Uterine artery embolization for the treatment of fibroids.
ABSTRACT Uterine artery embolization (UAE), or uterine fibroid embolization, is a non-surgical treatment for uterine fibroids that preserves the uterus and offers women an alternative to surgical procedures such as hysterectomy and myomectomy. Evidence from controlled trials comparing fibroid treatments is not yet available. Case series reports indicate that UAE is a relatively safe and effective treatment for symptomatic fibroids. The effect of UAE on fertility and pregnancy is not known, though pregnancies following UAE have been reported. UAE may reduce health care costs associated with treating fibroids through shorter hospital stays and faster recoveries.
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ABSTRACT: Leiomyomas (fibroids) are common estrogen-dependent uterine tumours that cause significant morbidity for women and a substantial economic impact on health delivery systems. Currently, there is no effective medical treatment option for this condition-hysterectomy is the mainstay of management. This is not an attractive choice for many women, especially patients desiring to preserve their fertility potential. Gene therapy is becoming a clinical reality, with more than 600 clinical trials worldwide. Researchers have recently attempted to develop a gene-therapy-based approach for the ablation of uterine fibroids. The localized nature of this condition and its accessibility using different imaging or endoscopic techniques make it an attractive target for direct delivery of gene-based vectors. Recent work from our laboratory suggests the potential use of a dominant-negative form of estrogen receptor (ER) to inactivate estrogen signalling in leiomyoma cells and induce apoptosis. Our in vivo data in a mouse model demonstrate the ability of an adenovirus-expressing dominant-negative ER to arrest leiomyoma growth. We and others also have described the utility of the herpes simplex virus-thymidine kinase (HSV-TK) plus ganciclovir (GCV) suicide gene-therapy system to effectively eradicate leiomyoma cells by utilizing the bystandard effect phenomena and the high expression of gap-junction protein in these tumours. Further work on rat models will pave the way for future leiomyoma gene-therapy clinical trials and allow the realization of gene therapy as a viable non-surgical option for this common problem in women's health.Human Reproduction Update 01/2006; 12(4):385-400. DOI:10.1093/humupd/dml015 · 8.66 Impact Factor
- Fertility and Sterility 02/2002; 77(1):176-8. DOI:10.1016/S0015-0282(01)02953-3 · 4.30 Impact Factor
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ABSTRACT: To report a case of transient ovarian failure shortly after arterial embolization for treatment of uterine fibroids, followed by recovery of ovarian function. Case report. A university-based hospital. A 49-year-old woman with menorrhagia and anemia secondary to uterine fibroids and refractory to medical management. The follicle-stimulating hormone (FSH) level on cycle day 3 before the procedure was 8.2 mIU/mL. Bilateral uterine artery embolization for treatment of menorrhagia. Serum FSH level. The patient developed amenorrhea and hot flashes 3 months after uterine artery embolization. Her serum FSH level at that time was 140.1 mIU/mL. Four months later, uterine bleeding resumed; her serum FSH level was 2.1 mIU/mL. Uterine artery embolization may hasten ovarian failure. This procedure should be reserved for women who have completed their child-bearing or are poor candidates for myomectomy. Patients should be counseled appropriately about the risk of possible ovarian failure.Fertility and Sterility 03/2001; 75(2):438-9. DOI:10.1016/S0015-0282(00)01678-2 · 4.30 Impact Factor