Determinants of choice of surgical management for uterine fibroids in a tertiary hospital in southern Nigeria

Abstract

To determine the incidence, pattern of clinical presentation and patients' characteristics associated with the choice of surgical management of uterine fibroids, a retrospective survey of all surgically managed cases of uterine fibroids was conducted. There were 420 cases of uterine fibroids which constituted 10.3% and 17.6% of new gynaecological admissions and surgeries respectively. The common presentation was abdominal swelling (70%) and/or menorrhagia (63%). Types of surgical management conducted during the study period were abdominal myomectomy and hysterectomy (71.4% (300) and 28.6% (120) patients respectively). The size of fibroid did not influence the surgical treatment option but increasing age and parity were positively associated with hysterectomy as choice of surgical management (p=0.001). Further analysis showed that parity demonstrated an independent association with choice of surgery as low parity had more of myomectomy compared hysterectomy regardless of size of fibroid(89/109(81.7%) vs 20/109(18.3%), p=0.001). While age and parity are identified determinants of type of surgery for uterine fibroids, the need/desire for future childbearing as reflected by low parity is an overriding influencing factor for the choice of a conservative surgical method (Myomectomy) as the commoner mode of treatment in our locale.