Subserous Fibroids: Symptoms, Treatment (Myomectomy) & What to Expect

Question
Good evening Dr.Kandeel
I would like to ask you  about treatment options for subserous fibroids. I am 24 Years old and have subserous fibroid in the posterior part of right uterine wall. I discovered it accidently 2 years ago . it was 4.5*5.5 cm and now it is 7.5*8 cm... I have some symptoms now like:
1- incresed bleeding during menses than usual.
2- increased PMS and PMDD.
3- slight pain and burning sensation in the right back side of abdomin in the position of right kidney especially in the second half of period.
4- Recurrent vaginal and vulvular inflammation and discharge.
History:
I had a pyeloplasty operation in the left kidney 2 years ago and have early pyelonephretic changes and minimal back pressure in the right kidney.
My Gynacologiest wants to remove the fibroid by open surgery now to:
1- Prevent any bad effects for fibroid on the right ureter and bladder especially having a previous operation in the other left kidney before.. and we will analyse the removed fibroid to exclude being cancerous though he is 99% sure it is benign (he told me that)
2- He sees that the fibroid size now is large compared to my abdomen size because I have very small abdomen and body.

My questions are:
1- Is it necessary to remove it now?
2- is this increase in size during 2 years from 4.5*5.5 to 7.5*8 cm... is it normal?
3- can it affect the right kidney and ureter and cause recurrent UTIs?
4- Can it affect my pregnancy chances when I get married in the future? and will it cause compression on my kidney with any possible pregnancy in future so remove it now?
5-Are there possible complications for open surgery? especially my previous operation in kidney was open surgery with big lumbar incision in abdomin.. will this weaken my muscles?
6- Is this fibroid related to PMS and recurrent vulvular infections?

thanks a lot

Answer
Emy

At 24, this fibroid is a huge one. It should be removed. However; it is better to be removed by laparoscope by a surgeon experienced in laparoscopy. Open surgery may be followed by dense adhesions that may cause some problems getting pregnant later in your life. Fibroids usually grows on average by an inch every year and therefore the growth of yours seems to be within the normal range.

Definitely a huge fibroid can compress the kidney and results in recurrent UTIs. However; it have nothing to do with recurrent vulvar infections or PMS. Submucous fibroids also do not cause heavy menstruation; it is the submucous fibroid who does so. Recurrent infections may occur if you are diabetic and I advise you check for your blood glucose level. Open surgery weakens the abdominal muscles temporary but they gain strength over time when you returns back to normal life. It is the pelvic adhesions that increase with each open suregery.

I hope this answer all your queries.

Good Luck