Ulipristal acetate in symptomatic uterine fibroids. A real-world experience in a multicentric Italian study.

Surgery is the most frequent treatment in women with symptomatic uterine fibroids. A new medical approach with ulipristal acetate (UPA) has been suggested. The aim of this study was to provide data on effectiveness and safety of UPA in premenopausal women with symptomatic uterine fibroids. This was a multicenter retrospective cohort study. Data on all consecutive premenopausal women with symptomatic uterine fibroids referred to three Italian centers were included in a dedicated merged database. Women aged 18-55 years, who received pharmacologic therapy with UPA 5 mg orally once a day, were included in the study. The primary outcome was the percentage of women who underwent surgery after UPA treatment. One hundred and forty-two premenopausal women with uterine fibroids were included in this study. The mean age was 43.2 years. Eighty-one (57.0%) of 142 women treated with UPA had only medical treatment and did not undergo surgery. Surgical treatment occurred in 70, 23, 32, and 8% of the women who received one course, two courses, three courses, or four courses, of UPA treatment, respectively. The incidence of side effects was 10.6%. The effectiveness and safety of repeated UPA treatment courses in reducing number of women requiring surgery is confirmed by real-world data.

Hysteroscopic Management of Uterine Arteriovenous Malformation.

BACKGROUND AND OBJECTIVES: Uterine arteriovenous malformation (AVM) is characterized by shunts between the myometrial arteries and veins. Treatment is based on the severity of uterine bleeding and ranges from conservative medical approaches to embolization of affected arteries. The aim of study was to evaluate the feasibility and safety of hysteroscopy for management of uterine AVM. METHODS: This was a retrospective study of a cohort of 11 cases occurring between March 2012 and December 2015 in our Regional Center of Excellence in Hysteroscopy, University of Florence. The diagnosis of AVM was made by transvaginal ultrasonography with high-definition flow in patients with mild to moderate symptoms. In all cases, we used the hysteroscopic platform Gynecare VersaPoint II (Ethicon, Somerville, New Jersey, USA), equipped with a 4-mm electrosurgical loop and associated with the SPIES (Storz Professional Image Enhancement System) system (Karl Storz, Tuttlingen, Germany). RESULTS: All patients were successfully treated with operative hysteroscopy with no reported complications. No patient had residual disease detected by ultrasonography performed after a month. At this writing, of the 11 patients treated with operative hysteroscopy, 4 had achieved a pregnancy that carried to term, 1 was pregnant at 20 wk, and 1 had a miscarriage in the first trimester. CONCLUSIONS: Hysteroscopy is a feasible and safe alternative treatment modality for AVM. Patients treated with surgical hysteroscopy have high fertility outcomes, a 100% success rate after the first treatment, no complications related to the surgical procedure, and a short hospital stay.

Sonographic diagnosis of a large and deep endometrioma of the uterine cervix.

We present a rare case of endometriosis of the cervix. Transvaginal sonography showed a 35-mm cyst in the cervix with diffuse, low-level internal echoes. Transvaginal sonography-guided aspiration with a 17-gauge needle was performed, yielding a very thick chocolate-colored fluid. Cytological examination of the fluid revealed the presence of endometrial cells. Symptoms resolved after aspiration and no recurrence has developed.