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

Abstract

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.

Keywords

• Uterine surgery
• hysterectomy
• uterine leiomyoma
• adenomyosis.

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