Question
A 57-year-old menopausal woman presents to the office complaining of new-onset pelvic pressure and urinary frequency. She denies vaginal bleeding or discharge. She is parous and reports four normal vaginal deliveries. On examination, she has a mild cystocele, and the uterus is mobile, measuring 12cm with no additional masses. Ultrasonography confirms a uterus that measures 13 cm × 7.5 cm × 6 cm with a 7-cm fundal pedunculated mass and normal ovaries. She has no prior history of uterine leiomyomas or pelvic symptoms. Which of the following is the next best step in the management of this patient?
| A. |
Myomectomy
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| B. |
Abdominal hysterectomy
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| C. |
Vaginal hysterectomy
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| D. |
Laparoscopic supracervical hysterectomy
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Show Answer
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Correct Answer � C
Explanation
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Ans. C
- There is no consideration for the preservation of fertility in a postmenopausal woman. Additionally, malignancy must be considered in a postmenopausal woman with a new pelvic mass. Myomectomy is not, therefore recommended.
- While abdominal hysterectomy is acceptable, this patient is a good candidate for successful vaginal hysterectomy given normal ovaries, mobile uterus, which is only mildly enlarged, prior vaginal births, and mass at the fundus.
- This patient is a multiparous woman who is postmenopausal with a single uterine fundal myoma. The most cost-effective technique with the shortest recovery time is with a vaginal hysterectomy.
- Minimally-invasive surgery would likely require morcellation of the noted fibroid for extraction. In a menopausal patient with a newly diagnosed pelvic mass, there is increased concern for malignancy and morcellation should be avoided.
