In-Office Versus Operating-Room Procedures for Transvaginal Removal of Prolapsed Pedunculated Submucosal Myomas

Objective: Transvaginal myomectomy is the mainstay of treatment for prolapsed pedunculated submucosal myoma. This research was conducted to evaluate the outcome of transvaginal removal of clinically diagnosed prolapsed myomas in an office-based versus an operating-room (OR) setting. Materials and Methods: This was a retrospective cohort study of all patients with prolapsed myomas treated at a single university hospital during 2008-2016. Results: A total of 76 patients with prolapsed myomas were included in this study. All patients were managed with transvaginal myomectomy, which was performed in the OR in 53 (70%) patients and in the office in 23 (30%). The main presenting symptoms were abnormal uterine bleeding (85%) and abdominal pain (19%) and did not differ between the groups. Patients treated in the office tended to have thinner myoma pedicles (<2 cm, 90% versus 41.4%; p = 0.007). The success rate - defined by complete myoma removal - was higher in the OR group (98.1% versus 82.6%; p = 0.01). Among patients treated in the office, abdominal pain was associated with procedural failure (50% versus 5%; p < 0.02). Only 1 patient (1.3%) required hysterectomy for symptomatic uterus myomatosus that occurred 3 years after the transvaginal myomectomy. Conclusions: This preliminary study supports management of clinically suspected prolapsed myoma in an OR setting. In patients with thin myoma pedicles coupled with the absence of abdominal pain, in-office removal can be considered due to its associated safety and high success rate in this subset of patients.