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Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know?
Obstet Gynecol Int. 2020; 2020:8625186.OG

Abstract

Introduction

Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment.

Materials and Methods

A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term "non-puerperal uterine inversion," and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment.

Results

Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm.

Conclusions

Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.University Obstetrics and Gynaecology Unit, Teaching Hospital, Mahamodara, Galle, Sri Lanka.Sidra Medicine, Doha, Qatar.Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32565821

Citation

Herath, R P., et al. "Nonpuerperal Uterine Inversion: what the Gynaecologists Need to Know?" Obstetrics and Gynecology International, vol. 2020, 2020, p. 8625186.
Herath RP, Patabendige M, Rashid M, et al. Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know? Obstet Gynecol Int. 2020;2020:8625186.
Herath, R. P., Patabendige, M., Rashid, M., & Wijesinghe, P. S. (2020). Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know? Obstetrics and Gynecology International, 2020, 8625186. https://doi.org/10.1155/2020/8625186
Herath RP, et al. Nonpuerperal Uterine Inversion: what the Gynaecologists Need to Know. Obstet Gynecol Int. 2020;2020:8625186. PubMed PMID: 32565821.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know? AU - Herath,R P, AU - Patabendige,M, AU - Rashid,M, AU - Wijesinghe,P S, Y1 - 2020/06/01/ PY - 2019/07/21/received PY - 2020/03/24/revised PY - 2020/05/13/accepted PY - 2020/6/23/entrez PY - 2020/6/23/pubmed PY - 2020/6/23/medline SP - 8625186 EP - 8625186 JF - Obstetrics and gynecology international JO - Obstet Gynecol Int VL - 2020 N2 - Introduction: Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment. Materials and Methods: A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term "non-puerperal uterine inversion," and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment. Results: Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm. Conclusions: Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases. SN - 1687-9589 UR - https://www.unboundmedicine.com/medline/citation/32565821/Nonpuerperal_Uterine_Inversion:_What_the_Gynaecologists_Need_to_Know L2 - https://doi.org/10.1155/2020/8625186 DB - PRIME DP - Unbound Medicine ER -
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