, Abadi MA, Tucker A. Adenomyosis: symptoms, histology, and pregnancy terminations. Obstet Gynecol 2000; 95: 688-91.
• Polena V, Mergui J-L, Perrot N, Poncelet C, Barranger E, Uzan S. Long-term results of hysteroscopic myomectomy in 235 patients. European J Obstet Gynecol Reprod Biol 2007; 130: 232-7.
• Medikare V, Kandukuri LR, Ananthapur V, Deenadayal M, Nallari P. The genetic bases of uterine fibroids; a review. J Reprod Inferti 2011; 12: 181.
• Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril 2007; 87: 725-36.
• Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94: 435-8.
• Fields K, Neinstein L. Uterine myomas in adolescents: case reports and a review of the literature. J Pediatr Adolesc Gynecol 1996; 9: 195-8.
• Fauconnier A, Chapron C, Babaki-Fard K, Dubuisson JB. Recurrence of leiomyomata after myomectomy. Human Reprod Update 2000; 6: 595-602.
• Dreyfuss ML. Pathologic and clinical aspects of adenomyosis and endometriosis: A survey of 224 cases. Am J Obstet Gynecol 1940; 39: 95-9.
• Curtis KM, Hillis SD, Marchbanks PA, Peterson HB. Disruption of the endometrial-myometrial border during pregnancy as a risk factor for adenomyosis. Am J Obstet Gynecol 2002; 187: 543-4.