68 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) ISSN (Print) 2313-4410, ISSN (Online) 2313-4402 © Global Society of Scientific Research and Researchers http://asrjetsjournal.org/ Uterine Leiomyoma in Kinshasa, the Capital of the Democratic Republic of Congo Ingala Pa*, Lepira Fb, Muhindo Sc, Mputu Ld a,c,dDepartment of Obstetrics and Gynecology, University of Kinshasa Hospital, Kinshasa, 00243, Democratic Republic of Congo bDepartment of Internal Medicine, University of Kinshasa, Kinshasa, 00243, Democratic Republic of Congo Abstract The aim of the present study was to determine the particularities of Uterine Leiomyomas among Congolese in Kinshasa the capital of the Democratic Republic of Congo (DRC) in the present conditions of medical practices. A sample of 644 patients with uterine leiomyoma were selected from 6440 cases of uterine leiomyoma among 30395 patients treated in gynecology units of three medical institutions of Kinshasa (University hospital of Kinshasa, Saint joseph hospital and Edith medical center) from January Ist ,2003 to December 31,2012. The study is a descriptive one. The following variables were taken account: medical history [age, age at menarche, parity, education, civil state, history of UL, symptoms and body mass index (BMI)]; lifestyle (smoking, alcohol intake); ultrasounds characteristics; hysteroslpingographies characteristics, treatment, and direct cost of treatment. Statistical analysis were performed using Excel 12.0 software. Demographic, clinical, ultrasound, hysterosalpingography and treatment data were evaluated using descriptive statistics: mean, standard deviation (SD), and percentage (%) as appropriate. The frequency of uterine leiomyoma was 21, 18%. That one concern mainly patients at 35 years old or more [49, 6% (35-44years), ≥45years (20, 6%)], singles (70, 4%), null parous (59,4%), having a high level of study (university: 54, 6%), history of UL (56, 7%), and alcohol intake (75, 5%). Hemorrhage (33, 2%) and pelvic pain (31, 6%) are the most frequent expression of those tumors. The most of those patients have excess weight (43, 1%) or obesity (46, 5%). The majority of uterine leiomyoma was corporeal (82, 9%) intramuscular (42, 4%) and their number didn’t overtake five by patient (70, 8%) in majority of cases. Majoration of the uterine cavity (46, 5%) and Fallopian tubes obstructions (30, 6%) are the most frequent abnormalities in hysterosalpingography. Myomectomy is the main treatment (65, 2%). The mean of direct cost were 803$ USA and 884$ USA for myomectomy and hysterectomy respectively. Keys Words: Uterine Leiomyoma -Particularities- Democratic Republic of Congo. ------------------------------------------------------------------------ * Corresponding author. http://asrjetsjournal.org/ American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 38, No 2, pp 68-76 69 1. Introduction The uterine leiomyoma (UL) is the most frequent genital tumor to women in reproductive age [1, 2, 3]. He is more frequent in black than white [4, 5, 6] and represents an important public health problem according to his incidence, prevalence, morbidity and cost of his management [7, 8]. In the Democratic Republic of Congo (DRC) the characteristics of UL have been explored many years ago when ultrasound was not used commonly as one of diagnosis methods [9, 10]. The objective of this paper is to evaluate the particularities of UL in the DRC regarding the present conditions of medical practices. 2. Materials and Methods The study protocol was approved by the Ethical Committee of Kinshasa School of Public Health. University of Kinshasa (ESP/CE/028/2013). 6440 patients with UL have been collected in three medical institutions (University of Kinshasa hospital, Saint Joseph hospital and Edith medical center) of Kinshasa the capital of the DRC among 30395 patients who have been treated in the gynecology units from January 01, 2003 to December 31, 2012. A sample of 644 patients as been selected by random from those patients for the study. The study is a descriptive one. Her objective was to determine the actuals particularities of UL among Congolese women in Kinshasa. The following variables were taken account: medical history [age, age at menarche, parity, education, civil state, history of UL, symptoms and body mass index (BMI)]; lifestyle (smoking, alcohol intake); ultrasounds characteristics; hysterosalpingographies characteristics, treatment, and direct cost of treatment. Statistical analyses were performed using Excel 12.0 software. Demographic, clinical, ultrasound, hysterosalpingography and treatment data were evaluated using descriptive statistics: mean, standard deviation (SD), and percentage (%) as appropriate. 3. Results Table I: Frequency of uterine leiomyoma F = 6440 / 30394 .100 = 21, 18 % The table below show that the majority of patients have 35 years old or more [49, 6% (35-44years), ≥45years (20, 6%)], have had their menarche at 12 year or late (71, 8%), have none parity (null parous) (59,4%) or more (multiparous) (40,6%), have reached university (54, 6%) and are single (70, 4%). History of UL (56, 7%), and alcohol intake are the main characteristics of their medical history. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 38, No 2, pp 68-76 70 Hemorrhage (33, 2%) and pelvic pain (31, 6%) are the most frequent expression their tumor. The most of those patients have excess weight (43, 1%) or obesity (46, 5%). Table II: Demographic, and clinical characteristics of patients From the table III the majority of uterine leiomyoma was corporeal (82, 9%), intramuscular (42, 4%) and their number didn’t overtake five by patient in the most of cases (70, 8%). VARIABLES n % Age (years) ≤ 24 25-34 35-44 ≥45 10 182 320 132 1,5 28,2 49,6 20,4 Age at menarche (years) <12 ≥12 182 462 28,2 71,8 Parity 0 ≥1 262 382 59,4 40,6 Education Primary or less Secondary University 146 146 352 22,6 22,6 54,6 Civil State Married Single 191 453 29,6 70,4 UL History Not Yes 278 366 43,1 56,9 Alcohol Intake Not Yes 158 486 24,5 75,5 Smoking Not Yes 616 28 95,6 4,4 Symptoms Hemorrhage Pelvic Pain Infertility Others 214 110 204 96 33,2 17,0 31,6 14,9 BMI Normal Excess Weight Obesity 66 278 300 10,2 43,1 46,5 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 38, No 2, pp 68-76 71 Table III: Ultrasounds characteristics of uterine leiomyomas Ultrasounds characteristics N % Localisation/ uterine subdivisions Corporeal Isthme Cervix 534 84 26 82,9 13,0 4,0 Localisation/thickness Sub sessorial Intra mural Sub mucosal Intra cavity 100 274 192 78 15,5 42,4 29,8 12,1 Number ≤5 ≥6-≤10 ≥11 456 102 66 70,8 15,8 10,2 Table IV: Hysterosalpingographies characteristics of uterine leiomyomas Hystersalpingographies characteristics N % uterines images normal majoration of cavity two cavities synechies 332 300 4 8 51,5 46,5 0,6 1,2 tubes abnormalities normal obstruction hydrosalpinx phimosis 408 196 26 14 63,3 30,4 4,0 2,1 The table IV show that majoration of the uterine cavity (46, 5%) and Fallopians tubes obstructions (30, 6%) are the more frequent hysterosalpingographies abnormalities of uterine leiomyoma observed among patients in that study. Table V: Treatment Treatement N % medical 52 8,0 Myomectomy Hysterectomy 420 172 65,2 26,7 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 38, No 2, pp 68-76 72 The table V shows that myomectomy is the main treatment of UL (65, 2%). Table VI: Direct cost of treatment Medical institution Direct cost of myomectomy Direct cost of hystercetomy university hospital 750$ usa 850$ usa Saint joseph hospital 360$ usa 452$ usa Edith medical center 1300$ usa 1350$ usa Mean 803$usa 884$usa The table VI show that the mean of direct cost of uterine leiomyoma are 803$ USA for myomectomy and 884$ USA for hysterectomy. 4. Discussion The present study shows that the frequency of UL is 21, 18%. Althout that high level that result is comparable to those others much Africans countries [11, 12]. On contrary of Africans countries the frequencies of UL in Europeans countries are less [13, 14]. Those observations support the opinion which consider that UL is the tumor of black women. The most of patients with UL have 35 years old or more. That result join the fact of advanced age and increasing age are two parameters which are always correlated with the rising of UL frequency. For explaining that phenomenon Rongieres & al [15], and Adama & al [16] think that by growing up, UL become symptomatics toward 40 years old and their diagnosis easiest. Majority of patients are nullparous (59,4%). That result is an argument which support the fact of a reverse relation exists between increasing of parity and occurring of UL. For many authors that relation can be understood by hormonal and no hormonal change of deliveries. Among others the reduction of number of menses cycles, the regression of the level of estrogen and progesterone, and the increasing of sex binding globulin (SBG) [17, 18]. The presence of history of UL to much patients suggest the rule of heredity in the pathogenesis of UL. Alcohol intake, excess weight and obesity are others factors which are more found to patients in that study. Those results join many others results [19, 20] and can be explained by tumor genesis action of acetaldehyde providering from the metabolism of ethanol [21] and the contribution of lipid metabolism in the production of estrogen [22]. Hemorrhage and pelvic pain as the main expression of UL is not an exception for the study [23, 24]. The most frequent localization of Uterines leiomyomas was the corporeal one (82, 9%) as for Algeria women [25]. Fallopian tubes obstructions appear as the main abnormality of UL in hysterosalpingography. That result join others studies which demonstrated that fallopian obstructions is the commonest pathology found on HSG in women presenting infertility in Kinshasa (DRC) and Kampala (UGANDA) [26, 27]. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 38, No 2, pp 68-76 73 Even if hysterectomy is the final treatment of UL [28, 29], the main surgical treatment is myomectomy in the present study. We think that that result can be understood according to the high need of maternity which characterize African area. The mean of direct cost of UL are 8O3$ USA and 884$ USA for myomectomy and hysterectomy respectively. Cravello & al [30], in France estimated direct cost to 4600FF for surgical hysteroscopy and to 7900 FF for vaginal hysterectomy. Soliman & al. [31] estimated between 11.717 and 25.023 $ USA all expenses of UL management by patient in USA. Cardoso & al. [32] evaluated expenses of UL between 5, 9-34, 4 billion $ USA by year in USA. The comparison of those cost evaluations suggest that the treatment of UL is less expensive in our area. But by taking account of level of life of the population, UL stay also an important problem of public health in DRC according to the cost of treatment. 5. Conclusion The present study show that the frequency of UL is 21, 18%. The patients concerned are essentially those one of 35 years old and more, null parous, singles having a high level of education, a history of UL, alcohol intake and body mass index over than the normal ranch. The majority of uterine leiomyoma are corporeal, intramuscular and their number didn’t overtake five by patient in majority of cases. Majoration of the uterine cavity and Fallopian tubes obstructions are the most frequent abnormalities in hysterosalpingography. Hemorrhage and pelvic pain are the most frequent expression of those tumors. Myomectomy is the main surgical treatment. The direct cost is important for a third world country as DRC: 803$ USA and 884$USA for hysterectomy respectively. Acknowledgement The authors gratefully thank, medical team of University clinics of Kinshasa, Saint Joseph Hospital and Edith medical Center for their invaluable help for the collection data of the study. References [1]. Sparic R., Mirkovic L., Malvasi A., Tinelli A. Epidemiology of uterine myomas: A Review Int J Fertil Steril. 2016; 9:424-35. [2]. Flake GP., Andersen J., Dixo D. Etiology and Pathogenesis of uterine leiomyoma: a review.Environ Health Perfect. 2003; 11:1037-1054. [3]. Baird DD., Dunson DB., Hill RC. Cousins D., Schectman JM. High cumulative incidence of Uterine Leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol.2003 Jan; 188(1):100-7. [4]. Catherino WH., Eltoukhi HM., Al-Hendy. Racial and ethnic differences in the pathogenesis and clinical manifestation of uterine leiomyoma. Semin Reprod Med. 2013; 31151:370-379 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 38, No 2, pp 68-76 74 [5]. 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Appendix: author contributions PIERRE INGALA, participate in protocol elaboration, data collection and analysis and draft the manuscript FRANCOIS LEPIRA, participate in protocol elaboration, conception and data analysis reviewed the manuscript. SERGE MUHINDO, participate in protocol elaboration, data collection and analysis and draft the manuscript. ARSNE MPUTU, conceived the study, participate in data analysis and reviewed manuscript. Uterine Leiomyoma in Kinshasa, the Capital of the Democratic Republic of Congo