Multiple hysteroscopic surgery combined with fenestration for the treatment of diffuse uterine leiomyomatosis.

Objective: Diffuse uterine leiomyomatosis (DUL) is a unique growth pattern of fibroids that can lead to infertility. Due to numerous of myomas, a large amount of dilatant fluid as well as longer time are needed following traditional hysteroscopic myomectomy, and the absorption of irrigating fluids, combined with the pressure from uterine distension, can lead to fluid overload and/or dilutional hyponatremia, resulting in transurethral resection of the prostate (TURP) syndrome. In this study, we proposed a recommended technique for treating DUL to prevent above mentioned complications.

Setting: Shengjing Hospital of China Medical University.

Participants: A 37-year-old young woman was diagnosed with DUL. She presented with menorrhagia (a hemoglobin level of 80 g/L), along with symptoms of dizziness and fatigue.

Interventions: The patient underwent two hysteroscopic procedures to fully resect the fibroids. In the first surgery, some of the fibroids were excised using a combination of hysteroscopic fenestration. During the surgery, hysteroscopic fenestration began with an incision made on the endometrium covering each submucous fibroid using a needle-type electrode. The subsequent myomectomy was then performed with a loop-type electrode solely on the fibroid body. This surgery was finished and 8000 ml of 5% glucose uterine distention solution (the deficit was less than 1000 ml) was used. A second hysteroscopic procedure was then performed to evaluate and address any intrauterine adhesions and to remove the remaining fibroids.

Conclusion: For the patient who underwent two hysteroscopic surgeries combined with fenestration, no case of TURP syndrome were observed during or after the procedures. Her menstruation returned to normal, and no intrauterine adhesions developed post-surgery. The patient achieved pregnancy and delivered at full term, resulting in a favorable reproductive outcome. Combining multiple hysteroscopic surgeries with fenestration, proved effective and feasible for DUL patients seeking to preserve fertility, aiming to reduce the risk of TURP syndrome.