Study Objective: To analyze the progression of patients after incomplete TCR (transcervical resection), including natural regression, pregnancy and repeated surgery.
Setting: Numazu City Hospital, Shizuoka, Japan
Patients: From 2005 to 2008, hysteroscopic myomectomy was performed on 21 patients with sessile type submucous myoma. Thirteen of these cases underwent an incomplete resection, and the follow up period after which post TCR occurred in these cases was between 5 to 26 months. Of 13 cases, 9 patients had a single myoma, and 4 had multiple myomas.
Results: Of 9 cases of a single myoma, 2 regressed spontaneously within 4 months postoperatively. Four cases remained stable. Three cases required another surgery, including TCR. The sizes of the persistent myomas were 13 to 19.5 mm, 13 to 18 mm, and 20 to 38 mm, respectively. Based on our results between stable and repeated surgery groups, the border size of a myoma was 20 mm. Both a patient with a regressed myoma and 1 with a stable myoma became spontaneously pregnant. Of 4 cases with multiple myomas, 2 cases remained stable and another 2 cases likely needed another surgery. The number of myomas in stable cases was 2, while the number of myomas that required another intervention was 7 and innumerable. Therefore, the border number of a myomas was 2.
Conclusion: Our results indicate that patients with persistent myomas that are single in number and smaller than 2 cm in size may be able to become pregnant and that these myomas may spontaneously regress. This study also showed that additional surgical intervention might be necessary for the persistent single myoma that is bigger than 2 cm or multiple myomas of more than 3 in number.
