Objective: To report one-step resectoscopic removal of submucous myomas tha
t were pushed back into the muscular layer by increased intrauterine pressu
re during hysteroscopic procedures.
Design: Case report. Setting: Kawasaki Municipal Hospital, Kawasaki, Japan.
Patient(s): Two infertile women presenting with menorrhagia in whom submuco
us myoma with a broad base was diagnosed.
Intervention(s): One patient was pretreated with GnRH agonist for 4 months;
the other patient did not receive this treatment. Resectoscopic myomectomi
es were performed under close sonographic monitoring.
Main Outcome Measure(s): Clinical symptoms and conception status.
Result(s): Tumor sinking occurred during the hysteroscopic procedures, but
complete resectoscopic removal of the submucous myomas was achieved under s
onographic and hysteroscopic visualization. One patient experienced hyponat
remia but recovered after conservative treatment. Both patients conceived a
fter myoma removal.
Conclusion(s): Sinking myomas, which may cause infertility, can be removed
with a one-step hysteroscopic procedure. Sinking of submucous myomas during
hysteroscopy might be caused by pretreatment with GnRH agonist and by incr
eased intrauterine pressure during hysteroscopy. We recommend that intraute
rine pressure be <45 mmHg, equivalent to hanging a bag of fluid under gravi
ty control 70 cm above the patient's uterus, at the beginning of operations
for sinking myomas. (Fertil Steril(R) 2000;74:1035-8. (C) 2000 by American
Society for Reproductive Medicine.).