considering laparoscopic subtotal hysterectomy for multiple fibroids

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My uterus is the size of a 16 week pregnancy with multiple fibroids,

ranging in size from filbert nuts to the largest right posterior

lower segment at 9.5 x 10 x 7.3 cm, fundal subserous 5.7 x 4 x 2.5,

left fundal intramural 5 x 5 x 5, left calcified funda 3.5 cm.

I have been living with the discomfort of these things (not to

mention the appearance of being pregnant) for several years and have

gotten to the point where I just want them out. However, I do NOT

have significant bleeding problems or any life-threatening symptoms

such as obstruction of ureters. I am merely bothered by frequent

urination, a sense of heaviness in my pelvis that makes ordinary

activities such as walking or exercise uncomfortable, and lower back

pain that I wonder might be related to pressure on the sciatic

nerve. My gynecologist says that the position and size of my

fibroids definitely affects my internal organs to some degree

(pressure on bladder, intestines, bowel) but nothing that puts me in

any kind of risk. He is a very nice person who has tried to relieve

symptoms (controlled bleeding by changing the birth control pill I

was on) and taken a wait and see attitude unless the fibroids block

my ureters or I get tired of living with the discomfort. I've never

been pregnant, but I wonder if the discomfort I'm feeling is

anything like what accompanies pregnancy.

The fact that I am even considering hysterectomy (I've never been

admitted to a hospital in my life and I'm 50 years old) suggests to

me that I must be very uncomfortable. I had a test to see if I am

close to menopause and I'm not.

I sought an consultation with a surgeon who can perform a subtotal

hysterectomy (leaving my ovaries and cervix) laparascopically, Dr.

MacKoul, a gynecological oncologist who has performed the

surgery on women with fibroids as large as watermelons. He did not

push hysterectomy for me, but after looking at my sonograms said my

best options are UAE, doing nothing or laparoscopic hysterectomy.

I have never had children and don't have a psychological attachment

to my uterus, but have always held the view that you don't take out

body parts unless you absolutely have to. Dr. MacKoul said a couple

of things that have me re-thinking my options. I had initially

thought I'd try UAE first, considering that least invasive, then if

that didn't work, would go for laparoscopic subtotal hysterectomy.

1. Doing nothing:

even after menopause, large fibroids may not shrink

significantly enough to give me the relief I'm looking for. Some

days I feel like performing surgery on myself to get them out, so I

don't know that I want to wait 2 more years...

2. UAE

Shrinkage varies, which means my large ones could still be

annoying.

I may have misunderstood Dr. MacKoul, but I got the impression that

fibroids may find new sources of blood supply when the arteries

currently feeding them are cut off. I may have also misunderstood

this point, but I gathered that while post-UAE pain is variable

among patients, it can be significant and last quite awhile (weeks,

not days).

3. Hysterectomy

Dr. Mackoul did not in any way push hysterectomy for me but said

that I might want to consider viewing a uterus taken over by

fibroids as a muscle that has been significantly distorted from

its " normal " state and not really a healthy body part that needs to

be preserved.

When I look at it that way, hysterectomy that preserves my ovaries

and cervix doesn't seem like such an awful option. One concern I

have is the ACOG pamphlet on hysterectomy that states " because the

uterus has been removed, uterine contractions that may have been

felt during orgasm will no longer occur. " When I asked Dr. MacKoul

about that, he stated flatly that the lack of a uterus would have no

effect on orgasm.

Is discomfort and annoyance a valid reason to elect any invasive

fibroid treatment? especially hysterectomy?

The doctor who would perform this surgery says that he doesn't want

to encourage me to have my uterus removed if I have any doubts about

it at all. However, I got the impression from him that I really

will feel considerable relief, both physical and psychological, if I

get rid of what I call my fruit basket.

But then I went to some websites that suggest your stomach gets fat

after hysterectomy (exactly one of the reasons I want these fibroids

out), there's less desire for sex (this doctor suggested that sex

would likely be more comfortable again without these darn fibroids),

post-op depression is to be expected, etc. None of that sounds like

anything that will make me feel better.

I had definitely decided against an abdominal hysterectomy, but when

I heard about this laparoscopic surgery, it's one day in the

hospital and 1-2 week recovery, which sounds about like the

embolization procedure (except that the fibroids will definitely be

gone with this procedure).

I'm very confused. I plan to take a trip in April that involves a

lot of walking (not at all pleasant in my current state, with the

pressure on the bladder that is made worse with walking), so I had

planned to have surgery in February.

Has anyone else had a laparoscopic subtotal hysterectomy? I can't

find many references to it in any of the hysterectomy groups, which

is raising my anxiety level about the procedure. Just a few

doctors do it in our area, so I'm wondering if it's relatively new

and possibly not well-researched.

My regular ob/gyn is just now comfortable enough with the level of

research behind UAE to recommend that procedure and I haven't yet

talked to him about laparascopic subtotal hysterectomy, which I just

learned about in reading Dr. 's book " A Gynecologist's

Second Opinion " revised 2003. I also attended a seminar on fibroid

treatment options by Dr. MacKoul in November of this year. I think I

would feel better about making a decision if I could hear from

people who have had the procedure.

Sorry this is so long and thank you in advance.